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Writer's picture Naftoli Neuburger MD

Covid and the Cardiologist

Updated: May 12, 2020

The Covid crisis of 2020 will be long remembered as a crisis that turned many preconceived notions on their head. Everyone will have his/her personal revelation and probably more than one.

One of my early lessons was that a principle that I held sacred had its limits. For almost 4 decades I was critical of doctors who tried to practice from a distance. I frowned on giving advice to patients that they never met. This was based on highly ethical longheld standards to prevent doctors from directing patients with only a superficial knowledge of the problem. I felt very strongly that to prevent physicians from pontificating about situations where they were missing facts we should insist that physicians meet and examine the patients they advise.

Well along came Covid where it was simply too dangerous to go and meet patients. But many of the patients had needs and these had to be met. Suddenly the old principle met its nemesis. It was instantly obvious that we had to offer guidance to patients that we could not meet and if their doctors were unavailable who we had never met. There was simply no hiding from the present situation by invoking the now outdated principle.

It must be understood that the principle of restricting advice to patients that a physician can interview and examine is not a bad principle and in normal circumstances it will always be worth following. However Covid introduced the concept that there are instances in which this principle would interfere with good patient care and would promote neglect instead of quality. If there is one such instance then there are probably a few.

So if we are clever the old principle that served us so well will not be discarded. It will be replaced by the old priinciple with a set of circumstances in which the old principle should be disregarded. Or more to the point good physicians will continue to insist on meeting as many patients as they can but will accept that there are reasonable circumstances in which they should advise patients remotely. Hopefully this will be accompanied by two footnotes. The first is that the remote doctor will strive to thoroughly understand all the details of the patient that they advise and compensate for the distance between them The second is that it is very rare that a remote doctor should overide the instincts and advice of a physician who is physically present and attending the patient.

With these fromulations the old principles that served us well will not be discarded but enhanced by applying the old principle and its exceptions wisely.

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