Brian G. Moses, MD, FACP, ACP Governor
Governor's Message
Who's the more foolish – the fool, or the fool who follows him? – Obi-Wan Kenobi, Star Wars Episode 4
Dear ACP colleagues and friends,
I hope you and your families are safe and well.
Normally, an ACP governor's letter this time of year would be filled with exciting information and stories from the annual Internal Medicine week as part of ACP's annual meetings. This spring, it was set to take place in sunny Los Angeles. Alas, this year, we logged in for a virtual governance breakfast, chatted over GROUP ME, and swapped photos of DIY haircuts. My class became governors on the same day the U.S. coronavirus death toll surpassed the 50,000 mark.
It has been an extraordinarily trying time. Of course, there has been the stress on physicians of having to work in a setting that may expose them to the virus, plus potentially the concern that they may take that same virus home to family or loved ones, some of whom may be particularly vulnerable. On top of that, we have been faced with this surprisingly outspoken (virtually, mainly) minority who are convinced that COVID-19 does not exist, and that there is some global conspiracy of epic proportions going on. As silly as these theories may be, there are many who have latched on to them (thus my Star Wars quote in the header – I plan on using pop culture quotes to add some humour to my Governor's messages, so keep your eye out for that!)
As a front-line GIM specialist in rural NS, I realize I am lucky to be working. Sure, it has been challenging – at times, exhausting – doing the full clinical work, the extra administrative work that this has created, and battling false statements and stories on social media to try to preserve and promote the messaging from our colleagues in Public Health. However, I have not had to face financial uncertainty, as so many people have, and for that, I think we can be grateful.
As office-based work picks up and activities begin to resume, all is still not as it was, nor will it be for some time. As we continue following social distancing, I will miss the daily banter with my colleagues. I will miss the patient encounters in the exam room, unencumbered by masks (or phones or screens for virtual care visits), where, because I have known a patient through myocardial infarctions, malignancies, a lost job, a spouse or parent with dementia – we connect and heal. Three million Canadians lost their job in March or April due to COVID-19 and, possibly, their health insurance to cover medications along with it, according to a Stats Canada report. I wonder how many of them are my patients.
Moving Forward
We have been incredibly lucky in Atlantic Canada to have relatively low numbers of COVID-19 (see table 1). We have not been unscathed, to be sure, with challenges such as the very high COVID-19 disease burden and mortality at Northwood LTC facility in Halifax and the recent case of a physician neglecting to self isolate in New Brunswick and bringing the first cases into the province for weeks as just two such examples. However, each of our provinces is cautiously moving forward with plans to re-open the economy and re-introduce certain social activities back into our lives. As we do this, as Internal Medicine physicians, we have the responsibility to lead by example. In the same way that this whole pandemic has been unprecedented, the gradual resumption of services will be, as well. We have never done anything like this, so looking to well-designed, large, randomized controlled studies to guide our actions is not possible. We will be relying on the best evidence that we have, with advice from our Chief Medical Officers, to try to do this as safely as possible, without delaying too long and causing undue harm to patients waiting for assessments, investigations, procedures, and treatments. As time goes on, thanks to efforts of clinicians around the world, including our own Dr. Lisa Barrett (Infectious Diseases), clinical trials have started that will hopefully give us the answers we are searching for or the vaccinations we need. Until then, we do the best we can with the evidence we have.
COVID-19 Cases and Deaths in Atlantic Canada (as of June 1, 2020)
| Province | Cases | Deaths | Population | Cases/million | Deaths/million |
|---|---|---|---|---|---|
| New Brunswick | 132 | 0 | 776827 | 170 | 0 |
| Newfoundland | 261 | 3 | 521542 | 500 | 5.752173363 |
| Nova Scotia | 1056 | 60 | 971395 | 1087 | 61.76684047 |
| Prince Edward Island | 27 | 0 | 156947 | 172 | 0 |
| Total Atlantic Provinces | 1476 | 63 | 2426711 | 608 | 25.96106417 |
| Rest of Canada | 89471 | 7232 | 35163289 | 2544 | 205.6690431 |
Remember – we are all in this together, and a colleague is only a phone call away for support to help make decisions when we face these challenging cases. We should also reach out and support each other in non-clinical ways, as well. In the March 23, 2020, JAMA study of front-line workers in Wuhan China, a significant proportion of participants experienced anxiety, depression, and insomnia symptoms, and more than 70% reported psychological distress. We need to remember the emotional toll this can take and be there for one another.
ACP has been hard at work on the unique challenges we face. I value ACP's core mission: to serve as the collective, unified voice of internal medicine and to foster supportive communities in our work as internists. While some may think ACP is just for American physicians, the advocacy of ACP crosses all borders in many ways. I believe the ACP, and our profession, will be remembered for coming together – not coming apart - through this terrible crisis, and we will be better for it on the other side. We have and will continue to find new and creative ways of seeing and assessing patients, treating complex medical problems, connecting with colleagues, and delivering high-quality educations activities. Your continued engagement in the ACP internal medicine community is essential to advance this important work.
Sincerely,
Brian Moses, MD, FRCPC, FACP
You can't be that kid standing at the top of the waterslide, overthinking it. You have to go down the chute. Tina Fey