The remains of a pandemic

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The only thing that makes life possible is permanent, intolerable uncertainty: not knowing what comes next.

                                                                                                     Ursula K. Le Guin

A brilliant recent article in the New York Times Magazine highlighting the work of 2 sociologists who collected stories about New Yorkers’ experiences of COVID-19 at 3 time points during the pandemic revealed, among many things, that people want to move on and forget about the pandemic.1 But, while the public may wish to move on and indulge in a kind of collective amnesia, for those of us in health care that is impossible.

The April issue of Canadian Family Physician features 3 research articles by family medicine colleagues from the University of Toronto in Ontario. One examines the impact of the pandemic on family medicine residents during the early waves of COVID-19 in 2020. Two qualitative studies done just prior to the pandemic explore primary care providers’ perspectives on the most effective use of virtual care and their views on how virtual care affects work flows in busy clinics.

The first study, by Laura Diamond and colleagues (page 271), was a large survey using a modified version of a previously used tool, the national Family Medicine Longitudinal Survey.2 The authors evaluated the impact of the early waves of the pandemic on both graduating and incoming residents across multiple domains. Each group had a high response rate—74% and 88% among the graduating and incoming residents, respectively, making the findings robust. Not surprisingly, incoming residents identified the loss of physical examination skills, along with the opportunity to build face-to-face relationships with both their peers and their patients, as the greatest losses. Although graduating residents said their greatest loss was being unable to complete much-desired electives, by far most still felt well prepared for practice. Studies such as this serve at least 2 important purposes: they provide a historic record of the profound effect of a global pandemic on one of the largest family medicine training programs in North America, and they describe challenges that residency training programs and teachers must address to fill gaps that continue to occur in unfolding waves of the COVID-19 pandemic—and which will occur again when we are faced, as almost certainly we will be, with the next pandemic.

The 2 companion qualitative studies by Jamie Fujioka and colleagues (pages e78 and e86) examined primary care provider perspectives on the clinical utility (which kinds of patients are best cared for virtually)3 and clinical work flows (which types of virtual care are most efficiently integrated into routine clinical care) of virtual care.4 Both studies were part of Ontario’s Enhanced Access to Primary Care pilot study, which started before COVID-19. Among the key findings of the work flow study was that most providers felt that asynchronous virtual care (messaging, e-mail) was easier to integrate into routine clinical work flows than synchronous virtual care (telephone and video visits).4 One of the key findings of the utility study was that primary care providers often disagreed on what types of patients were best served by virtual care, although most agreed that it worked well for nonurgent care.3 The findings in these studies are contingent, as the research was conducted prepandemic, but they are an important contribution to how we think about integrating virtual care into family medicine now and in the future.

More than 2 years after these 3 studies were conducted, the impact of the pandemic continues to unfold. Family physicians are now contending with the longer-term consequences—a backlog in preventive care, delays in diagnosis, patients living with long COVID, and the mental health consequences of societal disruptions caused by the pandemic. Similarly, family medicine teachers continue to work with learners whose earliest medical school training was profoundly impacted by the pandemic. As in the earliest days, our adaptive expertise5 as generalist physicians and teachers is being tested. As in the earliest days, we will rise to the challenges.

Footnotes

The opinions expressed in editorials are those of the authors. Publication does not imply endorsement by the College of Family Physicians of Canada.

Cet article se trouve aussi en français à la page 225.

Copyright © 2023 the College of Family Physicians of Canada

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