Family Medicine Doctors ‘Forgotten on the Front Lines’ of the Pandemic

When you think of frontline health care workers, doctors and nurses in hospitals might come to mind, but independent family doctors are in that category, too.



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“Forgotten on the front lines is what we are,” said. Dr. Guy Culpepper, founder of Bent Tree Family Physicians.

Culpepper says the front lines of the pandemic aren’t in emergency rooms, they’re at his front door.

“When you talk about flattening the curve, that curve flattening happened in my office,” he said.

From the parking lot of his Frisco office, Culpepper says more than 7,000 people have been tested for COVID-19. Nearly 1,200 have tested positive.

“We’ve kept 1,100 of them away from hospitals and emergency rooms,” Culpepper said.

Culpepper says he has about 250 active COVID-19 patients. Those recovering from home are checked on by phone every day. “We get about 1,500 telephone calls a day,” he said.

His numbers tell a story. They also speak to his heart.

“Part of the passion I have in managing my COVID patients and managing all my patients is the feeling of I’m only here because of them,” Culpepper said, emotionally.

Like many independent doctors, Culpepper closed his doors in the spring and furloughed all 75 employees.

On the verge of going out of business, it was a GoFundMe page set up by patients that helped him get through.

“We’re only kept up by those handful who know us and appreciate us because we know all too well that most of the country doesn’t know the work we’re doing,” Culpepper said.

Culpepper, who’s been in family medicine for 33 years, says no federal programs exist to sustain private physicians, like him. Nationwide, he says his profession is in crisis because private practices, “can’t handle the economics of a pandemic.”

He says nearly 10% of primary care practices that temporarily closed this year have yet to reopen.

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Doctors are not profiting from Covid. We are being consumed by it (opinion)

In the thoughtlessness that has become the hallmark of his presidency, Donald Trump stated at a rally this week that doctors are falsely inflating the numbers of coronavirus deaths for financial gain. These are fabricated musings, seemingly designed to shift blame from his own lack of competence by creating a false narrative for the American public.



a group of people standing in a room: Doctors and nurses wearing protective gear treat a patient in the Covid-19 intensive care unit (ICU) at the United Memorial Medical Center (UMMC) in Houston, Texas, U.S., on Monday, June 29, 2020. Covid-19 cases and hospitalizations have spiked since Texas reopened eight weeks ago, pushing intensive-care wards to full capacity and sparking concerns about a surge in fatalities as the contagion spreads. Photographer: Go Nakamura/Bloomberg via Getty Images


© Go Nakamura/Bloomberg/Getty Images
Doctors and nurses wearing protective gear treat a patient in the Covid-19 intensive care unit (ICU) at the United Memorial Medical Center (UMMC) in Houston, Texas, U.S., on Monday, June 29, 2020. Covid-19 cases and hospitalizations have spiked since Texas reopened eight weeks ago, pushing intensive-care wards to full capacity and sparking concerns about a surge in fatalities as the contagion spreads. Photographer: Go Nakamura/Bloomberg via Getty Images

As an emergency medicine physician treating patients with Covid-19, these words are piercing. Back in May, I wrote about the mental health toll that Covid-19 was having on health care providers. Five months later, I wish I could say things have gotten better. With 9.2 million cases and over 230,000 deaths, the stress we face in our field has not abated — we have just grown accustomed to its presence. No amount of cash could outweigh the negative impacts this pandemic is having on doctors.

Frontline health care workers have suffered from increased rates of post-traumatic stress syndrome, anxiety, and depression since the pandemic began. Most notorious was the death of Dr. Lorna Breen, an emergency physician in New York who committed suicide after treating patients with the disease as well as after contracting the illness herself.

One study found that over 1,300 health care workers in the United States have died from Covid-19. A Facebook group dedicated to the memory of some of these physicians now has over 8,000 members who regularly share their grief. Many of the casualties in the medical profession are young and in the prime of their life, such as Dr. Adeline Fagan, a resident physician who died after a prolonged course of the illness in Texas.

