Comment: Anti-vaccine patients are venting their anger at healthcare workers like me. This has an impact on care | Remark

As a pulmonary and critical care physician in Southern California treating hospitalized patients with COVID-19, I notice growing tension. Beyond simple overshoot, we are now part of collateral damage.

I recently asked a security guard to accompany me and an intensive care nurse to meet the family of a 42-year-old unvaccinated firefighter who refused to accept that COVID-19 caused his respiratory failure. . Flatly refusing intubation despite worsening over the weeks, it was not until his oxygen levels dropped precipitously and he complained of excruciating shortness of breath that he accepted a breathing tube.

A dozen furious family members and friends were now demanding answers. Due to visiting restrictions to limit contagion, they waited for me on lawn chairs outside the hospital. Through my N95 mask, I tried to explain in simple terms what was happening to their loved one. They were bombarded with incessant questions about test results, accusations of abuse and requests for therapies like vitamins, ivermectin and sedatives.

Repeatedly warning to “not lie”, they recorded me with their cellphones. I tiptoed through a minefield of mistrust. My painstaking medical explanations and efforts to connect with empathy never came to fruition. After 45 minutes, the three of us

returned to the hospital. The nurse, a 20-year intensive care veteran, sighed and said, “I can’t believe they attacked you like that.”

It used to be amazing, but it’s becoming too common. Endless months of resentment from skeptical COVID patients and their families are having a psychological impact on frontline healthcare workers. I see a new victim: worn-out, many practitioners are compromising longstanding standards of practice.

Among patients who don’t believe experts about COVID-19, there’s a familiar pattern. They get sick. They end up in the hospital with a serious COVID-19 illness. They initially show baffled defiance, which turns to utter helplessness as they gradually get worse.

Woman, 43, insisted ‘it’s just the flu’ until she begged to be intubated when oxygen masks failed to quell panic caused by low levels of oxygen. I begged a 40-year-old man to accept my care recommendations, only to have him shake my hand, look me straight in the eye, and say, “Do you feel my grip? I am strong. I am a man. Let me get through this. (He continued to accept intubation but died several weeks later.)

Navigating the Kubler-Ross stages of traumatic grief – denial, anger, negotiation, depression and acceptance – has always been part of providing critical care. But it’s a different challenge when patients are taken to hospital because of their deep denial of what we know about the pandemic. It’s a different challenge when their family and friends confuse their apprehensions about science with our sincere efforts to help them.

Disbelieving families summarily deny that COVID-19 (and lack of vaccination) can be responsible for the serious illnesses I see every day. Patients and their loved ones vehemently claim that healthcare workers and hospitals are “poisoning” and “punishing”, as if part of an Orwellian conspiracy, leading to bellicose and abusive behavior against staff.

Many providers have become accustomed to ill-informed rebuffs of medical recommendations, including vaccination. Pedagogical efforts turned into counterproductive debates.

Far from being “heroes” or even compassionate health care advocates, providers are seen as biased technicians with dubious motives who lock loved ones behind hospital doors.

One response to this emotional onslaught is, of course, attrition. Most of the veteran critical care nurses where I work have left, replaced by nurses on temporary assignment from across the country. Some physicians who have been ostracized by the very communities they serve are now considering non-clinical work or early retirement.

Among those of us still in the trenches, some medical professionals are now breaking traditional standards of practice. Providers resort to less evidence-based practices, desperate to help and also to avoid further conflict. By opening the door to “try everything,” they have become unwilling supporters of anti-science movements, putting additional pressure on those who promote well-established and proven practices.

Another understandable but disappointing strategy is to avoid difficult prognostic conversations. Providers can avoid a confrontation with someone by not relaying bad news about the direction a patient’s condition is deteriorating. This perpetuates false hopes for a cure and can leave patients clamoring for more and more treatment – which the provider knows will only amplify and prolong the suffering, and which will distract patients at risk of higher improvements.

There are no simple solutions, but there are many pieces to the puzzle: We as health care providers need to set realistic expectations early and throughout hospitalization. Hospitals need to provide more palliative care, social work and other support services to patients and families. More and better public health messages must combat medical misinformation. Medical systems and healthcare workers need more resources, more security, more public belief that we are all on the same side against a common viral enemy.

And to my colleagues who have been on the front line: I am with you. If you need to step away, we understand and thank you for all you have done to carry us through this pandemic.

Those of you who can come back to work tomorrow, please, because we need you – not only to fight the virus, but also to uphold our shared principle of doing no harm.

Venktesh Ramnath is Medical Director of Critical Care and Telemedicine at UC San Diego Health. Copyright 2022 Los Angeles Times. Distributed by content agency Tribune.

Copyright 2022 Tribune Content Agency.

Comments are closed.