Staying Close From a Distance
Aug 04, 2020 Cassie Tomlin
Primary care physician Ara Thomassian, MD, first heard about COVID-19 the way most of his patients did—on the news and in social media. And like his patients, he spends every day balancing his risk of contracting the virus and adapting to a more sequestered life.
Thomassian, who practices at Cedars-Sinai Valley Internal Medicine in Valley Village, Calif., relies on one consistent prescription for his patients during the evolving health crisis: honest, transparent communication. He finds it especially necessary, since, like those he cares for, he learns something new about the novel coronavirus on an almost daily basis.
"I'm leaning on the trust I've built with my patients as I'm honest about what I don't know," he says. "The anxiety of getting sick from this thing is overwhelming, but they trust me because I'm thorough, diligent and explain what I do know."
Since March, Thomassian has treated more than 150 patients for confirmed or suspected COVID-19 infections, while continuing to care for countless patients with other health concerns. Most of Thomassian's patients haven't been sick enough to require hospitalization or even an office visit, so he sees them by video appointment, talks with them by phone or exchanges messages through My CSLink™.
Whether he's monitoring a patient's COVID-19 symptoms, answering questions about new or ongoing health issues, or simply soothing worries, staying connected is crucial. For example, Thomassian has one patient who is 94 and lives alone. He checks in with her by phone every Friday to make sure he can address any new concerns. She looks forward to his calls, which make her feel less alone.
"When a patient and I can work through a problem, despite the circumstances, it strengthens our therapeutic alliance," Thomassian says.
He admits to his COVID-19 patients that he's learning on his feet as he evaluates their health, adjusts his advice based on new guidelines and shares sometimes unsatisfyingly inconclusive diagnoses.
In the pandemic's earliest weeks and months, rigid testing guidelines forced doctors to diagnose the disease based on symptoms alone, especially in otherwise healthy adults with mild cases. After cautiously gauging a patient's disease severity, Thomassian advised most to assume they were infected, isolate from their families, stay hydrated and take Tylenol. Some grew frustrated, especially since COVID-19 symptoms are less typical compared to those of other viral infections.
"A lot of times, these patients are very anxious—they've never experienced anything like this," Thomassian says. "But I walk them through what to expect based on the most recent science. Much of what I know about this virus is coming from Cedars-Sinai, where we have expert epidemiologists and infectious disease physicians providing constant guidance. That gives my patients and me a lot of confidence."
Thomassian says the experience he's developed after years of caring for patients with multiple medical conditions and chronic diseases applies now as much as ever.
"There's no cookie-cutter treatment to any health condition or problem," he says. "That's why we have to listen, ask the appropriate questions and take patients' medical history into consideration—so we can tailor our approach."
Now, during every appointment—whether for diabetes or blood pressure management—he discusses COVID-19 to educate patients about keeping themselves safe and when to reach out for help or go to the Emergency Department.
According to Thomassian, the fear, uncertainty and stress he sees in his patients over COVID-19 only make him more dedicated to his job.
"Patients share things with me that they don't tell anybody in the world," he notes. "There are patients who don't take advice from anyone else—but will listen to me."
Along with that sense of responsibility comes another emotion, Thomassian says. "I understand that being someone's physician means so much, and that brings me joy. I love what I do."
For most Angelenos, the COVID-19 pandemic has disrupted well-established, relied-upon routines. For many, stay-at-home orders have caused fear, anxiety and loneliness. Thomassian suggests his patients search their new situations for "silver linings," and focus on positive changes.
Learn (or teach) something new: Thomassian takes advantage of the added time at home by teaching his kids to swim. "Every day as it gets closer to 5 p.m., they're waiting for me in their swimsuits with sunscreen on—they really look forward to it, and I've been able to see them improve, which is rewarding for me."
Embrace the positive changes: Thomassian's work has changed dramatically, and one element he hopes will stick around is virtual care. Though video chat is not always an adequate substitute for an office visit, the ability to treat a patient from a distance improves access. It can be helpful when patients live far away or while they're out of town.
Elevate small rituals: Thomassian says many of his patients have noticed new tenderness in small moments with loved ones, like sharing coffee or a walk. "My family used to get really restless at home—if we didn't take a trip on a weekend or a day off, we felt it was a waste. Now, we've found that we don't need to go out to enjoy a meal. We're regaining an appreciation for togetherness."