Health care workers have a significantly increased risk of contracting Covid-19 compared to the general population. Those who are Black, like me, have 21 times the risk of contracting the disease. These same workers undoubtedly played a role in ensuring that Trump’s own hospital stay went smoothly.

Trump’s claims about doctors inflating Covid-19 cases are unfounded. While the Coronavirus Aids Relief and Economic Security Act provides additional reimbursement to hospitals for cases of Covid-19, this applies only to a small subset of patients with the disease — those covered by Medicare and all cases must be confirmed by a documented positive Covid-19 test. Falsely claiming otherwise would constitute fraud.

Billing is based on a complicated mix of severity, diagnosis and the intensity of treatment. Trump should know this as it is based on an algorithm developed by the Centers for Medicare and Medicaid Services, part of the federal government structure that he was elected to lead. Trump’s own publicly

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More US patients to have easy, free access to doctor’s notes

More U.S. patients will soon have free, electronic access to the notes their doctors write about them under a new federal requirement for transparency.

Many health systems are opening up records Monday, the original deadline. At the last minute, federal health officials week gave an extension until April because of the coronavirus pandemic.

Britta Bloomquist of Duluth, Minnesota, has been reading her clinical notes for years, first struggling through red tape and more recently clicking into a secure online patient website.

“It means information about your care can no longer be hidden from you. And you have a say in your care,” said Bloomquist, 32, who has a rare type of arthritis that took years to diagnose.

WHAT’S CHANGING?

Patients have long had a right to their medical records, including doctor notes, but obtaining them could mean filling out requests, waiting for a response and paying fees. A 2016 law said delays and barriers must be removed.

If you already use a patient portal such as MyChart to email your doctor or schedule an appointment, you may soon see new options allowing you to view your doctor’s notes and see your test results as soon as they are available. You may get an email explaining where to look, how to share access with a caregiver and how to keep other eyes off your information.

Many people won’t notice a change. About 15% of health care systems already are letting patients read doctor notes online without charge. That means about 53 million patients already have access to their doctor’s notes.

WILL THIS HELP ME?

Studies have shown that patients who read their notes understand more about their health, take their medications as prescribed more often and feel more in control of their care.

That’s true for Bloomquist. Diagnosed with a rare type of arthritis called ankylosing spondylitis, she had extensive surgery to straighten her right leg in 2018. She gets regular drug infusions and sees multiple specialists. It’s a lot to remember.

“I’ve become a health nerd,” Bloomquist said. “Reading the notes has kept me on the same page as my providers about what’s going on.”

WILL I UNDERSTAND THE JARGON?

You may have to look up terms. Or ask you doctor to translate at your next visit. And doctor’s notes tend to use abbreviations. “SOB” means short of breath, by the way. “BS” can mean bowel sounds.

And brace yourself if your weight is an issue.

“I’m a heavy-set person, OK? And their favorite word to use is obese,” said Rosie Bartel, 71, of Chilton, Wisconsin. “You have to get used to that. Doctors use that word.”

To Bartel, who became more involved in her care after getting an infection in the hospital, reading notes means she’s doing what she can to prevent errors and stay healthy.

“I don’t have to remember everything said to me in a 15-minute appointment,” she said.

WHAT IF I SPOT AN ERROR?

Patients do find mistakes in their notes and some errors

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For Mexico’s doctors, an especially mournful Day of the Dead

MEXICO CITY (AP) — The diminutive figure of a skeleton in a face mask and medical cap has a hand on a bedridden patient. At its side is the sort of skull made of sugar common on Day of the Dead altars. And behind is the photo of a white-haired 64-year-old man in glasses smiling at the camera: the late Dr. Jose Luis Linares.

He is one of more than 1,700 Mexican health workers officially known to have died of COVID-19 who are being honored with three days of national mourning on these Days of the Dead.

Linares attended to patients at a private clinic in a poor neighborhood in the southern part of the city, usually charging about 30 pesos (roughly $1.50) a consultation. Because he didn’t work at an official COVID-19 center, his family doesn’t qualify for the assistance the government gives to medical personnel stricken by the disease, his widow said

“I told him, ‘Luis, don’t go to work.’ But he told me, ‘Then who is going to see those poor people,’” said his widow, Dr. María del Rosario Martínez. She said he had taken precautions against the disease because of lungs damaged by an earlier illness.

