How to Overcome the Overwhelm-COVID-19

 

The Global Veterinary Ethics Congress

"It can be a really difficult time to be a veterinary professional right now. We are trying to see as many patients as possible without burning out our staff and veterinarians. We are navigating new technology and workflows."

How to Overcome the Overwhelm in Veterinary Medicine

Kate Boatright, VMD

 

No matter what area of practice you work or what geographical region, you’re probably experiencing unprecedented, overwhelming caseloads. Pet ownership in the United States has grown by over 11 million in the last year. The veterinary workforce—already suffering from shortages in many areas of both veterinarians and veterinary nurses, has not.

In small animal medicine, general practices are booking weeks out for both sick and well pets. Referring a patient to a specialist can result in wait times of weeks or even months for an appointment.

 

Veterinary emergency rooms have become the overflow solution for pet owners. Have an ear infection that your regular vet can’t see for three weeks? Head to the ER. Have a pet who needs to see an internal medicine specialist due to its chronic gastrointestinal disease? Going through the ER should expedite the referral process, right? In the past, these have been viable options for pet owners, but the overflow from GP and specialists on top of the normal ER caseloads has become overwhelming.

 

Right now, it isn’t uncommon for ERs to have wait times of 8-12 hours or more for stable patients. Many ERs have been forced to cap their caseload and divert clients to other hospitals. Some ERs have reduced their hours or even stopped services completely. These decisions have not been made lightly. They have been made to preserve the best possible patient care and protect the mental, emotional, and physical health of the limited staff.

What can we as veterinary professionals do?

1. Set boundaries to protect yourself and your team.

It's okay to say "no, we can't see you today," but be empathetic. It is a difficult time to have a sick or injured pet and many clients are not used to hearing “no.” Provide them with alternative options for having their pet seen. Use phrases like, “I understand that you are worried about Fluffy, but we cannot provide quality care to any more patients today.”

 

It's also okay to tell a client that we won't tolerate their behavior when they become aggressive and abusive our staff. The stories of outrageous client behavior seem to have multiplied amidst the pandemic. It’s okay for clients to be upset that they are being turned away or asked to wait for hours. It’s not okay when they yell, berate, and threaten our staff and our clinics. Setting firmer boundaries around what client behavior will be tolerated in our clinics will help to protect the emotional and mental health of our staff.

2. Improve collaboration between all levels of practice.

We need better collaboration between GP, ER and specialty veterinarians. GPs are often capable of performing preliminary workups or starting treatment of cases until the specialty appointment is available. GP vets can also do initial stabilization of emergencies. If we have the time, we can do the emergency surgery in our hospital and send the patient for post-operative care.

 

If your hospital lacks some of the necessary equipment, like ultrasound, reach out to surrounding hospitals to assess their expertise. Creating a collaborative approach between practices in our communities will improve patient care for all. There’s more than enough business to go around.

 

Finally, we in GP must start talking to our local ER and specialty hospitals before sending a client on their way. Is the clinic accepting patients? Is there anything else we should do before the client leaves our hospital? What is the current wait time? What is a rough estimate for the care based on the GP assessment? Knowing the answers to these questions allows GP clinics to take a couple of minutes to prepare the client for the best location to go to, potential wait times, and what the financial burden might be.

 

This can minimize frustration for everyone involved. If a client can’t afford the specialty hospital care, we’ve saved them a trip to the ER and saved the ER staff the time it would take to triage and assess a patient whose owner cannot pursue care. If euthanasia is the best option for the pet, most owners would rather have the procedure performed by a veterinary team they know than strangers in an emergency hospital.

3. Embrace new technologies.

Hello, telemedicine! While this isn’t new, its use has accelerated faster than many anticipated. Telehealth has brought new companies into the veterinary space. The good news is that there are organizations working to provide guidelines on telehealth (AAHA and the AVMA published guidelines earlier in 2021 and the Virtual Veterinary Care Association was founded in 2020) and advocating with the legislature in many states regarding its use in veterinary medicine. The landscape of virtual care is in flux. The ethical, legal, and business implications of virtual care are still being learned, but it is a powerful tool that can assist us in providing better patient care and moderating our caseloads as we move forward.

4. Educate clients.

Finally, veterinary professionals can work to educate pet owners on many things that can make the lives of those in the profession better. Share with your clients what our profession is experiencing, both due to the pandemic, and our longer-standing issues of poor mental health, high levels of burnout, and lack of diversity.

