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NEJM: The Invisible Hand — Medical Care During the Pandemic

The New England Journal of Medicine recently published a column by Michelle Kittleson, MD, PhD, associate professor of Medicine and a cardiologist in the Smidt Heart Institute at Cedars-Sinai, about caring for patients during the COVID-19 pandemic.

“For physicians and patients alike, COVID-19 has clouded every aspect of our lives with uncertainty,” writes Kittleson in her personal account of treating heart patients during a unique time in U.S. history. “And the consequences of our suppressed panic and anticipatory dread are impossible to predict.”

Kittleson writes about  a patient she has been treating since before COVID-19 was widely known. When she first met the patient, he and his spouse wanted him to undergo a heart procedure that might -- or might not -- help identify an underlying heart problem. Kittleson’s recommendation, based on the latest research, was the procedure was not neccessary and he should first try a prescription drug regimen. 

Fast forward to today. Kittleson writes that the patient and his spouse decided to take her advice, drop their insistence on the procedure and begin medical management instead. Their decision wasn't based on Kittleson’s advice. Instead, it was the patient's fear of leaving his home and risking exposure to COVID-19.

“This patient was affected by COVID-19, not by means of a viral pathogen in his respiratory tract, but by means of fear of that pathogen,” writes Kittleson. “I am grateful that the invisible hand of COVID-19 inadvertently steered him away from a procedure he didn’t need. But I worry that other patients may not be so lucky. Will fear of COVID-19 prevent them from presenting for medical attention when they need it?”

The bottom line, Kittleson writes, is that doctors must ask themselves a new question in this era of COVID-19.

“What is the best approach to treating their disease, and how does our fear of COVID-19 affect our shared risk–benefit calculus?” writes Kittleson.

She stresses that now, more than ever, it’s imperative to listen to patient symptoms and their fears.

“We must do our best to chart a course in the face of uncertainty, because other diseases will not take a hiatus as the pandemic spreads exponentially around us,” she writes.

Click here to read Kittleson's complete column in The New England Journal of Medicine.

Read more on the Cedars-Sinai Blog: Healthcare Heroes: Cedars-Sinai ER