In addition to the usual marigolds and paper cutouts for Day of the Dead altars, hers this year includes little skeleton figures shown doing consultations or surgeries in honor of colleagues who have died.

It’s echoed in many parts of a country that as of September, according to Amnesty International, had lost more medical professionals to the coronavirus than any other nation.

They include people like nurse Jose Valencia, and Dr. Samuel Silva Montenegro of Mexico City, whose images rest atop altars in the homes of loved ones in Mexico City,

Martínez’s altar is in a living room beside a room in their apartment where she and her husband gave consultations. Martínez, who also fell ill but recovered, now sees patients only online or by phone.

Linares died May 25 after being hospitalized at a peak of infections in Mexico City. Martínez lost consciousness at the news, but when she came to, she found her only son and her sister were hugging her. “Don’t touch me, don’t touch me!” she yelled, fearing they too would be infected.

At the peak of her own illness, she trekked from saturated hospital to overflowing clinic, looking for help.

Martínez, 59, said she now feels better, and at peace, though not resigned to the loss of her husband of 36 years, who she first met as a girl selling gum outside a movie theater to help support her eight brothers and sisters.

“I feel strange,” she said. “But I owe it to the patients and they are going to help me get through this.” She said, though, that she expects to work fewer hours.

“I’m afraid because we don’t know how much immunity you’re doing to have, how long it will work,” she said. “The illness is very hard, very cruel. …

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More US Patients to Have Easy, Free Access to Doctor’s Notes | Political News

By CARLA K. JOHNSON, AP Medical Writer

More U.S. patients will soon have free, electronic access to the notes their doctors write about them under a new federal requirement for transparency.

Many health systems are opening up records Monday, the original deadline. At the last minute, federal health officials week gave an extension until April because of the coronavirus pandemic.

Britta Bloomquist of Duluth, Minnesota, has been reading her clinical notes for years, first struggling through red tape and more recently clicking into a secure online patient website.

“It means information about your care can no longer be hidden from you. And you have a say in your care,” said Bloomquist, 32, who has a rare type of arthritis that took years to diagnose.

Patients have long had a right to their medical records, including doctor notes, but obtaining them could mean filling out requests, waiting for a response and paying fees. A 2016 law said delays and barriers must be removed.

If you already use a patient portal such as MyChart to email your doctor or schedule an appointment, you may soon see new options allowing you to view your doctor’s notes and see your test results as soon as they are available. You may get an email explaining where to look, how to share access with a caregiver and how to keep other eyes off your information.

Many people won’t notice a change. About 15% of health care systems already are letting patients read doctor notes online without charge. That means about 53 million patients already have access to their doctor’s notes.

Studies have shown that patients who read their notes understand more about their health, take their medications as prescribed more often and feel more in control of their care.

That’s true for Bloomquist. Diagnosed with a rare type of arthritis called ankylosing spondylitis, she had extensive surgery to straighten her right leg in 2018. She gets regular drug infusions and sees multiple specialists. It’s a lot to remember.

“I’ve become a health nerd,” Bloomquist said. “Reading the notes has kept me on the same page as my providers about what’s going on.”

WILL I UNDERSTAND THE JARGON?

You may have to look up terms. Or ask you doctor to translate at your next visit. And doctor’s notes tend to use abbreviations. “SOB” means short of breath, by the way. “BS” can mean bowel sounds.

And brace yourself if your weight is an issue.

“I’m a heavy-set person, OK? And their favorite word to use is obese,” said Rosie Bartel, 71, of Chilton, Wisconsin. “You have to get used to that. Doctors use that word.”

To Bartel, who became more involved in her care after getting an infection in the hospital, reading notes means she’s doing what she can to prevent errors and stay healthy.

“I don’t have to remember everything said to me in a 15-minute appointment,” she said.

