Photo Credit Dr. Chadwick Strain
New normal is coming
May 12, 2020

The future of medicine will be changing due to the coronavirus pandemic, Dr. Chadwick Strain ’91 said. Some changes will be good, some may not be. But, at a time when the country has been debating different healthcare options, he believes this experience will definitely make an impact.

“Some of what we are experiencing now will become the new normal,” he said.

Strain is part of a group of 85 anesthesiologists with three divisions. His brick-and-mortar hospital, situated on the south side of Indianapolis, includes 16 operating rooms.

He is currently doing 12-hour shifts at Community Hospital – South, working the airway coverage pool with 13 group members. The airway coverage pool was requested by the hospital administration in order to minimize the exposure to COVID-19 for nursing and other physicians since intubation for ventilation is one of the highest risk procedures, Strain said. That is because of the potential aerosolization of the virus during the procedure.

That airway coverage pool is in addition to his regular operating room coverage. The O.R. coverage is down, though, since elective surgeries were halted. Also, since people are limiting their activities and travel, the level of trauma coming through the emergency departments has also decreased, he said.

One problem that has developed, Strain said, is that people coming in with surgical emergencies are waiting longer due to their fear of exposure to COVID-19. They are worse off upon arrival. Also, chronic health issues such as diabetes, COPD (chronic obstructive pulmonary disease), and cardiovascular disease are being managed incompletely due to the prioritization of resources.

“When they are coming to the hospital,” Strain explained, “they are in worse shape due to the lack of routine care they were receiving before the pandemic.”

This is where one of the changes in medicine will help, he believes. Telemedicine would allow a patient to talk to a physician, describe their symptoms, and the physician could advise the patient on their next step. This may cut down on ER visits, improve emergency room response times, and help decrease costs.

Because of COVID-19, many physicians have switched some of their regular appointments to video conferencing. Initially, Strain said, a lot of doctors were hesitant to switch because they believed their patients would not like it. However, since it has become necessary, both physicians and patients are seeing the benefits.

“Patients are having a good experience with it,” Strain said, so he can see the momentum growing. A lot of the follow-up and routine visits could be handled in this fashion. It would save the patients a trip to the office, save the doctor time, and reduce office paperwork.

One of the potential consequences of telemedicine may be downsizing of the office staff, he said. Other challenges will be performing adequate physical exams and providing the resources to patients at risk to access this technology.

One very positive aspect that has grown out of the pandemic is the amount of information being exchanged among physicians and health systems, he said. While they may be in competition at some levels, Strain said he is very happy with the willingness of the entire Indianapolis metropolitan medical community to openly exchange information. Within his health system, the medical updates have gone from monthly to weekly to daily. The hospital network blog is providing clinical and therapeutic updates.

There is also a Facebook group specific to anesthesiology and critical care information sharing. Started for Indianapolis area physicians with connections to Indiana University, the group that now gone statewide. And when COVID-19 started spreading in the Midwest, Strain said his health system connected with the University of Chicago hospital and the Cleveland Clinic to learn from their experiences and how they were handling preparations for the pandemic.

Seeing the medical community pull together in the midst of debating what healthcare should be and how to pay for it “has been very impressive,” Strain said. And, he hopes, these collaborations will continue as the medical landscape changes because of the coronavirus.

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