 

Teach clients why preventative care is so important to the health of their pets and how to be proactive when their pet is sick. Let’s try to help keep pets out of the ER, teach clients how some common emergencies can be prevented, and how to recognize a true emergency.

 

We can also teach clients what to expect at an emergency clinic and what triage means. This can help to assure them that their pet is not being ignored. Waiting to see the vet, especially at an emergency room, is a good thing because it means their pet is stable. Clients must trust that the veterinarians and veterinary nurses who are triaging patients are making their decisions with each pet’s best interest as a priority.

 

There might not seem to be time to do all of these things, but we can utilize social media, our teams, our professional organizations, and our industry partners to help spread this education to the pet owning public.

Concluding Thoughts

It can be a really difficult time to be a veterinary professional right now. We are trying to see as many patients as possible without burning out our staff and veterinarians. We are navigating new technology and workflows.

 

But in my mind, it’s also an exciting time to be a veterinary professional. We have the opportunity to change the standards in our profession—to create a future that is more positive and sustainable for those who are in the profession today and those who will come after us.

Questions to Dr. Boatright?

Send them to DonDeForge100@gmail.com and they will be forwarded~

DH DeForge, VMD

Chair of the Global Veterinary Ethics Congress

12July2021

COVID-19-We are learning as we go!

The Global Veterinary Ethics Congress

 Dr. Juthani says. COVID-19~~“I think most of us 

have had to have the humility to sometimes say:

"I don't know. We're learning as we go."

Lessons we have learned: 

COVID-19 Pandemic

BY KATHY KATELLA-- MAY 14, 2021

The pandemic upended our lives! 

Is there anything we can

Learn from the experience?

Commentary: DH DeForge, VMD-Acting Chair Global Veterinary Ethics Congress

Below is an eye-opening discussion from specialists at Yale Medicine's Infectious Disease experts.  

When you review this article, I would ask that you spend time on Lesson 7 and 8. 

As veterinarians, COVID-19 accelerated the establishment of Telehealth in many practices throughout the United States and in other countries.

As veterinarians, we were faced with balancing family and work more than ever. Some veterinarians closed their doors never to reopen.

Others dug deep into the trenches, in their practices, and made it through two waves of pandemic virus.

  

We have not come to the end of the tunnel.  We can see light but variants of COVID-19 pose challenges that can cause loss of life.  It is not over.  We must help those who are elderly or in high risk to get vaccinated.  

We must encourage those you love to become vaccinated.  Vaccine is the only way to put this pandemic behind us!

I am not an expert in public health and infectious disease.  

I do agree with Dr. Juthani from Yale Medicine:

“We have been doing the best we can with the knowledge we have, in the time that we have it,” Dr. Juthani says. “I think most of us have had to have the humility to sometimes say, ‘I don't know. We're learning as we go.’

From Yale Medicine:

The COVID-19 pandemic changed life as we know it—and it may have changed us individually as well, from our morning routines to our life goals and priorities. Many say the world has changed forever. But this coming year, if the vaccines drive down infections and variants are kept at bay, life could return to some form of normal. At that point, what will we glean from the past year? Are there silver linings or lessons learned?“

Humanity's memory is short, and what is not ever-present fades quickly,” says Manisha Juthani, MD, a Yale Medicine infectious diseases specialist. The bubonic plague, for example, ravaged Europe in the Middle Ages—resurfacing again and again—but once it was under control, people started to forget about it, she says. “So, I would say one major lesson from a public health or infectious disease perspective is that it’s important to remember and recognize our history. This is a period we must remember.”

We asked our Yale Medicine experts to weigh in on what they think are lessons worth remembering, including those that might help us survive a future virus or nurture a resilience that could help with life in general.  

Lesson 1: Masks are useful tools

What happened: The Centers for Disease Control and Prevention (CDC) recently relaxed its masking guidance for those who have been fully vaccinated. But when the pandemic began, it necessitated a global effort to ensure that everyone practiced behaviors to keep themselves healthy and safe—and keep others healthy as well. This included the widespread wearing of masks indoors and outside.

 

What we’ve learned: Not everyone practiced preventive measures such as mask wearing, maintaining a 6-foot distance, and washing hands frequently. But, Dr. Juthani says, “I do think many people have learned a whole lot about respiratory pathogens and viruses, and how they spread from one person to another, and that sort of old-school common sense—you know, if you don’t feel well—whether it’s COVID-19 or not—you don’t go to the party. You stay home.”