Patients do find mistakes in their notes and some errors are serious enough to affect their care,

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Ask the Doctors: Studies show fitness trackers can predict illness | Health

Dear Doctors: My husband caught a cold this summer, and he swears the readings from his fitness tracker a few days before warned him that he was about to be sick. Do you think that’s really possible?

Dear Reader: Your husband’s observations about how changes in the data from his fitness tracker preceded the onset of a cold actually dovetail with the findings of a study that were published at the start of the year. And it’s not the first research of its kind to make the connection. With millions of people now using fitness trackers, scientists are diving into the trove of uploaded data to see what the details may be able to reveal about public health.

For anyone unfamiliar with fitness trackers, they’re wearable sensors, much like a wristwatch, that measure a range of activity and health metrics. Depending on the device — there are dozens of different brands and types — fitness trackers measure steps taken, total mileage, speed, direction, elevation climbed and duration of activity. On the physiological side of things, they can track heart rate, heart rhythms, skin temperature and minutes of sleep. Some manufacturers even claim that, using motion sensors and algorithms, their models can map how long someone spends in the various stages of sleep. (Full disclosure: Many sleep specialists are skeptical about the accuracy of the sleep-stage results.)

In a recent study, researchers from the Scripps Research Translational Institute analyzed data collected from the fitness trackers of 47,000 adult women and men. Using a minimum of two months’ worth of readings taken over the course of two years, which included activity, heart rate and sleep, the researchers found that their predictions of regional flu outbreaks matched the statistical data collected by the Centers for Disease Control and Prevention during those same time periods. An earlier study, published by researchers at Stanford University in early 2017, had come to similar conclusions. In that study, the scientists collected 250,000 daily readings from just 43 individuals over the course of a year. The participants wore a range of biosensors, which collected information about daily activity, heart rate, oxygen saturation levels, skin temperature and sleep data. They even tracked exposure to radiation, such as the X-rays and gamma rays encountered in air travel.

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Iowa doctors say virus spread risks overwhelming hospitals

DES MOINES, Iowa (AP) — Iowa’s number of coronavirus cases, deaths and hospitalizations continued to surge higher Wednesday as medical professionals have begun to express concern that hospitals could be overwhelmed with patients if no action is taken to slow the virus spread.

Iowa hospitals had 596 coronavirus patients Wednesday, by far the highest number so far in Iowa. The 113 patients admitted in the past 24 hours also was the highest seen since the virus surfaced in Iowa in March. The number of patients needing intensive care unit services has also trended upward in the past month.

Iowa doctors and hospital officials are preparing for a system overrun by COVID patients by talking about how to transfer patients between hospitals and enacting surge plans that could turn non-hospital facilities into spots to handle any overflow.

“What we know is if the last four weeks are indicative of what happens over the next four weeks we will have the system overwhelmed,” said Suresh Gunasekaran, CEO of University Hospitals and Clinics in Iowa City. “If hospitalizations continue to increase at the exact same rate they have been for weeks, the math itself tells you that you run out of beds.”

University hospitals, the state’s only academic medical center, is often where other hospitals send patients with complex intensive care needs. It is seeing a significant volume of COVID-19 patients from around the state, Gunasekaran said.


He said Iowans need to understand that the coronavirus patient surge often displaces the ability to care for patients with other complex needs stemming from problems such as heart disease, cancer or neurological conditions.

State public health officials reported 1,814 new confirmed cases Wednesday and an additional 22 deaths for a total of 1,680.

Over the past two weeks, the rolling average number of daily new cases has increased by 249, an increase of nearly 23%, according to researchers from Johns Hopkins University. Iowa has averaged about 1,400 new cases a day for the past week.

“My take away from this is that things are bad but also they can and will likely get much worse because the number of new cases is just staggering,” said Dr. Rosanna Rosa, an infectious disease doctor with UnityPoint Health.

A spokesman for the Iowa Department of Public Health said the state is in regular, often daily, contact with health systems, hospitals and regional medical coordination centers to assess hospital capacity, staffing and resources.

“At this time, hospitals are reporting that they are able to manage the increased number of patients, and are prepared to implement surge plans to expand capacity if necessary,” spokesman Alex Carfrae wrote in an email.

