One year ago, the idea of an entire ward of a hospital being dedicated to one virus was something Dr. Neeja Bakshi never thought she’s see in her career as an internal medicine physician.
Now, she’s one of the leaders of the Royal Alexandra Hospital’s COVID-19 ward.
“In the U.S. and Canada, I don’t think that we’d ever, at least in this generation, thought that we would be having wards dedicated to one illness, and certainly something so infectious,” Bakshi told Global News.
“I’ve never had to learn a brand new disease like this in such a short period of time and figure out how we’re going to treat it and how it fits in with the rest of the diseases that still are there.
“Physicians have been really tested both from the knowledge perspective as well as just how they’re working from day to day.”
Bakshi said for doctors practising in hospitals, every aspect of going to work is drastically different, with changes that start even before they step through the door; layers of personal protective equipment have become an essential part of their uniform, and check lists to confirm they’re fit to work are second nature.
“A year ago, I still remember talking about: should we be masking, should we not be masking? What other protections do we need?” Bakshi said.
Family doctors have also been met with a wide range of changes to the way they see and treat patients, one of the biggest being doing appointments virtually.
“Initially, people thought it was a risky behaviour (to go to a doctor’s office) because they’d be sitting in the waiting room with other people,” family physician Dr. Ernst Shuster said.
Schuster said for most doctors, dealing with patients through phone or video calls was a big learning curve.
“It’s a bit more risky as a physician to deal with people virtually because you don’t get the full picture,” Schuster said.
He said it helps if doctors know their patients well, but it’s still hard to read body language and pick up on cues when someone is on the phone or a web cam.
There’s only so much that can be diagnosed in a virtual visit, and often times patients will have to the office anyway.
“It brings in a whole new art in medicine that we never learnt before — what can you safely deal with, with video conferences or telephone, and what can you not?”
Schuster said even when patients are coming to the office, masking presents an interesting challenge when assessing their needs.
“Reading people’s expressions, especially when you know them, it’s just such a big part of… realizing where the patient is and dealing with their emotions and also their pains,” he said.
Seeing patients in a pandemic
When it comes to admitting patients to hospitals, the process has changed dramatically, as each new admission — whether they’re a known COVID-19 case or not — comes with heightened risk.
“We are now having to screen patients to make sure, do they need isolation? Do they not need isolation?
“We’re having to fill out more forms than we ever had to before to check off where their screening symptoms are,” Bakshi said.
When new patients arrive at the unit, they’re placed in isolation until their test results are back. Taking them out of isolation once they’re determined negative is another process, and Bakshi said that means more paperwork and logistics, which add time and “more people to the equation that’s involved in a patient’s care.”
While family doctors’ offices have been treating patients in different ways, they’ve also been seeing fewer patients on a regular basis, something that Schuster is very concerned about.
With people either ignoring or not prioritizing symptoms or warning signs of illnesses other than COVID-19, Schuster said diagnosis of things like cancers are way down.
“The fear, of course, is that you combine later diagnosis with longer waits for any treatments, which we have right now due to the shutdowns and so on, (and) elective surgery — I think it’s going to be deadly for some people.
“It’s going to be, for sure, deadly,” he said.
“The problem is that when people then get sick, then they end up in acute care and in the hospital, and that’s also more costly than if we can deal with them in the office.”
‘The longevity is something nobody fathomed’
For Bakshi and her team, honing in on nearly a year of their “new normal” brings a lot of different emotions, one of the most prominent of which is exhaustion.
“The longevity of this is something that nobody fathomed.
“The mental exhaustion is certainly there,” she said.
Bakshi said doctors have developed excellent habits for PPE, hygiene and things she admits should probably have been the norm over the years with other illnesses. However, that doesn’t change the fact that “it’s a hard pill to swallow.”
“We keep the language of, ‘When the pandemic is over, we’ll do this.’ The reality is we don’t know when that will be,” Bakshi said.
