Interview with Dr. Susan Gersh on Practicing Internal Medicine during the COVID-19 Pandemic

Dr. Susan Gersh is an internal medicine physician at Temple with an emphasis on preventative medicine. Leah Goldberg is a third year medical student. 

Tell us a little about your work and the impact of COVID. 

Preventative care is a big part of what we do. I think COVID has really interfered with preventative medicine in ways that can be potentially harmful for patients. Patients are very scared to go in – whether that’s for a mammography, colonoscopy or other test. A lot of preventative medicine is not strictly time sensitive, so when it’s a little late it shouldn’t be that big a deal, however it can turn into a problem if it gets delayed too long. People are just really afraid. I’m alsoafraid. Should I recommend patients don’t go get their mammogram because they’re asymptomatic and it’s just a screening test? It might be dangerous for the patient to be in a hospital for the test that can wait a bit. 

Also, people are just not coming in to get care that they need because they are afraid and there are no clear guidelines of how dangerous it is to be in a doctor’s office right now.  

Can you speak to what the transition to telehealth has been like?  

I’m the worst telehealth doctor – I can’t stand it. I am a big hugger, just ask most of my patients. It’s a big issue; touch can be very healing and lack of touch very isolating. Exams are being performed but it’s a different kind of interaction, with the exams minimalized.  

As soon as we were allowed to do [visits] in person, I did all of mine in person. Technology is limited. You would think that the visit would be shorter via telemedicine but a lot of times it isn’t. On the phone patients can sometimes go on about a lot of things that you can’t really help with, like “my knee is itchy, my husband is getting on my nerves, etc” I find it unrewarding in every way.  

It also has forced us to practice in ways that feel inauthentic. Would I have ever given antibiotics from only a phone call in my life? Never. Prescribing medication without seeing a patient - that is just not how you do it. It feels like such a morally, ethically, not-true-to the-profession way that we have to practice medicine right now.  

There are things about [telemedicine] that are beneficial, and if it wasn’t forced on us in a short period of time with very little infrastructure, it could be much better and hopefully will be in the future. For example, if there was a better way for patients to upload photos, or have a high-tech video platform and I could really see that rash on your skin, we’d be in a better position (though still not as good as in person).

What other issues have you seen surface during this pandemic?  

More domestic violence. Most abusers are now also unemployed and financially strapped. They are drinking more and they are forced to always be inside, sometimes with a child and a partner. Kids aren’t being seen at school with a broken arm or black eye, so there is less opportunity for intervention. It has really made things more challenging.  

Then, there’s the misinformation. I have patients who are elderly and going to the casino. It’s a really bad idea. Disseminating information has always been an important part of our job, but especially now when there is so much misinformation, which makes it even more challenging.  

Lack of family involvement in the care of patients is also something that has made this so difficult. My mom passed away during this pandemic, and I couldn’t see her until she was on hospice and nearly gone. Then, there  was no service, no family get together, no nothing, just “here’s her ashes have a good day.” Human touch and family support is so important. It feels, as a human, something is so wrong with this. 

With the national dialogue surrounding medicine, do you feel that COVID-19 has changed trust in the doctor-patient relationship? 

I don’t think COVID has impacted trust between me and my patients. I think patients are extremely empathetic toward the doctors. So many of my patients have thanked me for what I do. They sense that you are putting yourself on the line to provide care. And not that this isn’t want we signed up for, but we are definitely putting ourselves on the line, especially the inpatient doctors. 

On that note, can you speak to the mental stress of being a physician on the front lines of this pandemic?  

Personal connection is very important– just to decompress, talk about the day. It is particularly difficult for doctors who live alone. They have no one to be “in the boat with” and are very socially isolated. Friends who are non-doctors are afraid of you: “You’re a doctor, you’re infected.” They don’t want to come near you. A physician colleague of mine needed a ride to the doctor herself and none of her non-medical friends would take her because they were afraid to be near her.  

This situation is a double-edged sword. Here we are risking our health to take care of people, and then being isolated in our home lives, and then on top of that family and friends are afraid of you. It impacts your family life, too. Some family members are also reluctant to see you even with social distancing precautions.  

People have a lot of COVID fatigue—people are tired of doing this. I have been seeing social media posts of people I know on long distance trips together, all out hiking, hugging each other, eating in close contact with no masks and it makes me both jealous – “I would love to do that,” and angry that they are not taking the pandemic seriously and prolonging it for the rest of us. 

As a physician, your obligation is greater, because if I ease up a little bit and become an asymptomatic carrier and then I go see a diabetic elderly cancer patient… I just can’t do that. Also, as a physician you need to set that example for others - the standard, scrutiny and isolation is more intense. 

How have you been taking care of yourself? 

I’m a big fan of mental health therapy, but even that isn’t as helpful anymore. Usually when you have an issue and you’re working something out, how you’re viewing the world can change or you can make a behavior change. The pandemic is not something you can view differently and the behaviors that may have helped are just not an option right now with all the restrictions. 

I can’t change myself and make this better. I am surviving because of my two dogs; I walk in the woods with them 3 days a week. I have one friend who I hike with, social distanced wearing masks. Being in nature, being outside helps. 

On a more positive note, what is the most rewarding part of working as a physician during this time?  

Being that person to listen to the stories and validating how hard this is. There’s not a lot of people validating that this sucks, it’s hard. People come who have lost so much. I had a patient who had COVID herself while her mother and aunt also had it. They were all very sick in the hospital at the same time. Unfortunately, her mother and her aunt both died, and she was unable to see them as she was also a patient in the hospital when they passed. Just being able to hear her story and to listen and to say “Wow, that is so brutal, I am so sorry that this happened and it really sucks,” is healing in a way. Because there are such limited interactions, there’s not a lot of people who can listen to how hard this is or to offer condolences.  

Even this interview for me is an outlet to acknowledge how hard this is. Having people to listen and validate the struggle helps. This is hard for everyone, so it’s difficult for people to listen because everyone is struggling. So, to be that person who can be there and listen to how brutal this is, is important.  

I try to remember things people can do to feel soothed and support themselves. People may need to be on medication if they are really depressed. I want patients to go back to virtual church services or any other spiritual practices to be part of their community and to hear how much everyone is struggling so people don’t feel alone.  

Often you want to answer patients with a specific answer or remedy and for this situation, there really just isn’t one. Acknowledging that is very helpful: “This is just going to have to play out. Here are some things you can do but no one has been here before.” We go to physicians for an answer, for a plan – and here we don’t have one. 

It also changes how you look at yourself as a physician – what do I do now if I can’t offer someone a fix? Well, at least I can be a good listener, and wait for a vaccine and life to try to return to some degree of normalcy.