Masks are a case in point. They are a key COVID-19 prevention strategy because they provide a barrier that can keep respiratory droplets from spreading. Mask-wearing became more common across East Asia after the 2003 SARS outbreak in that part of the world. “There are many East Asian cultures where the practice is still that if you have a cold or a runny nose, you put on a mask,” Dr. Juthani says.

She hopes attitudes in the U.S. will shift in that direction after COVID-19. “I have heard from a number of people who are amazed that we've had no flu this year—and they know masks are one of the reasons,” she says. “They’ve told me, ‘When the winter comes around, if I'm going out to the grocery store, I may just put on a mask.’” 

Lesson 2: Telehealth might become the new normal

What happened: Doctors and patients who have used telehealth (technology that allows them to conduct medical care remotely), found it can work well for certain appointments, ranging from cardiology check-ups to therapy for a mental health condition. Many patients who needed a medical test have also discovered it may be possible to substitute a home version.

What we’ve learned: While there are still problems for which you need to see a doctor in person, the pandemic introduced a new urgency to what had been a gradual switchover to platforms like Zoom for remote patient visits. 

More doctors also encouraged patients to track their blood pressure at home, and to use at-home equipment for such purposes as diagnosing sleep apnea and even testing for colon cancer. Doctors also can fine-tune cochlear implants remotely.

“It happened very quickly,” says Sharon Stoll, DO, a neurologist. One group that has benefitted is patients who live far away, sometimes in other parts of the country—or even the world, she says. “I always like to see my patients at least twice a year. Now, we can see each other in person once a year, and if issues come up, we can schedule a telehealth visit in-between,” Dr. Stoll says. “This way I may hear about an issue before it becomes a problem, because my patients have easier access to me, and I have easier access to them.”

Meanwhile, insurers are becoming more likely to cover telehealth, Dr. Stoll adds. “That is a silver lining that will hopefully continue.”

Lesson 3: Vaccines are powerful tools

What happened: Given the recent positive results from vaccine trials, once again vaccines are proving to be powerful for preventing disease.

What we’ve learned: Vaccines really are worth getting, says Dr. Stoll, who had COVID-19 and experienced lingering symptoms, including chronic headaches. “I have lots of conversations—and sometimes arguments—with people about vaccines,” she says. Some don’t like the idea of side effects. “I had vaccine side effects and I’ve had COVID-19 side effects, and I say nothing compares to the actual illness. Unfortunately, I speak from experience.”

Dr. Juthani hopes the COVID-19 vaccine spotlight will motivate people to keep up with all of their vaccines, including childhood and adult vaccines for such diseases as measles, chicken pox, shingles, and other viruses. She says people have told her they got the flu vaccine this year after skipping it in previous years. (The CDC has reported distributing an exceptionally high number of doses this past season.)  

But, she cautions that a vaccine is not a magic bullet—and points out that scientists can’t always produce one that works. “As advanced as science is, there have been multiple failed efforts to develop a vaccine against the HIV virus,” she says. “This time, we were lucky that we were able build on the strengths that we've learned from many other vaccine development strategies to develop multiple vaccines for COVID-19.” 

Lesson 4: Everyone is not treated equally, especially in a pandemic

What happened: COVID-19 magnified disparities that have long been an issue for a variety of people.

What we’ve learned: Racial and ethnic minority groups especially have had disproportionately higher rates of hospitalization for COVID-19 than non-Hispanic white people in every age group, and many other groups faced higher levels of risk or stress. These groups ranged from working mothers who also have primary responsibility for children, to people who have essential jobs, to those who live in rural areas where there is less access to health care.

“One thing that has been recognized is that when people were told to work from home, you needed to have a job that you could do in your house on a computer,” says Dr. Juthani. “Many people who were well off were able do that, but they still needed to have food, which requires grocery store workers and truck drivers. Nursing home residents still needed certified nursing assistants coming to work every day to care for them and to bathe them.”  

As far as racial inequities, Dr. Juthani cites President Biden’s appointment of Yale Medicine’s Marcella Nunez-Smith, MD, MHS, as inaugural chair of a federal COVID-19 Health Equity Task Force. “Hopefully the new focus is a first step,” Dr. Juthani says.

