Published on Jan 07, 2021

Video Transcript

[MUSIC PLAYING] JOHN WHYTE: Welcome, everyone. You're watching "Coronavirus in Context." I'm Dr. John Whyte, chief medical officer at WebMD. Today I want to spend a little time talking about the impact of COVID on health care professionals. We've talked about the impact of PTSD, but I also want to talk about the role, in terms of vaccine confidence as well as what might be on the horizon.

And to help provide some insight, I've asked Dr. William Fox. He is chair of the Board of Governors of the American College of Physicians. Dr. Fox, thanks for joining me.

WILLIAM FOX: John, it's great to be with you today.

JOHN WHYTE: Well, everyone's talking about the vaccine and vaccine confidence. But I want to ask you-- something that we haven't talked enough about is-- we're talking about patients having concerns about the safety and efficacy of vaccines, but we also know some of our clinical colleagues are expressing some reservations. So how do we help inspire confidence in the vaccine?

WILLIAM FOX: Well, first of all, I think we should just pause for a minute and just acknowledge the moment that we are in. I think it was last January 10, where the genomic sequence of the SARS-CoV-2 virus was first published. And now it's 11 months later, and we are delivering a vaccine into the arms of patients. And I think that's an extraordinary achievement for science.

So this provides us with a lot of hope as we move into this dark winter. But I think physicians, to answer your question specifically, are a lot like patients. They run the gamut in terms of their fears and concerns. The last I saw, I think, when I read a media report, was that about 70% of individuals across the board have an interest in getting that vaccine. But that means that 30% still have concerns, and physicians are among them.

JOHN WHYTE: And it varies by race as well. We do know, in some categories, there is higher mistrust of the health care industry, as you know.

WILLIAM FOX: Yes. I think fortunately, John, patients still trust their physicians to provide trustworthy advice to them. And so I think physicians play a very big role not only in convincing their patients or working with their patients to instill that confidence, but also to work with their colleagues to encourage them to get the vaccine so that the public can see that physicians are, first and foremost, supportive of this process.

JOHN WHYTE: So we have to be out there, showing that we have confidence in the vaccine. What is the college, the American College of Physicians doing, organized medicine, to help inspire confidence? What tools and resources? Let's be honest, Dr. Fox, we know in vaccines that require multiple doses-- hep-B, chicken pox-- we have challenges in getting people to come back for fully licensed vaccines. So what strategies can ACP help practicing internal medicine physicians utilize?

WILLIAM FOX: Well, I'm really proud of what the American College of Physicians has done with regard to this vaccine process. The American College of Physicians has representatives to the American College of Immunization Practices. That's the group of the CDC that helps determine which group should be vaccinated and also in what order.

And we were very involved in that process and very supportive of that process. We recently put out a statement in full support of the FDA and CDC recommendations regarding this vaccine. We're also encouraging our members to support efforts to get this vaccine on social media.

I've already seen many of my colleagues post their shots with the hashtag #COVIDVaccine or #IAmVaccinated. And I've even seen some use the hashtag #TanBadgeOfCourage, referring to the Band-Aid that you normally get after the shot. So I think we are out there, we are fully supportive of this process, and encouraging all of our members to move forward with this vaccine and share their experiences, in a way, to help others and move them along in this process.

JOHN WHYTE: I do want to talk about some misinformation out there that has made a lot of our clinical colleagues angry. And that's been that there's been the accusation that physicians are coding diseases relating to other health conditions-- heart disease, diabetes, cancer-- as COVID, when they're not. Tell us what's going on there. And has that made you angry, Dr. Fox?

WILLIAM FOX: Well, I trust in the integrity of physicians. And I've heard these kinds of things out there, that physicians are miscoding patients as COVID. But, for the life of me, I'm not sure where the evidence for this is. Certainly, in our outpatient practice, I can't imagine that ever being done.

There was some talk earlier in the year that physicians are profiting off of this. Nothing could be farther from the truth. In fact, a lot of health care systems, and especially independent, small practices like mine, are really hurting financially as a consequence of this pandemic, which seems somewhat ironic, but that certainly is the case. And to a large degree, that's based on the way physicians are paid. But I think to accuse physicians of profiting off of the COVID pandemic is really ill-advised and wrong.

JOHN WHYTE: Absolutely. I mean, our clinical colleagues are on the front line, day in, day out, putting themselves at risk. We know that PPE has been an issue. Has that gotten better? The college has worked to help make PPE available. But where are we on that? Are we still having instances where there's not enough? Or have we resolved that to some degree?

WILLIAM FOX: I don't think it's fully resolved, John. Certainly we are much better off than we were at the very beginning of the pandemic. We all saw photographs of physicians using garbage bags as part of their PPE protection. Those were really dark days at the beginning. There is an organization called the Primary Care Collaborative, and they work in conjunction with the Larry Green Center.

