In this issue, we talked to Dr. Lisa Varghese-Kroll at Optum Physician Advisor Solutions in Washington, D.C. and Dr. Lanre Falusi at Children's National Health System in Washington, D.C. Shortly after the first wave of COVID-19, Drs. Varghese-Kroll and Falusi teamed up to combine their expertise in physiatry and pediatrics respectively. The result? Health and Home with the Hippocratic Hosts, a podcast focused on informed parenting, medical news, life-hacks and more. The following article is based on their experiences as of mid-2020.
Lisa Varghese-Kroll, MD, FAAPMR
Optum Physician Advisor Solutions
Lanre Falusi, MD, FAAP
Children's National Health System
Physicians, moms and long-time friends who are here to break it all down for you, Drs. Lisa Varghese-Kroll and Lanre Falusi started a podcast shortly after the first pandemic wave hit to spread awareness and conduct informed conversations about what people might be seeing in their personal and professional lives. We were able to sit down with them to discuss their thoughts on the pandemic.
Tell us a little bit about yourselves.
Lisa Varghese-Kroll (LVK): In my professional capacity, I'm a physician advisor who serves as a regulatory compliance consultant and an expert witness for hospitals around the country. For us, we've been seeing our client hospitals obviously face unprecedented challenges with surges of COVID patients and the need, in 2020, for rapid conversion of COVID units while also protecting their staff and maintaining their compliance with regulatory guidelines. Specifically, our inpatient rehabilitation facility (IRF) clients have their own challenges because they're managing overflow patients, providing therapy and sanitation guidelines and keeping up with changes in CMS regulations.
Lanre Falusi (LF): I'm a general pediatrician and I work in an urban area in Washington, D.C. I'm part of a large hospital, so I've spent my clinic time seeing patients where we do COVID testing in the office, educating families either about the health effects of COVID, how to prevent it and having conversations around schools and decision-making in light of the pandemic and various mandates.
LVK: Together, we've had this professional experience of working within the healthcare system and providing care and support during the pandemic coupled with our personal experience of feeling that anxiety of living in society and going out into the world and working, which really inspired us to start our podcast, Hippocratic Hosts. All of these experiences combined really solidified our sense that we needed to do something beyond our professional duties.
LF: In my day-to-day, I was finding myself saying the same thing over and over. As Lisa said, it made us feel even more strongly that it was important to record it and share it and spread it because everyone was having the same questions.
Obviously, you're close friends and talking about what you're seeing while collaborating on the podcast. When you're discussing what you're both seeing in the different specialties, what are you seeing are the commonalities?
LVK: I would say one of the big commonalities is the anxiety on the part of the staff, which is very understandable. I think that crosses all specialty lines because this is so new, we don't have, as we said, all of the data. We don't necessarily know how we can provide the same level of care with tremendous restrictions while protecting the health of our staff. We are really feeling it out as we go. None of this situation has ever been a perfect experiment because you can't necessarily say that A caused B.
These are the challenges that are very difficult because, obviously, we all went into this field because we wanted to care for our patients. At the beginning, though, we couldn't be within six feet of them and we're trying to give them physical therapy. What I heard, at the peak of the pandemic, from colleagues in and out of physiatry was the struggle around protecting staff while caring for patients.
LF: One thing that I've seen is the explosion of social needs and barriers. I consistently saw so many more families who are screened positive for food insecurity, for example, or seeing kids who have rising anxiety and depression because they are (necessarily) separated from their friends; I saw young kids where FaceTime just wasn't cutting it for them and they were cut off from any sort of socialization. There have been lots of mental health issues and parents who've lost their jobs and then are trying to figure out how to get meals on the table or where the next paycheck will come from. That's definitely been a commonality.
What can you both speak to, from the physiatric and pediatric perspectives, for how coordination of care can be leveraged to mitigate these commonalities?
LVK: As we continue to move through this situation, that will likely be a primary challenge and hopefully something that collectively as physicians and as allied health professionals can come together to fill the hole in the net that we have been seeing. Without that coordination, we may have wonderful resources to offer to patients, but it will never reach them.
For example, coordinating for the care of a child patient. We always rely on our general pediatricians because they are really the ones that, in many cases, may see our patients as much as or more than us. It's really a hand-in-hand collaboration because there's no way a child can receive services only in physiatry and really go on to live their best life. The physiatrist has to be closely aligned with the pediatrician, but also the patient's therapists, maybe their nephrologist, whatever their other needs are. I think that throughout this, and because of this, we're really going to see that shift in working together and the need to promote these connections and the ease of that communication.
LF: One way that we can leverage it is to consider telemedicine services, even a little bit more creatively. While there is still so much that we don't know about COVID, short- and long-term, we do know in medicine that telemedicine is here to stay. Telemedicine is one way that we can ensure communication between physicians then to ensure access for families as well. I think part of that, though, means helping families overcome those barriers around Internet access and devices. A lot of that, though, is policy. As I mentioned earlier about social needs and barriers, people among all levels of the socioeconomic ladder are being affected tremendously. Technology can help families coordinate care among their various specialties of the primary care providers, but it can also help to coordinate community care, organizations that help with food access or our mental health providers.
As much as we all hate staring at Zoom all day, there's a lot there we can do to just make care better for folks who are going to be recovering perhaps for months or years after their release from the hospital or as they're recovering from COVID.
