Learning new ways to provide care during the COVID-19 pandemic
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As chief medical officer for Pittsburgh Mercy, Dr. Jack Todd Wahrenberger has found that COVID-19 is forcing medical professionals to unlearn some very basic practices and to learn new ways to care for patients.
Over the last several decades, doctors — indeed all health care workers — have been coached to lean in and have a higher degree of physical contact with patients, to be caring physicians and not cold clinicians. That practice has changed in the age of COVID-19.
“The challenge for me, as the chief medical officer, is that everyone has been trained in a pre-pandemic system,” Wahrenberger says. “Everything we’ve been taught our entire careers … it’s in our DNA to lean in and now we’re being told to lean away.”
The coronavirus pandemic that came on rapidly this spring wasn’t necessarily a surprise to the medical community. Dr. Wahrenberger had learned in medical school that, historically, pandemics surface about every 70 years.
“We were overdue for a pandemic,” he explains. “We, in the medical community, thought maybe that we’d dodged a bullet, so we developed a health care system for today. ‘Lean, efficient, high touch, and just in time’ has been the mantra in the past.”
The novel coronavirus has “really turned us on our heads,” Dr. Wahrenberger says.
Pittsburgh Mercy’s medical colleagues had been trained in the use of Personal Protective Equipment (PPE). But most of the direct care workers, therapists, and other Pittsburgh Mercy colleagues never had to use PPE before and had to learn to use it properly.
Colleagues who provide direct care at our residential sites, our community-based teams, and even behavioral health therapists,” he said, “did not sign up for this. Usually, our colleagues gravitated to behavioral health because they were interested in talking and understanding the thoughts and feeling of people. These were the kids in school who were more excited about the patient interview than the operating rooms.”
He has coached Pittsburgh Mercy’s colleagues to not to transfer any fears they have about the disease to the many vulnerable persons we serve. He’s found himself taking on the role of teacher and tutor as colleagues have pushed through the new ways of doing things. He has been impressed by their resilience.
“I’ve been amazed at how people have stepped up and learned new things, even if they are anxious and in spite of their own fears due to the pandemic,” Wahrenberger said. “That’s what keeps me going on days that are really tough.”
To date, COVID-19 has no standard treatment and no cure. Because Pittsburgh Mercy has no hospital, the response to the coronavirus has been different than dealing with the immediate mortality and morbidity of the disease. Pittsburgh Mercy is focused more on the impact of interrupted care for the persons we serve who have chronic conditions. Our colleagues are also serving those community members who are experiencing psychological trauma, mental illness, economic injury, and burnout.
“The most important thing we can do with COVID-19 is to slow it down or prevent it from entering our facilities.” he said. “We have to at least take credit for keeping it controlled.”
One of the most vulnerable programs is Pittsburgh Mercy’s Central Recovery Center (CRC), a short-term alternative to jail for people who are experiencing a mental health crisis. The CRC takes referrals from Allegheny County Jail, which has experienced an outbreak of COVID-19. Dr. Wahrenberger says incoming individuals are tested and rooms have been designated for quarantine until the results come back. That may take up to 72 hours.
“That’s a hard ask for anyone,” he says, especially for individuals who have mental health issues and may lack coping skills. “Hats off to our staff that they are able to coach people to stay there.”
The stress caused by the coronavirus outbreak has allowed teams throughout the organization to pull together and create solutions in “amazing, selfless, inspiring” ways.
In response to the pandemic, Pittsburgh Mercy has embraced telehealth as a way to keep providing services to those in our care. In psychiatry, providers have commented on how much patients have been willing to talk and receive care. They are very grateful that we have maintained our services, Dr. Wahrenberger notes. Persons served have also expressed thanks to not have to come in for office visits and especially to not to have to use public transportation during the pandemic.
“Patient satisfaction is pretty good,” he adds. “For people who are really scared, this is good. It’s been a lifeline for people.”
For people who have existing relationships with Pittsburgh Mercy’s colleagues, telehealth is easier than for a new individual. Long term, for people who need a higher level of care, telehealth is not as “robust” as it needs to be and they will have to be seen in person for treatment eventually.
However, COVID-19 might have finally forced telehealth more into the mainstream.
“The genie might be out of the bottle with it,” he says. “I am hopeful some things will never go back to before the pandemic.”
And how has COVID-19 affected Dr. Wahrenberger personally?
“The first month, I wasn’t sleeping well at all,” he admits. Eventually, he was able to pace himself and be more “in the moment” with patients he was seeing. He is keeping abreast of new developments by following respected national and local health care professionals. His wife, Charity, has supported him, making sure he eats and talks about things other than COVID-19.
To cope, he has taken to biking the half-hour to work three days a week from his East End residence. As he walks his dog Scout, he has taken the time to get to know people in his neighborhood, many of whom are sitting on their porches while practicing social distancing. He’s also been focusing on gratitude.
Recently, as he got to know the people in his neighborhood, a mother with three young children asked what they might do to help Pittsburgh Mercy. She and her children made child-size face coverings and gave them to Dr. Wahrenberger. Grateful for their gift, he donated them to our Child Diversion and Stabilization Program.
Can you open your heart and make a donation, no matter how small, to help Pittsburgh Mercy continue our work to serve those individuals and families with behavioral health, addiction, intellectual disabilities, and physical health issues, as well as those experiencing homelessness and veterans? Please visit www.pittsburghmercy.org and click the green “Give” tab. Thank you.