Lesson 5: We need to take mental health seriously

What happened: There was a rise in reported mental health problems that have been described as “a second pandemic,” highlighting mental health as an issue that needs to be addressed.

What we’ve learned: Arman Fesharaki-Zadeh, MD, PhD, a behavioral neurologist and neuropsychiatrist, believes the number of mental health disorders that were on the rise before the pandemic is surging as people grapple with such matters as juggling work and childcare, job loss, isolation, and losing a loved one to COVID-19.

The CDC reports that the percentage of adults who reported symptoms of anxiety of depression in the past 7 days increased from 36.4 to 41.5 % from August 2020 to February 2021. Other reports show that having COVID-19 may contribute, too, with its lingering or long COVID symptoms, which can include “foggy mind,” anxiety, depression, and post-traumatic stress disorder.

 “We’re seeing these problems in our clinical setting very, very often,” Dr. Fesharaki-Zadeh says. “By virtue of necessity, we can no longer ignore this. We're seeing these folks, and we have to take them seriously.”

Lesson 6: We have the capacity for resilience

What happened: While everyone’s situation is different­­ (and some people have experienced tremendous difficulties), many have seen that it’s possible to be resilient in a crisis.

What we’ve learned: People have practiced self-care in a multitude of ways during the pandemic as they were forced to adjust to new work schedules, change their gym routines, and cut back on socializing. Many started seeking out new strategies to counter the stress.

“I absolutely believe in the concept of resilience, because we have this effective reservoir inherent in all of us—be it the product of evolution, or our ancestors going through catastrophes, including wars, famines, and plagues,” Dr. Fesharaki-Zadeh says. “I think inherently, we have the means to deal with crisis. The fact that you and I are speaking right now is the result of our ancestors surviving hardship. I think resilience is part of our psyche. It's part of our DNA, essentially.”

Dr. Fesharaki-Zadeh believes that even small changes are highly effective tools for creating resilience. The changes he suggests may sound like the same old advice: exercise more, eat healthy food, cut back on alcohol, start a meditation practice, keep up with friends and family. “But this is evidence-based advice—there has been research behind every one of these measures,” he says.

But we have to also be practical, he notes. “If you feel overwhelmed by doing too many things, you can set a modest goal with one new habit—it could be getting organized around your sleep. Once you’ve succeeded, move on to another one. Then you’re building momentum.”

Lesson 7: Community is essential—and technology is too

What happened: People who were part of a community during the pandemic realized the importance of human connection, and those who didn’t have that kind of support realized they need it.

What we’ve learned: Many of us have become aware of how much we need other people—many have managed to maintain their social connections, even if they had to use technology to keep in touch, Dr. Juthani says. “There's no doubt that it's not enough, but even that type of community has helped people.”

Even people who aren’t necessarily friends or family are important. Dr. Juthani recalled how she encouraged her mail carrier to sign up for the vaccine, soon learning that the woman’s mother and husband hadn’t gotten it either. “They are all vaccinated now,” Dr. Juthani says. “So, even by word of mouth, community is a way to make things happen.”

It’s important to note that some people are naturally introverted and may have enjoyed having more solitude when they were forced to stay at home—and they should feel comfortable with that, Dr. Fesharaki-Zadeh says. “I think one has to keep temperamental tendencies like this in mind.”

But loneliness has been found to suppress the immune system and be a precursor to some diseases, he adds. “Even for introverted folks, the smallest circle is preferable to no circle at all,” he says.

Lesson 8: Sometimes you need a dose of humility

What happened: Scientists and nonscientists alike learned that a virus can be more powerful than they are. This was evident in the way knowledge about the virus changed over time in the past year as scientific investigation of it evolved.

What we’ve learned: “As infectious disease doctors, we were resident experts at the beginning of the pandemic because we understand pathogens in general, and based on what we’ve seen in the past, we might say there are certain things that are likely to be true,” Dr. Juthani says. “But we’ve seen that we have to take these pathogens seriously. We know that COVID-19 is not the flu. All these strokes and clots, and the loss of smell and taste that have gone on for months are things that we could have never known or predicted. So, you have to have respect for the unknown and respect science, but also try to give scientists the benefit of the doubt,” she says. 

“We have been doing the best we can with the knowledge we have, in the time that we have it,” Dr. Juthani says. “I think most of us have had to have the humility to sometimes say, ‘I don't know. We're learning as we go.’"