By: Dr. David Ziring |Associate Director, Cedars-Sinai Pediatric IBD Program |Pediatric Gastroenterology |Cedars-Sinai Medical Center
In the midst of this global pandemic, I’ve had an increasing appreciation for the importance of the doctor-patient relationship. The special bond that I have with my patients fortunately seems to benefit us both. I would imagine that this connection not only provides my families support as their children are navigating life with a chronic illness, but it gives both of us some measure of connectedness in a time when we are distanced.
I have the benefit of being a pediatric gastroenterologist and specialist in Inflammatory Bowel Disease (IBD) – And now that I have been in practice for 15 years, I have been able to maintain some rather long-term relationships with my patients and their families. One of the reasons that I chose this field in particular is it has given me the opportunity to forge these bonds. I’ve been to gymnastics practices, high school graduations, have been offered homemade pottery and chocolate chip cookies. We have talked about poor (and great!) choices of boyfriends and girlfriends, first jobs, and wonderful accomplishments such as speechwriting for US Senators, designing antenna arrays on SpaceX rockets, and traveling the world to do missionary work. Patients have emailed me photos of their newborn infant’s hours after delivering, and they have been witness to hundreds of photos of my own daughter as she grows up.
The novel coronavirus has patients working (or not) and schooling at home, isolating in the effort to keep our community safe and healthy. On the one hand, having an inflammatory bowel disease is stigmatizing-often children don’t want to discuss it with their peers, and increasingly they feel that they must be the only one who has it. I would imagine that it’s one thing to socially isolate because you appear skinny or moon faced from steroids, or you have to raise your hand frequently to excuse yourself from class to use the nurse’s restroom because the stalls in the school’s restroom offer no privacy.
No one has a choice in being handed this diagnosis and having to navigate the often unpredictable and stubborn nature of the disease. But to compound the constraints placed on your life by IBD with those of a novel and scary virus – which happened to be transmitted by a bat in December and now infecting the worldwide population, forcing us all to remain indoors with our closest family only for months on end – just does not seem fair. On the other hand, my patients are all very different and their IBDs are different, and I would imagine that many are enjoying this time away from their peers to engage themselves deeply in reading, writing, and art.
While a video visit will never replace an in-person experience and the opportunity to sit face to face, offer a handshake or hug, the chance to visit in one’s kitchen or poolside by video gives me the chance to tell patients I sympathize with them, and to continue to offer my support. We discuss now more than ever the importance of proper diet and nutrition, but also mindfulness and good sleep.
And selfishly, these same deep attachments that we share motivates me to continue to drive into clinic, to don a mask and to scrub my hands. These relationships drive me to leave my family (and my daughter’s “distance learning”) safely ensconced at home because I want to learn about how my patients are managing the end of senior year, to help them navigate their summers, make sure they’re not sneaking out to visit a friend or significant other, and to bake challah virtually. They bring a deep and lasting satisfaction to my job that is a safe and effective vaccination against physician burn out.
Some of my most treasured memories are of holding an anxious patient’s hand as she drifts off to sleep prior to an endoscopy. When we start to do elective procedures again, no one will deny me that small pleasure. In the age of the novel coronavirus, hand soap is not in short supply.
Yes, I certainly spend lots of time arguing with insurance companies to get patients the medications they need at the proper doses and times, I meet with our radiologists to review MRIs, and I discuss difficult cases with my surgical colleagues. I review lots of blood test results, respond to emails, and refill medications. But now I do this in a very quiet office, at my computer, and surrounded by postcards and photographs, thank you notes and drawings, from the patients I have invested myself in.