Dr. Megan Ranney
Title: Emergency physician at Rhode Island Hospital and associate dean of public health at Brown University
Location: East Greenwich, Rhode Island
As an emergency room physician, Ranney sees how the COVID-19 pandemic is affecting the diagnosis and treatment of patients with other serious conditions.
As told to Ruben Castaneda, as part of U.S. News & World Report’s “One Pandemic Question” series. Responses have been edited for length and clarity.
Q: How has the pandemic impacted care for other conditions in the emergency room?
There was a period of time at the height of the pandemic where everything was COVID-19 — every patient started to look the same. You walked into in an exam room and every patient had a fever and a cough.
You had to remind yourself to keep an open mind and think about the other conditions that patients might have. Nine times out of 10 when it looked like COVID it was COVID, but you don’t want to miss the 1 out of 10 when it isn’t. This was especially true for junior trainees, especially those just one year out of medical school. Some new doctors started their medical training during the height of the pandemic and had never seen the full spectrum of diseases that occur during the autumn and winter. I’d try to get them to talk about what other conditions a patient might be experiencing, even when we both knew the diagnosis was going to be COVID.
In parallel, we did see more people coming into the emergency room with later stage non-COVID problems. There were people who’d had appendicitis for several days whose appendix had already burst. People who’d had a heart attack a day or two earlier. People who had double vision and headaches for months and when they finally were examined were diagnosed with brain cancer. They were so scared of contracting COVID that they put off coming in to the ER until they felt really horrible, and it was too late for me to help them much.
The other thing that changed during the pandemic was the ability to connect with patients. Before the pandemic, I’d never had to wear personal protective equipment for an entire shift. But now, I wore it all the time, every day. And I constantly felt like I was putting myself at risk when caring for COVID-19 patients. For me, these human connections — getting to know patients and their families — is one of the greatest joys of the job. That connection can be useful in getting patients to buy into a treatment plan or figuring out whether they’re safe to go home. But because of COVID, you wouldn’t spend a lot of time in the patient’s room because you didn’t want to get infected. You didn’t get a chance to establish a rapport and trust with patients.
Now, in the last month or two as things have started opening up, we are seeing all these patients with all these chronic problems that have been simmering for several months. People with congestive heart failure, people getting diagnosed with late-stage cancer, people with bad dental problems. They didn’t want to go to the doctor or dentist during COVID, until they got vaccinated. They were scared of catching the virus.
Eye doctors, dentists and primary care physicians are now being inundated by people who are seeking appointments. People who haven’t had their teeth cleaned in more than a year are coming in. People who put their normal care off for a year because of appropriate fear of the virus are now coming in for normal health care.
There is going to be a ripple effect from missed preventive care and delayed surgeries. People who delayed getting their gall bladder removed may end up in the hospital with inflammation and need emergency surgery. People who put off having a mole removed could end up with metastatic melanoma.
I hope we’ve learned some lessons from the pandemic. I hope that we’ve learned first and foremost that we need to invest in training and supporting a strong public health and health care workforce that’s prepared not only for something like COVID but also to deal with all these other problems that have been there below the surface: mental health, substance abuse, diabetes. We need data. We need community outreach. We need attention to equity. We need resources to refer people to.
I also hope we’ve learned to support our medical supply chain. Relying on “just in time” delivery of PPE, medications and testing supplies sets us up for failure.
Finally, I hope we’ve learned that our health care and public health systems can be innovative and adaptive. In this state of emergency we all adapted and changed and tried new things very quickly. I hope we don’t lose that. We had collaborations between health departments and private businesses to roll out testing, public health campaigns to develop solutions for the lack of personal protective equipment and contact tracing. Another example is telehealth. There were not a lot of places doing telehealth at the start of the pandemic, and it has exploded. I hope that sticks around.
And most of all, I hope people keep respecting the work that health care and public health workers do to keep us all safe, every day. It’s invisible until you need it.
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How the Pandemic Has Impacted Care for Other Health Conditions originally appeared on usnews.com