Dr. Annette Osher and Dr. Kimberly Parks are both leading cardiologists and primary care physicians who have partnered with Castle Connolly Private Health Partners LLC (CCPHP) to offer concierge membership style programs in major metropolitan locations—but those aren’t the only things they have in common. Both of these women also felt a duty to serve on the front lines of the COVID-19 pandemic.
“Personally, for me, I felt like it was an obligation. It was good citizenship,” explained Dr. Parks, who practices in the Boston area at Synergy Private Health. She continued, “And frankly, it’s what I was trained to do. These are the types of situations that, in medical school, you expect to be involved in—managing and treating sick patients that need your care and expertise.”
Practicing at Osher CCPHP in New York City, Dr. Osher received the call for volunteers from Governor Andrew Cuomo and decided she wanted to respond. Similarly, she felt compelled to do so: “I just thought it was the right thing to do. That’s just the way I am.” She continued, “You could hear ambulances all day and night. How could you not want to do something about it? Lots of people left the city. But for me, I go forward when things get rough or scary. … But believe me, I was scared. I didn’t know what I was going to face.”
Unique contributions for unique situations
Both physicians stepped in to do whatever work was asked of them in combatting COVID. Working mostly at Newton Wellesley Hospital, an affiliate of Massachusetts General Hospital, Dr. Parks collaborated with the cardiology division to learn about and develop protocols for treating COVID-19 patients. One of her initial challenges was figuring out how to monitor all of the patients being treated with hydroxychloroquine and azithromycin, which required monitoring an “overwhelming amount of EKGs.”
Dr. Parks was also involved in deciding how to conduct procedures that put providers at risk. She explained, “For example, with echocardiograms, there’s a lot of hands on. The Sonographer is very close, within just a couple feet of the person. What do we do when a COVID patient needs such a test? What do we do with stress testing, which is potentially an aerosolizing procedure where someone is exercising on a treadmill and breathing rapidly?”
Perhaps one of her most somber responsibilities was contributing to a critical care triage committee which outlined how they would ration life-saving equipment—if it came to that (it hasn’t).
Alternating time in the hospital with remote work, Dr. Parks spent a good amount of time researching COVID-19 and learning from her cases. “This was brand new. We didn’t know what to expect except what we were learning from early experiences in China and New York. We dedicated time every day to review all of the cases, to dig through the literature and have a repository of educational materials so that when a question came up, we’d have a place to refer to.”
Meanwhile, Dr. Osher lived through those experiences in New York.
Working at Bellevue in Manhattan (affiliated with NYU Langone Medical Center) for a week as the city’s pandemic plateaued, Dr. Osher stepped in as an extra pair of hands to do whatever her colleagues needed. And with about 450 people on ventilators in their ICU, there was plenty to be done.
“There were cardiac arrests in this ICU about every 15 minutes,” she said. “It was like Dante’s inferno. I was in the River Styx with no boat, no paddle, no nothing. Death was everywhere. The codes for cardiac arrests were so frequent, and almost always the person died. Then you had to go call the family. Then there was another code blue on 16E. Over and over again all day long. I have never been in a situation like that where you are surrounded by death. You have a feeling like you are not able to do anything. You feel like you’re kidding yourself. It was a very traumatic experience.”
But while she may have felt like she had little impact, Dr. Osher did, in fact, make a difference for at least one autistic patient, which was detailed in a New York Times feature. Despite strict visitation policies, Dr. Osher was able to bring the patient’s mother in to help lessen his agitation while weaning him off the ventilator—and ultimately to be with him when he died.
“I tried hard to think to myself whether or not I made a difference or if I had any effect,” Dr. Osher explained. “I think my difference was helping this boy with autism and his mom.”
Balancing COVID with concierge
Both Drs. Parks and Osher have primary care members in their concierge membership programs that still needed care during this intense time, as well as families of their own. How did they manage caring for everyone at once?
