I’m a primary-care doctor in Washington state. I was recently confronted with a ticklish and painful situation.
Here are the facts and the sequence of events:
On a recent Wednesday morning, I saw a forty-five-year-old woman in my office for an earache. She told me that a member of her church had been diagnosed with coronavirus, and that many schools in the area were being closed because of possible exposure. Later that day I started to receive emails and phone calls from families in my practice, giving more information about this situation.
A week later, I got the phone call I’d been dreading. This same patient told me that four days earlier her entire family–both parents and all four children–had been tested at home by the Department of Health, and that the test results had just come back. They were all positive.
I told my office manager, who suggested that I talk to my hospital’s chief of infectious diseases. I did so, and she asked me many questions in order to assess my risk of coronavirus exposure.
Based on my answers, she deemed my risk low. The reasons: (1) I had washed my hands after the encounter; (2) I wore a mask (I think I did, but I’m actually not sure); and (3) I wear glasses. Of course, goggles would have been better than glasses; a N95 respirator mask would have been better than a surgical mask; and gloves would have been better than just handwashing (and back before I knew much about COVID-19, I was doing a quick handwashing, not the twenty-second handscrubbing routine). A medical gown would have protected me a little more, too.
When I asked if I should get tested for the virus, she said, “It’s an individual decision, but unless you have symptoms, it seems unnecessary.”
I then told my partners about the situation and shared my question.
“Don’t get tested,” my senior partner said firmly. “If you test positive, the office will be quarantined–shut down for fourteen days.” She didn’t have to state the obvious: No patients, no revenue.
My practice’s managing partner told me the same thing and added: “Also, it will cost $10,000 to disinfect the office.”
That evening, I spoke to my family. They all begged me to get tested. Because we’d all been together at my granddaughter’s birthday party three days prior, they also wanted to know whether I had exposed them, as well as the other people who’d attended. In the back of my mind hovered a horrible thought: If I have coronavirus, I shouldn’t be working; I couldn’t live with myself if I were exposing my patients to this virus.
As a primary-care doctor, I know that most of my younger patients are healthy and would get over this illness unscathed–but I worry for my older patients, some of whom are immunocompromised. I worry most of all for my own nonagenarian mother, who fortunately did not attend any social events in the week after my possible exposure.
I didn’t know if it was anxiety or the coronavirus, but that evening the cough that I’d been dealing with for three months started to change. It went from a little throat tickle (probably just post-nasal drip) to a hack that sounded like I’d been smoking two packs a day for sixty years. After tossing and turning through the night, I decided that I had to do the right thing and get tested. It wasn’t for the sake of my own health, because there’s no treatment for coronavirus. But getting tested was the only way to know if it would be safe for me to see patients.
My family encouraged me in this decision; my office manager supported it–and both of my partners told me that I was making a big mistake.
I even got a phone call from my partner’s wife, a hospital intensivist.
“If you get tested, not only will your office be shut down by the Department of Health; everyone in the office will have to get tested,” she told me. “If anyone is positive, you’ll be shut down for fourteen days. If my husband is positive, I’ll be tested, and then quarantined for fourteen days while I’m waiting for the results. As an intensivist, my services are crucial for the sickest patients with COVID-19, because they’re in the ICU.
“And finally,” she added, “if none of us are working, how will we all pay our mortgages?”
But I’d made up my mind. I needed to know if I was a danger to my patients or to anyone else.
As it turns out, one of my nurses was coughing also and wanted to get tested, so we put on our masks and gloves, went out to the parking lot, swabbed each other and went home. (Luckily Bioreference had just started to offer test kits, and we had received a few that day.)
I’m still in quarantine while we await our test results. My partners and I closed the office this weekend while the office underwent a thorough cleaning, and we practiced telemedicine with our patients.
I’m sleeping a little better at night, knowing that I did the right thing, but I dread going back to work and facing my partners. If my test is positive, they’ll be mad at me for causing us extra expense and lost income. If my test is negative, they’ll accuse me of overreacting.
This experience has taught me two things.
First, for me, public health overrides profit. Second, when I graduated from medical school, I did not take the Hippocratic oath (primum non nocere, “first, do no harm”), but rather the oath of Maimonides. In the face of this challenge, I’m following the words that I uttered then: “The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all times; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.”
Update:
My COVID-19 test came back negative. I returned to work two days later. Now, for everyone’s safety, our patients are trying to avoid coming to the office, we all practice better infection control, testing is becoming somewhat more available, the ICU beds are full, people are scared, and most are practicing social distancing.
The pandemic continues….