He said staffing shortages can occur during times of seasonal illness or viral outbreaks and hospitals have a variety of solutions to maintain adequate staffing levels.

Rosa said a better public health approach would be to make it clear to Iowans that these illnesses and deaths are preventable, a point made in a recent report from the White House Coronavirus

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Kushner told Woodward in April Trump was ‘getting the country back from the doctors’

White House senior adviser Jared KushnerJared Corey KushnerDemocrats accuse Kushner of ‘casual racism’ over comments about Black Americans Scaramucci says Trump has united country: ‘It just happens to be against him’ Obama slams Kushner comments on Black Americans: ‘What history books do they read?’ MORE in April told journalist Bob Woodward that the country had progressed in its response to the coronavirus pandemic to the point where President TrumpDonald John TrumpGiuliani goes off on Fox Business host after she compares him to Christopher Steele Trump looks to shore up support in Nebraska NYT: Trump had 7 million in debt mostly tied to Chicago project forgiven MORE was “back in charge” and “getting the country back from the doctors.”

Kushner, who is also the president’s son-in-law, told Woodward on April 18 that the country was moving into what he deemed the “comeback phase.” The comments came one day after Trump tweeted out support for people protesting against coronavirus-related restrictions with calls to “liberate” Michigan, Minnesota and Virginia.

“There were three phases. There’s the panic phase, the pain phase and then the comeback phase. I do believe that last night symbolized kind of the beginning of the comeback phase,” Kushner told Woodward, according to an audio recording published by CNN.

“That doesn’t mean there’s not still a lot of pain and there won’t be pain for a while, but that basically was — we’ve now put out rules to get back to work,” he continued. “Trump’s now back in charge. It’s not the doctors. They’ve kind of — we have, like, a negotiated settlement.”

Kushner told Woodward that working out guidelines allowing parts of the economy to reopen “was almost like Trump getting the country back from the doctors. Right? In the sense that what he now did was, you know, he’s going to own the open-up.”

The comments came in April, when the country had managed to reduce infection rates and improve hospital capacity after the administration promoted an initiative to “slow the spread” for 30 days by encouraging social distancing and mask wearing.

Trump told Woodward in February and March that he was aware the virus was dangerous and could spread through the air, but that he wanted to intentionally play down its severity to avoid causing panic, according to previously released recordings.

But in the six months since, Trump has agitated for the country to fully reopen, leading to a spike in virus cases. In that same time frame, he has pushed aside medical experts who were leaders on the White House coronavirus task force, including Anthony FauciAnthony FauciConservative operatives Wohl, Burkman charged in Ohio over false robocalls 68 percent of Americans say they know someone diagnosed with COVID-19: poll The Hill’s 12:30 Report – Presented by Facebook – One week out, where the Trump, Biden race stands MORE, Deborah BirxDeborah BirxFauci: Trump has not been to a task force meeting in months Scott Atlas: Fauci ‘just one person on the task force’ Overnight

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Doctors urge flu shots in light of COVID-19. Here’s what you need to know.

Health experts have urged Americans to get their flu shots this year to help ward off a “twindemic.”

“There’s considerable concern as we enter the fall and the winter months and into the flu season that we’ll have that dreaded overlap” of COVID-19 and the flu, the nation’s top infectious disease expert, Dr. Anthony Fauci, said earlier this month. 

The U.S. is battling a fresh surge of new coronavirus cases as winter approaches, and hospitals in some western and Midwestern states are filling up with COVID patients. The new rise follows an outbreak of COVID-19 cases that hit the Northeast hard earlier this year, followed by a rise in cases in the South over the summer. 

“We far surpassed what we’re used to with the flu with COVID this spring,” said Dr. Stephanie Sterling, chief of infectious disease at NYU Langone Hospital–Brooklyn, in New York. “And to consider COVID plus flu together, this kind of pandemic would be devastating for communities and for healthcare systems.” 

She said we need to do everything we can to prevent the flu. 

“We don’t want a bad influenza season coinciding with a second wave of COVID,” Sterling said. “Flu shots are safe. They do help prevent illness.”