She said her team is in a “healthy state of denial” as they work through a period where hospitalizations have plateaued in Alberta, and things like surgeries and diagnostic procedures are coming up to their normal levels.
“We’re just pretending that there’s not going to be another wave. But but truthfully, planning for one,” she said.
“I think we all keep thinking about two months ago, thinking: how are we going to be able to continue on like this?”
Bakshi said physicians are trained for countless different scenarios, but never for the gravity of a public health crisis like the pandemic, the reality of which she equates to experiencing trauma.
“Whether you’re a nurse, social worker, a physician — we were never trained to go through a pandemic. We were never trained to deal with mass casualty at this level,” she said.
“Regardless of what your role was during that second wave, I think that you had to have been affected in some way. And then that’s the big acute trauma.”
Pandemic politics: ‘old wounds’ and ‘hostility’
Even before COVID-19 changed every aspect of how doctors did their jobs, physicians in Alberta were living through uncertain and trying times — struggles they say have only grown amid the pandemic.
Just over a year ago, the Alberta government ended up its master agreement with physicians in the province and announced a wide range of new rules and fee structures.
Despite a new tentative agreement having been signed between the province and the Alberta Medical Association last month, the government sent a clear signal in Budget 2021 that the goal of bringing physicians salaries in line with other provinces is still a top priority once the pandemic is over.
Schuster said for family doctors, the pandemic has only exacerbated what he described as “hostility” between the government and the province’s primary care physicians.
He said doctors “never want to be seen not putting our patients first,” which means they have little room to argue or advocate for themselves during the pandemic.
Schuster said in particular, the provincially-set fees for virtual visits are lower than in-office visits. That, paired with fewer patient visits overall, has many doctors facing a 40 per cent income reduction, while their expenses remain the same.
“I have to say that it crystallized how little value the system puts into primary care,” he said.
“I sometimes feel like this government and AHS acts like a primary care doesn’t exist.
“If anything, I would say I feel way more alienated as a family doctor than I ever have before the pandemic.”
Bakshi said “old wounds” were opened up when doctors weren’t feeling supported in the early days of the vaccine campaign, when they weren’t getting a lot of communication on when they would be getting shots.
“That really took a toll on our mental health. It came at a time where we were exhausted. We were right in the second wave,” she said.
“I just remember going from one COVID team to six COVID teams in a span of four days. And so we were we were tired. We were not seeing the end of this.
“We felt very underappreciated at that moment.”
However, when it comes to feeling protection and planning in the workplace, Bakshi, who was involved in the planning of the COVID ward, said she was impressed with how quickly things proceeded.
“I am hopeful that once the dust settles from the pandemic — and I think there is hopefully some recognition of all the work health care providers have done and sacrificed — I think that there will be some opportunity for conversation,” she said.
Global News requested a comment from Alberta Health on relations between the ministry and doctors, but did not receive a response by deadline.
Positive pandemic lessons learned
Both doctors say there is some good to come out of the changes physicians have faced this past year, one of the biggest being more creative and collaborative ways of caring for their patients.
Schuster believes virtual patient visits in some capacity are here to stay — something he welcomes.
He said in situations where a patient has already been examined and doctors simply have to discuss test results and next steps, virtual visits would cut down on unnecessary extra time for both parties.
“Once we find the right balance… it can be hugely valuable. You don’t have to drive to the office, you don’t put yourself in danger driving to the office during a snowstorm, you may not have to miss work that much and so on,” he said.
In the hospital setting, Bakshi said physicians, nurses and operations staff have been working together more than ever before, which has established a community within the workplace that helps not only patients, but the employees as well.
“I think physicians, for the most part… just kind of figured things happened and got done and we didn’t know who was doing them. But in this in this scenario, we really had to work closely with operations every step of the way,” she said.
“That relationship is quite strong, and I think that’s a really powerful relationship, because I think when physicians are involved in health policy changes and decisions and how things work in a hospital, it can only mean good things for everybody involved.”