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Opinion

Making Wise Decisions During the Pandemic

doi: 10.1097/01.COT.0000666564.65418.e3
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Wendy S. Harpham, MD, FACP
Wendy S. Harpham, MD, FACP:
WENDY S. HARPHAM, MD, FACP, is an internist, cancer survivor, and author. Her books include Healing Hope—Through and Beyond Cancer, as well as Diagnosis Cancer, After Cancer, When a Parent Has Cancer, and Only 10 Seconds to Care: help and hope for Busy Clinicians. She lectures on “Healthy Survivorship” and “healing hope.” As she notes on her website (wendyharpham.com) and her blog (wendyharpham.com/blog/), her mission is to help others through the synergy of science and caring.

Dear Patient,

The Covid-19 pandemic affects your daily decisions as a patient. Armed with answers to common questions about Covid-19, you can make the best decisions for getting through this crisis as safely as possible.

How might the pandemic affect your decisions?

Your decisions matter, including those about where you go and what you do. Right now, you increase your chance of the best outcome by respecting limits due to your (1) condition, (2) therapies, and (3) risk of catching Covid-19.

One challenge is learning to live as well as possible within the new limits due to the pandemic. Another challenge is the unprecedented problem of overcrowded hospitals. During the peak of the epidemic in our area, our local hospitals may not have enough healthcare workers and supplies to care for everyone. Until this is over, we need to work extra hard to keep you out of the hospital without compromising your care. You both help us and protect yourself by...

  • Avoiding any and all infections.
  • Optimizing your treatments.
  • Preventing accidents.

How can you minimize your risk of catching any infection, not just Covid-19?

  • Avoid people with GI symptoms (e.g., nausea, vomiting, diarrhea) or respiratory symptoms (e.g., sneezing, coughing, runny nose, watery eyes), even if they say it's allergies.
  • Don't work with tools, utensils or thorny plants that could cause a puncture wound. If you absolutely must, then wear protective gloves. Wear goggles if there is any risk of flying pieces, no matter how unlikely.
  • Follow CDC guidelines for avoiding Covid-19. Note: Special store hours for people at high risk are for shoppers who have nobody else to do it. It's safer to have someone at low risk do your shop and leave the groceries at your door. [https://tinyurl.com/CDCstopcov]

How else can you minimize your risk of an unexpected visit to the clinic, emergency room or hospital?

During the pandemic, our job is not just to avoid Covid-19. Until this is over, all of us also need to minimize the daily risks we take. Steps you can take include...

  • Adding self-checks for taking proper doses of medications.
  • Recommitting to following doctor-prescribed restrictions in diet and activities.
  • Rethinking your decisions about activities where accidents—no matter how unlikely—can lead to a clinic or ER visit.

When you must do an activity, find ways to minimize risk, such as getting rid of tripping hazards in your home. When you want to do an activity, either replace it with something lower-risk or let it go. For example, instead of climbing a stepladder to reach an ingredient on a high shelf, choose a different recipe.

What if you're tempted to relax restrictions and take a risk?

Normal emotions often get in the way of doing what you know to be the right thing. Right now, life feels “not normal,” which is unsettling. Doing things differently puts the seriousness of the pandemic center stage, instead of letting it drift to the back of your mind. The losses associated with the constraints may elicit sadness about other unwanted changes. Loss of independence may threaten your sense of self. To counter those negative feelings, remind yourself that...

  • These restrictions are temporary.
  • You may find some better ways to do things from now on.
  • Giving up independence now gives you more later by keeping you well.

If still tempted to take unnecessary risks, try this mental exercise: Imagine yourself in the emergency room because the unlikely accident happened. Will you say it was worth it? Or will you wish you hadn't taken the risk?

What if taking proper precautions increases your anxiety?

As mentioned, new routines may remind you of what's at stake and provoke anxiety. Learning to do things new ways takes patience and effort, both of which may be in shorter supply during this prolonged crisis.

An important way to decrease anxiety is by creating a “new normal for now” that helps you get good care and live as fully as possible. For insights on creating a new normal that helps you regain a sense of control and nourish hope of a better tomorrow, see The Healing Power of the New Normal for Now. [https://tinyurl.com/newnormalfornow.]

For insights and tips on managing stress and boosting your immunity, see Managing the Stress of the Covid-19 Pandemic. [https://tinyurl.com/covidstress]

During this crisis, how do you decide when to call with questions or symptoms?

We understand how stressful this pandemic is for everyone, especially during and after cancer treatment. In addition to your usual worries about cancer, you now have worries about catching Covid-19. Meanwhile, medical problems unrelated to Covid-19 or cancer can develop, such as appendicitis or migraines.

Knowing when to report symptoms is a judgment call. Given the current strain on healthcare workers, you may feel more hesitant than usual to call about symptoms that might resolve on their own. At the same time, you may experience more anxiety than usual about waiting too long and missing opportunities to treat you at home—and then ending up in the clinic, emergency room, or hospital. Here's some advice:

For starters, here's a link to advice on what to do if you think you might have Covid-19. [https://tinyurl.com/sickwithcovid]

Remember that many offices have ramped up their telemedicine capabilities to do more diagnosing and treating over the phone. If you develop symptoms that are not responding quickly to usual treatment, keep the primary goal in mind: Taking good care of all medical problems at home when possible. To achieve that goal, we depend on you to report worrisome symptoms sooner rather than later. In general, call our office for cancer-related issues and your primary care physician for other issues.

What now?

Embrace your power to get through this pandemic by taking good care of yourself, keeping us informed of problems, and looking forward with hope. We've gotten through tough situations before. Together, let's do all we can to get through this challenging time as safely as possible.

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
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