As the number of Americans with Covid-19 rapidly rises, doctors are among them, having no special immunity to the virus. They are being quarantined in large numbers, leaving hospitals short of staff to care for the influx of Covid-19 patients. In response, these facilities have started redeploying specialists like ophthalmologists, dermatologists, and even psychiatry residents like us to treat patients on coronavirus floors.
Sure, we’ve heard the mocking memes like, “Don’t go outside unless you want a psychiatrist treating your pneumonia.” We’re accustomed to people thinking psychiatrists aren’t real doctors. We’re usually OK with the jokes, but not now. During the pandemic, they are creating unnecessary fear.
We believe that if you are afflicted with Covid-19 and have a psychiatry resident as your doctor, there is no need to panic. In fact, there may even be some important benefits.
Psychiatrists are physicians, which means they went to medical school and passed the United States Medical Licensing Examination, a test of general medical knowledge required to start residency. All new doctors — including psychiatrists — have similar training in their first year of residency, also known as internship. This year involves working on units nearly identical to coronavirus units. As interns, psychiatry residents treat conditions ranging from pneumonia to heart attacks. Most also work in intensive care units taking care of a hospital’s most critically ill patients.
When psychiatry residents are redeployed, they are essentially repeating their internship experience. They work under the watchful eye of an attending physician. This experienced doctor supervises their work and ensures that Covid-19 patients receive appropriate care. In addition, pharmacists review their medication orders, and the electronic medical record implements a separate range of safety checks.
Interns and residents have always been a key part of hospitals’ medical teams and the primary face-to-face physician for patients. This was true before the coronavirus pandemic and it’s true now. The difference today is that your primary doctor may be a psychiatry resident who already completed her or his internship, rather than an internal medicine intern who hasn’t yet finished the first year of post-medical school training.
Having a psychiatry resident instead of an internal medicine resident as your doctor may actually offer unique benefits. Patients with respiratory illnesses are at risk of a range of psychiatric complications. Many will suffer from delirium, a disorienting condition in which patients become confused about where they are and what is happening. Some with this condition have visual hallucinations that psychiatrists specialize in treating.
We expect there will be a rise in post-traumatic stress disorder triggered by serious illness in the intensive care units and invasive procedures like the placement of breathing tubes. Psychiatry residents are more likely to identify and treat this condition, which can include nightmares, hypervigilance, and underrecognized symptoms like dissociative experiences, in which patients can have disturbances in how they perceive the world or themselves, including “out of body” experiences.
Some of the experimental medications for coronavirus, including hydroxychloroquine, have a range of psychiatric side effects, including nightmares, paranoia, and even suicidal thoughts. If these medications end up having clear benefits and their use becomes more widespread among patients with Covid-19, having psychiatrists available in the hospital will be key.
It goes without saying, but psychiatrists also have expertise in helping patients and families deal with the depression, anxiety, and grief that often accompany serious medical illness. Mental health issues are so common among people who are ill that psychiatrists are often called upon to provide consultations in the hospital. At the hospital where we both work, psychiatry consults are placed for 1 in 5 patients.
We agree with the opening sentiment of the anti-psychiatry memes floating around: People should stay home to prevent the spread of the coronavirus. But if you catch the infection and find yourself in the hospital with a redeployed psychiatry resident as your doctor, you’ll get excellent care.
Jack Turban and Chase T.M. Anderson are resident physicians in psychiatry at Massachusetts General Hospital.
Clear, thoughtful, beautiful comments by the authors. They stimulate one to step back and make sure the whole patient is treated and that we do not forget the mental health of those under our care. It is also a reminder to the medical community how we all are colleagues, along with nursing, putting our lives on the line for our patients. As an anesthesiologist I am reminded by the authors that we too are often regarded as technicians and not, “real doctors”. This is a group of medical experts keeping patients safe and alive during procedures.
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