Why is getting a flu shot so important this year? 

“One is to prevent flu illnesses and it’s complications, but the benefit in this current season are resources that would otherwise be needed to care for patients with the flu that would become scarce, could be directed toward the pandemic,” said Dr. Ram Koppaka, a medical officer for the CDC’s National Center for Immunization and Respiratory Diseases.

The CDC estimates that last flu season, there were 38 million flu illnesses, 400,000 flu hospitalizations and 22,000 flu deaths. Koppaka said there were also 188 pediatric deaths from influenza. 

An estimated 48% of U.S. adults and 64% of children received a flu vaccine during the same season. Koppaka said the number of flu vaccinations had been increasing prior to COVID-19, but there was still a need for improvement. 

Sterling said that despite communities having a good amount of flu vaccinations, emergency rooms and hospital beds are often overwhelmed during a normal flu season.

This could be a great concern for hospitals in rural areas. Many rural hospitals have limited beds and ventilators, and rural Americans may be at higher risk of getting severely ill from COVID-19 due to a range of factors, according to the CDC.

Additionally, the body does not do well fighting two infections at the same time, according to Dr. Jacqueline P. Cooke, a hospitalist at Jefferson Health in New Jersey. 

“The danger with COVID-19 is that the viral infection leads to overwhelming pneumonia and that type of viral pneumonia is what is causing the vast majority of people to need respiratory assistance and ventilation,” she said. 

Who should get a flu shot?

The CDC encourages people six months of age and older to get an annual flu shot. There are different types of vaccines that

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UK doctors demand free meals for kids as COVID fuels hunger

LONDON (AP) — Pediatricians are urging the British government to reverse course and provide free meals for poor children during school holidays as the COVID-19 pandemic pushes more families into poverty.

Some 2,200 members of the Royal College of Pediatrics and Child Health have written an open letter to Conservative Prime Minister Boris Johnson, saying they were shocked by his “refusal” to back down on the issue. The House of Commons last week rejected legislation that would have provided free meals during all school holidays from October through the Easter break.

The doctors say some 4 million children live in poverty, and a third rely on free school meals. Many parents in Britain have lost their jobs or are working reduced hours during the pandemic, making it imperative to make it possible for poor children over the holidays get at least one nutritious meal a day, the doctors argue.

“Families who were previously managing are now struggling to make ends meet because of the impact of COVID-19,’’ the doctors wrote. “It is not good enough to send them into the holiday period hoping for the best, while knowing that many will simply go hungry.’’

Most schools in England begin a one-week holiday on Monday.


The doctors heaped praise on Marcus Rashford, a 22-year-old star soccer player for Manchester United who has used his celebrity to highlight the issue. Rashford’s campaign helped pressure Johnson’s government into providing free meals during a nationwide coronavirus lockdown earlier this year, and he has gathered more than 800,000 signatures on a petition to extend the program.

Rashford has spoken movingly about depending on free school lunches as a child and was recently honored by the queen for his dedication to the issue of child hunger.

Northern Ireland Secretary Brandon Lewis, who spoke for the government on Britain’s Sunday morning news programs, claimed that lawmakers were taking a broader approach. He said the government has increased welfare benefits nationwide and has provided 63 million pounds ($82 million) to local communities to help people.

“What we are looking to do is ensure that we deal with child poverty at the core, putting the structure in place that means even in school holidays, children can get access to the food that they need,” he told Sky News on Sunday.

The opposition Labour Party has warned it will bring the issue back to the House of Commons if ministers do not change course in time for Christmas.

Advocates for children have been shocked by the political stalemate. The Children’s Commissioner for England, Anne Longfield, said she has been both horrified and disappointed by the debate.

“We’re a wealthy country, it’s 2020,” she told Sky News. “To have a debate about whether we should make sure that hungry and vulnerable children have enough to eat is something that is strikingly similar to something we’d expect to see in chapters of ‘Oliver Twist’ — a novel published in the 19th century.”

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Follow all of AP’s coronavirus pandemic coverage at http://apnews.com/VirusOutbreak

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