Yesterday, while on shift in the ER, a surgeon approached me about a patient he had just seen in consultation. He told me the patient was refusing a COVID19 test prior to going to the OR. I hadn’t yet met this patient, he arrived in the ER overnight; I was the day attending 1/x
I asked the surgeon what would happen if the patient continued to refuse? He said that clearly if he were an asymptomatic carrier of coronavirus the patient could infect the staff, nurses and doctors and that the OR would be put out of commission due to his unknown status. 2/x
About 40% of people infected with coronavirus are asymptomaic carriers, so this was an issue, but patients have the right to refuse any test - I told the surgeon I would go talk to the patient. 3/x
When I entered the room I saw a middle aged man, lying quietly on the gurney. “Good morning sir,” I said. “My name is Dr. Sawyer. How are you feeling?” I washed my hands and took a seat on the chair beside the gurney. “I’m in pain.” He said. 4/x
“You’re in pain?” I asked. “Well that’s no good. We gotta get your pain under control. What medications are you allergic to?” I went on. “None.” He said. Well we can certainly address that. There’s no reason you need to be in pain.” I explained. 5/x
We discussed how to best manage his pain and agreed on a dose of morphine. I next moved onto the issue at hand. “So, the surgeon told me you don’t want to get tested for coronavirus before your surgery.” I said. Without saying a word, he handed me a his phone. 6/x
On his phone was an open Facebook direct message with a photo of an Asian scientist, auto generated from a link on Wikipedia, and a long message. “Take a look at this.” He said. 7/x
This is the basic equivalent of what I saw. 8/x
“Ah, I see.” I said. I handed his phone back to him and asked for a moment to look into it myself. “There is a lot of coronavirus disinformation out there right now so I just want to check this out real fast.” He nodded in agreement. 9/x
“I found an article on Reuters with a quote from Dr. Honjo.” I explained to the gentleman. I went on to read the quote to him, in full. I followed up by saying. “Ya know, the coronavirus is very real and it has a lot of us working in healthcare very concerned.” 11/x
“And I know you feel fine, but we have to be extra cautious because a lot of healthcare workers have been infected with the coronavirus in recent weeks ans months; some have died. And if there are no nurses and doctors then who’s going to take care of the patients?” I asked. 12/x
“He said, I already had one of those tests and I don’t want them in there tickling the back of my brainstem,” he said. I laughed, in a congenial non-condescending manner. “They’re not swabbing your brain - it’s just the back of your nose.” I said. 13/x
“And I get it, it really does feel like they’re swabbing your brain. It sucks, but unfortunately it’s the only test we have right now and it only really sucks for a couple minutes, then your done.” I went on. 14/x
“And I’ll admit, you probably don’t have the coronavirus, but we have to be sure, for your safety, for our safety, and for the safety of the other patients in the hospital.” I said. “I’ll do it,” he said. “I’ll take the test.” 15/x
“Thank you sir. We really appreciate it - and I’ll get you that pain medication before we do the swab” I said. “Also, I understand your hesitation given what you read. But there is a lot of misinformation out there right now, particularly regarding the coronavirus.” 16/x
“And the main thing we’re seeing with disinformation is the attempt to divide us, as Americans. To make us argue with each other on everything big and small.” The man nodded in agreement. “And I really want to thank you for chatting with me on this.” I concluded. 17/x
I stood up and told him we’d get him his pain medicine right away. As I was washing my hands before leaving the room the patient said, “Hey doc, I don’t mean to be a pain in the ass.” “You’re fine. Don’t even worry about it.” I said. 18/x
“I just want to be sure we get you taken care of and that everyone is safe” I said before leaving his room. I communicated the plan with the nursing team and sent a text to the surgeon. //End//
Update: the patient tested negative for COVID19.
You can follow @NickSawyerMD.
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