I don't know if you've ever heard about it. But they are doing a series of surveys. I think they do one every other week or every month on the condition of, especially, outpatient physicians like me. And in the last survey, I think they recorded that 38% of physician practices-- it was in the 30s percent, something like that, were still having issues obtaining PPE.

It's certainly better, but we haven't solved that issue yet. The American College of Physicians has worked with a nonprofit agency called Project N95 in an effort to get PPE at cost to physician practices. I know many states, like the state of Virginia, have also worked to get PPE to practices. So it's better. We haven't solved it completely yet. In my office, we probably reuse PPE a little bit more than we would like.

JOHN WHYTE: And let's talk about burnout. It's not just for the physician community. It's nurses, it's pharmacists, it's EMT, it's the administrative staff that are in the emergency room, in other areas of the health care system. Burnout was a problem pre-COVID. What are we doing now to address issues of burnout, and what resources are available for our clinical colleagues?

WILLIAM FOX: Yeah, so burnout remains a big issue. And just to put something like that in perspective, physicians die by suicide at a rate that is twice as great as the general population. We all remember a local story here in Charlottesville, Dr. Lorna Breen, her story got national attention. She was an emergency department physician in New York, and she has family here where I live in Charlottesville.

And she succumbed to suicide. And that just kind of encapsulates a lot of the issues that physicians are going through. Physicians, and the staff as you mentioned, they are strained to the limits with the number of patients that they're taking care of. And it's relentless. It is nonstop. They are seeing a lot of trauma in terms of the number of patients that they are caring for who are dying, many under very difficult circumstances, many dying alone because they can't have family members with them in the rooms.

We need to do a better job with physician burnout. The ACP and the AMA and other medical organizations are working really hard on this, providing a lot of great resources. On the ACP website, there are a lot of resources. But we need to kind of drill down and get to some of the systemic issues that create burnout in the first place.

And that means working with health institutions all over the country. We also need to remove the stigma surrounding getting help, getting mental health help, in the setting of this pandemic and even afterwards. We don't want physicians or other health care workers to be stigmatized or punished in any way for trying to reach out for help.

JOHN WHYTE: How do you think things are going to change with a new administration? In terms, it'll be new leadership at FDA, CDC, the Department in general, as well as CMS, and many of those issues impact practicing clinicians. What do you see as the potential biggest area of change, and what are you, and organized medicine and the college, planning to do about it?

WILLIAM FOX: Well, one potential silver lining, John, of the entire pandemic was that it moved forward in 20 days what we worked 20 years to try to-- to try to get, which is real telemedicine, the ability to interact with our patients via live audio-video, real-time communication. So during the pandemic, the current administration realized that this was really important. And it was a lifesaver for physicians as well.

And our patients love it. They find that for the right circumstance, it is much more convenient and highly effective. So we hope that after the pandemic, we can incorporate telemedicine into our practices without some of the restrictions that have been in place. Obviously, there will be a lot of other changes. Our organization is really-- I think we can say that this pandemic has put into stark relief the issues of uninsured and underinsured in this country.

And if the American College of Physicians stands for anything, one of the things it has stood for the most is the idea that we need to get universal access to health care in this country. So we do hope to work with the incoming administration to try to expand access to health care and access to insurance through either a regulated private insurance company, private insurance rather, or a public option.

JOHN WHYTE: So what's the message that you have to our clinical colleagues that you want to leave them with, as we close out what everyone will admit is an extremely difficult year, recognizing that the first few months of 2021 are going to be very similar, as they are right now? What's your message?

WILLIAM FOX: Well, we all recognize this has been one of the most extraordinary years in 100 years. And we know that the physicians and other health care workers on the front lines are working harder than they have ever worked. But we also recognize they are rising to the challenge. They are overcoming all kinds of obstacles.

I know that I and other members of the American College of Physicians, we are really proud of the work that they are doing. They are leaning in, they are solving the issues that need to be solved. So we are incredibly appreciative. They are heroes, in my mind. And we do know that we are going to get through this. It may be a tough winter. It will be a tough winter. But there is hope-- there is hope in the form of a vaccine. And we just need to hold on a little bit longer, follow the advice of public health officials, roll up our sleeves, get to work, roll up our sleeves, get the vaccine.

JOHN WHYTE: Well Dr. Fox, I want to thank you for taking the time today to provide your insights as well as the work that you're doing to keep our clinical colleagues dealing with the issues that they have on a day-to-day basis on the front line as well as helping make sure patients get quality care during this pandemic and beyond.

WILLIAM FOX: John, thank you so much for giving me the opportunity today.

JOHN WHYTE: And I want to thank you all for watching. If you have questions about COVID-19 send them our way. You can email it to [email protected] as well as post it on our social properties-- Instagram, Facebook Pinterest and Twitter.