LVK: Telemedicine, as we've seen, has also had such an impact when it comes to breaching that barrier of inability to be physically close to patients. In physiatry, the VA has really been at the forefront of telemedicine. They've been doing this for years, and we've always relied on their studies and lectures at Academy meetings about how they really managed to make this work. A lot of it is policy; they have the absence of barriers that in private practice we have had to deal with. This ties in, too, with a lot of what Lanre said regarding that barrier to access of devices, etc. But everything around telemedicine, particularly in physiatry, were early steps that now we have more urgency to explore in how we can make that accessible or available for everyone who needs it.
In light of our "new normal," how do you, Dr. Varghese-Kroll, see this as physiatry's time to come into the forefront and impact an entire continuum of care movement in the future?
LVK: Physiatry has always been based on the function of the whole person. It's one of the things that most attracted me to the field. Our primary goal has always been to return a patient to their highest possible level of function, and we've always used creativity to solve the unique problems that come with unique individuals and unique living situations. So, in the case of an illness like COVID-19 where we have not had any pre-existing data and we can't yet know exactly how recovered patients are going to look 10, 20, 30 years from now, physiatrists already have the skillset to work with patients today. Physiatrists are able to devise solutions based on patient deficits at this current moment and then, with the ability to adjust to their needs, the deficits change, and we collectively learn more about this disease.
So, whether a COVID patient ends up with pulmonary compromise, cardiac compromise, neurologic compromise, etc., every day we're learning about new body systems that are impacted. Whatever the case may be, physiatry as a field is already experienced in caring for people with disorders of all of those body systems. This makes us valuable and uniquely qualified to be in it for the long haul.
Too, we need to accept that there is going to be a new "normal." We're going to have likely hundreds of thousands of people going through a prolonged recovery phase. We don't yet know how long most of them will need or specifically what they're going to need. The reality is that we're going to be dealing with this for years, particularly for patients that are severely affected. From the physiatry standpoint, we will be playing a key role in shepherding people through that process and in dealing with not just the patients themselves, but also their loved ones. This is also something we have a lot of experience with.
I feel like, in terms of us starting this podcast, we're hoping that listeners who might have no connection to medicine will become interested in the intersection of healthcare and real life and also potentially introduce them to our specialty. The more that we can talk about what we do can be key in determining how well we can help, in this instance COVID-19 patients, but also future patients of all other diagnoses.
What advice would you have for other physicians out there about how to handle this situation, how to continue moving forward, etc.?
LVK: My biggest advice to other physicians other than self-care — which I think is crucial because we can't take care of others unless we've taken care of ourselves — is that education is key. Personally, that means to me educating your own personal sphere, whoever that might be. Whether that's your patients and their families, your coworkers, staff that might not be physicians, etc. I think that is the only way we're going to move forward through this and collectively as a society make good choices.
We also need people with expertise to speak up. In this situation, this is a medical situation so, therefore, it's people with medical expertise. Sharing science-based facts about this disease and the short- and long-term implications is the most important thing physicians can do. This is also how physiatry can be at the forefront of care. When people hear what physiatrists have to say, many people may not have heard of physiatry, but this may be the time that they do. This is the time when people can learn what it is we do and how crucial the field is going to be for this particular disease. Don't be afraid to talk about what you know. The more people that speak up, the more difference it will make.
When it comes to that mental health aspect, how have you been dealing with it, the anxiety and stress? Is there anything you've found that's been particularly helpful in managing?
LVK: We have an episode on work-life balance on our podcast that I think has been extremely timely because those lines are so blurred. Even for people who are tele-working, it's really challenging; you find yourself asking, "where does my workday end and my home life begin? Who knows?" And essential workers who have not been tele-working, how do you not bring that stress home?
Personally, I have found that maintaining a routine has been helpful. I mean, in human history, this has really never happened, that the whole planet is facing a pandemic together. We don't have a guidebook. Which is why maintaining a routine, limiting media intake for my children while remaining informed so we can support causes, that's important. Also, trying to allow for some mental rest because this all has been, and continues to be, very overwhelming.
LF: I feel like the key word that you just said, Lisa, was managing. It's all about doing your best in the present moment. I would add encouraging people, whether it's kids or adults, to talk about their feelings is equally important. You know, I think sometimes when everyone knows that everyone else is going through something difficult, it's easy to, in a way, diminish your own feelings about it. You might think, "No one wants to hear my issues as we're all going through it together. They're all stressed out, too." But we find that if you're able to talk through your feelings, that then helps others open up as well.
If people don't have folks that they trust and feel like they can talk through everything with, as we say in the episode that Lisa mentioned, it could mean finding a mental health therapist or a psychologist or psychiatrist. Again, unprecedented time. Hopefully no one would feel any guilt or shame in seeking out help, but actually feel like they're empowering themselves to be able to do that.
To Lisa's point about a routine, I agree and would add that includes just getting enough sleep. No one's going to be able to exercise and sleep and eat well and drink all their water, etc., all at once. But prioritize at least one thing, even if it's only getting that seven or eight hours of sleep a night.
Any final thoughts to share with your fellow physiatrists?
LVK: Personally, I'm going to take away the need to remain vocal about what it is that we do and what it is that we know. In the middle of a pandemic, I'm not expecting to make a huge push when explaining who we are and what we do purely because there is so much messaging going to the public now and the broader need for society to collectively come together. After this, though, I'm going to be much more focused on that messaging and the need to be a little bit more vocal about what physicians do in general for society as well as physiatrists specifically. I would hope that my fellow physiatrists would raise their voices right along with me.