Looking to Physiatry's Next Steps: An Interview with Dr. Amy West

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In this issue, we talked to Dr. Amy West at Northwell Health in Long Island City, NY. Dr. West works in sports medicine and was redeployed to an exclusively COVID-19 wing of her emergency room where she helped educate patients who were in stable condition about their coronavirus diagnosis, discussed next steps as well as provided her expertise in escalation of care. The following article is based on her experience as of mid-August 2020.

Dr. Amy WestAmy West, MD, FAAPMR
Sports Medicine Physiatrist
Assistant Professor of PM&R and Orthopedics,
Zucker School of Medicine at Northwell Health

At the beginning of the pandemic, there were rumors going around about redeployment. But at what capacity? Buzz started that you could be sent to testing sites to swab people's noses; you would be put on the inpatient unit managing patients; or you would be put in a rehabilitation facility. Northwell Health, being the biggest health system in New York, was one of the hardest hit, so the question was not just where, but when. I sensed it was coming and at the point that our clinics were shut down or minimized, I knew I should be doing something. I didn't know what it looked like, but it made sense to help out in some capacity.

My practice is primarily outpatient musculoskeletal care and I'm actually the only physiatrist employed by the orthopedics department. Because of this, my redeployment was a little different from the other PM&R practitioners in our health system as I went with them to an essentially exclusive COVID-19 wing in the emergency room. There, my primary task was to educate those who were not admitted to the hospital and considered stable, which is a "perfect fit" for a physiatrist's skill set.

As physiatrists, we have to do that quite a bit: educate people as to what the next steps are. We tell them, "This is what's going on and this is what to do now." The whole country is in a bit of that state, wondering, "This thing has happened; people are affected by it. How do we live our lives?" Physiatry answers that question or figures out ways to answer that question. We help people pick up the pieces of their lives from where they are now (coming to us), during and after the acute setting.

My reassignment was a two-week walk (in April 2020). In that time, I saw a steady stream of people during my 12-hour shifts; all who were very ill with the same thing, though not always presenting with the same symptoms. People would come in feeling terrible with symptoms like diarrhea for two week or coughing or fevers. We had people come into the ER saying, "my back really hurts," and they were having myalgias from the virus. Even people from the same household didn't have the same symptoms! Talking people through it, saying, "You have the virus. We're going to assume you have COVID-19, we're not testing you (we didn't have tests at the time), but just assume you have it," was difficult. That concept, too, is really hard for some people, especially when there are so many people at home with nothing to do but watch the news and continue to worry.

The patients I saw ranged from those who came into my clinic with injuries as a result of trying new physical activities in their homes that they hadn't done in years, like rollerblading and attempting TikTok dances, to people suffering back pain from lifting corpses in the morgue. The latter is what I'd say is the craziest thing I saw. It's just not a job that crosses your mind that needs to be done. There are so many dead bodies that need to be moved around and then to talk to patients and ask, "well, how are you lifting the body?" It's an odd conversation to have in such an odd time.

These experiences unknowingly helped prepare me when I got back to my clinic in a more normal capacity. People started coming in with pain from being in a prolonged position or positions where their shoulders were twisted. For example, I'd see strange mononeuropathies that were seemingly unrelated to any kind of positioning or people who were so deconditioned that it was a struggle to come back from that. Put anyone in a bed for months on end and they don't move; they're going to come out of that experience with some kind of issue, some musculoskeletal issue. I saw how these problems began with my redeployment and now, months later, I'm seeing similar patients and can put these pieces together in the outpatient setting.

Physiatrists focus on quality-of-life. We focus on lifestyle medicine, so this pandemic is really an opportunity for us. It's been a call-to-action for us to focus on these things because that may prevent another global catastrophe like this from happening again. We always have viruses around, but we have control over preventative care and beyond.

That's probably one of my biggest takeaways from this. We need to start thinking about issues like metabolic health, pulmonary rehabilitation, etc., in much greater detail because if we ignore that and we're just looking at the infectious disease part, we're missing the boat. And it's bound to happen again in some form.

We are a specialty that has the luxury of focusing on people's lifestyles and optimizing people's function. Physiatrists don't necessarily have to worry about "what antibiotics are we using?" - that's not our space - but our space is to say, "Okay, how do we support this person in living a healthy lifestyle?" Let's talk about nutrition more, and not just to look and feel good, but to prevent you from having a bad outcome. For an overwhelming majority of people who are metabolically healthy, COVID-19 is an inconvenience for them, whereas if you're metabolically unhealthy, it can be a death sentence. And that's controllable. We can help patients control that outcome by making the right choices. Being advocates for that puts us in a place where we're needed.