The additional flexibility and connectivity built into the concierge medical model served these doctors and their members well. While some members had heightened anxieties and additional needs due to the spread of COVID-19, these physicians were already well equipped to communicate with each of them effectively through phone calls, secure messaging, and telemedicine appointments. Both Drs. Park and Osher already had access to a robust tele-health platform through CCPHP, the company they have partnered with to establish, operate and support their concierge membership programs. CCPHP also empowered and supported their members with a myriad of communications and adjunctive services—including carefully curated updates on COVID-19, live webinars with access to a leading infectious disease physician, virtual events focused on stress management and emotional wellbeing, along with continued access to personalized health coaching services.
Thankfully, members were very supportive of these doctors’ decisions to dedicate time to the front lines against COVID-19.
“I was still communicating with my members regularly, and they knew I was being activated to work at the hospital,” explained Dr. Parks. I have to say, it was amazing, the overwhelming support from my members. The sense of community that you develop in a concierge style practice is very special. One of the benefits of a small concierge panel is you can manage the members issues very effectively while remote. During those very rare times that I wasn’t immediately available, my colleagues were very supportive and available.”
Dr. Parks further explained that she tried to stay as connected as possible to her members, sending regular email updates (with help from CCPHP), leading a virtual town hall meeting, offering remote cooking classes and group meditations, and continuing to offer care—both through telehealth and in person.
“We have been mostly a remote telemedicine service, but we continue to run our labs for blood draws and examine acute issues,” said Dr. Parks. “We’ve accommodated our members as much as possible during this time. Some patients are terrified to leave home or leave their cars, I have actually gone to the parking lot for blood draws.”
With the outbreak in NYC, Dr. Osher shut down her practice for in-person visits, but she also continued to provide tele-health services to her members during the pandemic, while she was volunteering at Bellevue—and even when she contracted COVID-19 herself. And like Dr. Parks, she also received immense support from her member base. She communicated with members early on to set expectations that she may be a little slower to respond to their calls and emails while volunteering, but she still checked all of her messages each day at lunch time and after her shift. Additionally, a number of her CCPHP NY colleagues stood close watch as back-up if needed.
“If your members see you’re going to do this for a stranger, they know that you are going to go to bat for them, too,” Dr. Osher explained. “It seems to me that it’s only positive.”
Dr. Osher explained that the concierge relationship has actually brought her closer to her patients during this time of intense need because she’s able to be so responsive. “Having the patients be able to phone me whenever they are in need of medical advice is wonderful. I am likewise able to respond to them quickly and allay their fears, as well as treat them.”
As for family, Dr. Osher’s adult daughter ended up quarantining with her—she got stuck in NYC after visiting in mid-March. “Luckily for me, she was here when I was sick and was a cheerleader for me at Bellevue. It’s been great to have a support person, and she’s been a real motivator. I wanted to be an example for her.”
Moving forward post-pandemic
Now that COVID-19 cases are trending downward in New York, Dr. Osher has reopened her practice to see patients in-person a couple of days a week. She’ll follow her members’ lead and open more days if there’s interest—and she’s anxious to start seeing them again. “I really like to see and touch my patients, see the color of their skin, hear their breathing. I miss the practice of medicine.”
But while there may be changes to her practice in the short-term, Dr. Osher does not see the pandemic causing long-term changes in how they practice medicine.
“We’re resilient. There’s been malaria, tuberculosis, HIV. There have been all these things and we survive,” she explained. “There will always be new viruses, bacteria, and we will always figure it out and survive. That’s human nature.”
Dr. Parks has similar reflections. “I think the patients feel more connected to the practice now in some way because we’ve been able to remain connected with them through this time. All of our communications and programming have helped to keep people engaged.”
Both doctors agree that this has been a historical time to work in medicine.
“I have always wanted to participate in Doctors Without Borders, and I think this was that for me,” said Dr. Osher. “I mean, it was the inverse. The virus took away our borders. But this felt like a pioneering experience, going into the absolute unknown.”
“For me personally, and probably for many physicians, it’s a privilege to be able to work in this era,” added Dr. Parks. “We’re making history. This is something that our successors will learn from for years to come. We got to be a part of it, learning and shaping how we respond to these types of tragedies.”
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