Reflections in a Post-COVID Environment: An Interview with Dr. Tony Lee

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In this issue, we talked to Dr. Tony Lee  at Synergy Rehabilitation and Wellness Center in Scottsdale, AZ. During the initial outbreak, Dr. Lee continued to work in his outpatient practice, adapting to the "new normal" that the coronavirus imposed. This time gave Dr. Lee the chance to reflect on the importance of learning from Team Physiatry's many members and the impact of PM&R early and across the care continuum. The following article is based on his experience as of September 2020.

Tony Lee, MD, FAAPMRTony Lee, MD, FAAPMR
Synergy Rehabilitation and Wellness Center

In my outpatient practice, we were doing all the right things to combat the virus or, at least, what we knew to be the basic minimum of protocols at the time. We were taking temperatures, asking questions about social distancing, safe travel - all the pertinent information. We found out what our peers were doing and what the guidance suggested; for our practice in particular, we started spacing patients out a little more and switched to a telehealth approach. 

The difficulty lie in being a smaller practice, though. A struggle for smaller, if not all, practices came with procuring personal protective equipment (PPE). Outpatient practices were at the mercy of our suppliers. Unless you stocked up well before the pandemic, you were probably only given a small allotment of your total order. For example, if you wanted five boxes, you likely were only allotted two. Larger hospitals weren't seeing this type or magnitude of restriction as smaller practices were, and understandably so. 

Reflections on Academy Support

It was great to see what AAPM&R was doing to provide its members the chance to get PPE. For a small practice, being able to see there was a resource available was amazing. A lot of practices I know were scrambling with questions like: "where do I get masks? Where do I get gloves? Where do I get this?" and the fact that the Academy made those resources available, I think, was probably overlooked by a lot of people. That, to me, was one of the greatest things AAPM&R did during the height of the pandemic was to give smaller practices like mine a resource that we didn't normally have.

The Academy also provided Team Physiatry with resources, like town halls, Zoom meetings and the Care in the Time of COVID-19 forum. I used to be the President of the Arizona Society of Physical Medicine and Rehabilitation, so one thing we did do early in the pandemic was to organize a virtual meeting for as many PM&R doctors that wanted to get involved. We benefited greatly by attending the AAPM&R meetings and modeled our approach after the Academy's. Let's just do the same thing to see what issues people may or may not be having. Ultimately, we wanted to approach the situation with the question: "how can we learn from each other?"

Reflections on the Future of Physiatry

This leads naturally into: how do we move forward? The basic premise of physical medicine and rehabilitation is to restore people's function. We know that after COVID-19, patients have cardiac issues, pulmonary issues, etc. That leads us back to the cardiac and pulmonary rehabilitation treatments that we were all taught. It's up to us as physiatrists to play a big role in getting these people back to a functional level. The only way we can do that is to play our part early and across the care continuum. 

That's always been the big issue with PM&R in the community. We just don't get to patients who need us sooner rather than later. To play our part, we need to be proactive and get in front of our primary doctors and hospital administrators. We need to not be afraid to market ourselves, to not be afraid to really speak up. To me, that's the whole point of Team Physiatry - it makes medicine more efficient. The care is more efficient.

Reflections on Team Physiatry

We've all been trained to work with that team approach from the beginning. As residents, we all did it. You're doing the team rounds, you're doing your team meetings with the social worker, the therapist, PTs, OTs, everybody. And what we know or don't know about COVID-19 is going to make the team approach even more important. We know there are a lot more systems affected than just pulmonary or cardiac. We may not know it all, but we definitely know that it's going to require more than just one specialist or one primary care doctor tailing it all. 

A primary care physician is not going to be able to really think about all that's needed after a COVID-19 diagnosis, right? PM&R is perfect in terms of understanding that, "oh, you need this specialty, or this therapist involved, or you need this resource." However, it's not just with coronavirus, though, it's the entire premise of: with the right exams, we can tell or estimate where their deficits are. We're hopeful we can get to them and treat them sooner. After COVID-19, we might just say "oh, you know, they're not feeling as well so we'll attribute it to [COVID or PASC]." At the same time, I think we've all learned that we don't want other diseases to get forgotten, overlooked or lumped in with COVID-19.

Final Thoughts

It's upsetting that patients truly have been the ones who are suffering, not just in a COVID-19 setting or Post-COVID world. In our practice, patients were putting off procedures, putting off treatments, because they didn't want to go out into the world and potentially expose themselves. That just makes it even more difficult to treat them down the line. Things built up, up, up to the point where they were visiting only as restrictions loosened, waves shifted and, eventually, the vaccine was released.

But it's just unfortunate that the patients had to suffer even without the coronavirus. Unfortunately, that was with every specialty, any type of medicine. 

Hopefully, throughout all of this, PM&R doctors - Team Physiatry - have been doing their jobs in terms of reassuring patients that we're there for them. We're going to help them now and down the line. And hopefully PM&R docs will get in front of the right people so that we can start getting to patients earlier in their care. At the end of the day, we're here for the patients, to restore their function and work as a united team to provide the top-notch level of care that PM&R is known for.