18 thoughts on “Put to the Test”
Do No Harm is my personal Mantra, closely followed by Self Protect from those who do me harm. It is when our integrity is challenged we find out what we are truly made of. All of mankind is in the same boat, we depend on one another to do what is right, to have ethics, morals and integrity when it counts most. Thank you for sharing your story. May GOD continue to bless the work of your hands.
Do no harm? Time to get new partners. Thank you for doing the right thing.
we were prepared with telehealth and all remote visits as well as a drive-through before this panic started
why were these doctors in this office not prepared?
Thank you for being a decent human being and doing the right thing. I’m a retired OR nurse. I have to say my only reaction to your partners’ opinions and behavior is disgust. There is no deep question here – if you work with the public and you might be infectious, you must isolate yourself until you are either proved to be negative or over your illness. There is no further thought or discussion necessary, If only everyone agreed and had started doing the right things earlier, we could be a little less apprehensive right now. What on earth is wrong with people??
By the way, I am not unfamiliar with putting oneself at risk for patients – in the very early days of AIDS (when many nurses refused to even go into the room of an HIV positive patient, let alone use a needle on them) I was working as an IV nurse, and had HIV positive blood both splashed on my lip, and on a separate occasion, driven into my hand by a needle being used for a blood culture test – the gloves that I was wearing were useless both times. Happily I did not get the virus. If I had, I would not have spread it around to others. At the time, I made the difficult (for me anyway) decision to stay in nursing and find ways to deal with the fear of AIDS after reading lots of medical history about how other professionals had coped with previous epidemics, eventually following some advice that my father (holocaust survivor) had given me about life – “Don’t be afraid of dying, since you have no control anyway. If you’re not meant to die, being in harm’s way won’t matter, and if you’re meant to die, there isn’t anything you can do to change that.” So just do what’s necessary, being as safe and careful as you can.
Thank you.
In addition to resisting the profit arguments of your senior partner, your managing partner and your partners spouse,
in addition to putting the health of your co-workers and patients foremost in your decision-making,
in addition to being an ethical decision-maker in a system that clearly advised you to do the unethical in order to “pay the bills”,
you chose to write about it and share it with us, for which I offer heartfelt thanks
And thanks to The Pulse for providing the forum
Good work
You made a difficult decision which resulted in your peace of mind and that of your partners and patients, plus your actions resulted in a true change in clinical practice based on your experience during this pandemic. Sounds like a win-win, and congratulations on demonstrating professionalism in such a concrete fashion for all of us.
We also at BUSM 1979 took the oath of Maimonides. Thank you for sharing and caring
What ethical standards and bravery you showed in this situation. I laud you. I won’t try to comment in detail on the priorities of the other doctors. They shame the profession.
Thank you for your frank and poignant reflection. This seems like quite a difficult decision, but as you reported, your oath to your profession and your integrity were your guides and I applaud you for being true to yourself! Thank you, A Seattle Nurse
Thank you for following your personal and professional ethics. I am a retired health administrator and I know how dependent people are on the educated and careful guidance from their physician. Including me!
It seems to me that is one is a symptomatic, no fever and not coughing, that wearing a mask and washing one’s hands (maybe gloves) would eliminate the risk of transmission. Not allowing asymptomatic health care workers to work is counterproductive..
Thank you for sharing your story and, above all, for putting ethics over profit. I am sorry, but not surprised, that your partners were not like minded. Stay safe and healthy!
Thank you for sharing and caring. Hopefully all working MDs will be as diligent as you have been. You set an example for others to care as well as to provide the care their patients need. You are a true Heroine! I’m retired from a career in public health an epidemiology, and my motto has always been “Physician Heal Thyself”
I can deeply appreciate your dilemma… Thank you for doing the right thing for yourself AND your family, especially since you had been at the birthday party… You would never have been able to live with yourself if you did expose them and someone dies… May you forever live in peace with your decision, even if the consequences are not what you hope for…. ‘ no good deed goes unpunished’ sometimes…
Congratulations to the author!
I’m so glad she/he tested negative, and most of all, that
she did the right thing.
I am disgusted by her partners, not to mention her partner’s wife.
I’m sorry to sound harsh,but these people should not be
practicing medicine.
Perhaps when this is all over,
the author of this piece could
join another practice?
The oath of Maimonides is quite
wonderful. It should be taught and discussed in all medical schools, perhaps in the first year.
And may the G-d of Abraham, Isaac and Jacob protect you. You are an example for all. Rather than be angry with you, your partners should be ashamed of themselves.
Thank you for sharing your conundrum. We all want to think that we would do whatever is best for our patients and families but can forget how difficult it can be sometimes. Bravo to you for getting tested. And I am happy for you that you are negative – but that does NOT mean that you should not have been tested (even if your partners might say so). My best to you in this complex time.
Great story; great result; you did the right thing