The following is an edited transcript of an MDAdvantage podcast with Steve Adubato and Dr. Raj Brahmbhatt that was recorded on July 29, 2020. In this discussion, Dr. Brahmbhatt shared his experiences managing the COVID-19 pandemic as a family medicine physician and Chief Medical Officer of Riverside Medical Group.
ADUBATO: What are the most significant challenges at Riverside Medical Group that you and your colleagues are facing during this pandemic?
DR. BRAHMBHATT: There are multiple challenges. Obviously, our number one challenge is being able to care for our patients and making sure they are getting their healthcare needs met throughout all of this. Thankfully, our numbers of COVID-19 cases are down in New Jersey, so things are opening up; it’s a lot easier now compared to March, April and May, when it was tough to get in touch with patients and get them the everyday care they needed.
Another challenge, of course, is facing the pandemic itself. We had to scale testing very quickly; we had to make sure we had enough safety equipment, like personal protective equipment (PPE). We took for granted the closets full of hand sanitizer and hand soap that we had before, and all of a sudden, it became a huge commodity.
ADUBATO: What are your patients’ most significant concerns?
DR. BRAHMBHATT: The first is that they don’t want to get sick with COVID-19. Their biggest concern is ending up in a hospital with a breathing tube. And of course, they don’t want their family members to get sick. Health-wise, their other big concern is making sure they can get the medical attention they need, especially our older population, our frailer population and our chronic disease population.
ADUBATO: What are the main concerns of your staff?
DR. BRAHMBHATT: The two biggest concerns that we have been able to manage are: Am I going to get sick? Am I still going to have a job? Everybody—from physicians to nurses to medical assistants to front-desk staff to cleaning staff—was afraid of being exposed to COVID-19 at work. From the beginning, we downsized our operations; we consolidated our offices; we took all our high-risk staff out of the offices. We accommodated them to work from home or to take some time off. We also wanted to make sure we put all of our resources in the right places. Instead of distributing PPE to 50 offices, we kept it down to 10 offices, maintaining skeleton operations and giving staff the PPE they needed. And of course, like everyone else was doing, we made sure to take temperatures, create newer and updated cleaning schedules for the offices and the waiting areas, and limit the number of patients.
“Within about three months, we saw more than approximately 40,000 telehealth visits—up from zero visits before COVID-19.”
The development of our telehealth platform was the biggest thing we were able to accomplish to keep our staff employed. We did that very quickly and on a really big scale. Within about three months, we saw more than approximately 40,000 telehealth visits—up from zero visits before COVID-19.
ADUBATO: Has the problem with PPE availability improved for your practice?
DR. BRAHMBHATT: We do have better availability. The issue now is not so much getting PPE, but the quality of the PPE we can get. There are, for example, 100 different types of N95 masks—some are a lot better quality than others, meaning that they seal better or are not as flimsy. As a practice, we’re okay currently, but we still have to be very careful. We’re constantly talking to our entire staff of 1,500 employees bimonthly regarding to how to use the PPE, making sure no one is wasting it, and making sure the PPE is being used when it’s supposed to be used. We’re in August right now, and flu season is right around the corner, so we have to keep our stock up to be prepared for that.
ADUBATO: What does it mean to be prepared going forward, living in the age of COVID-19?
DR. BRAHMBHATT: For us at Riverside Medical Group, it means a lot of planning because the symptoms of flu and COVID overlap, including cough, body aches and fever. For most people who have mild symptoms, flu and COVID-19 can look and feel exactly the same. We have to make sure that we have access to testing, which, thankfully, we do at this point. But once every person who has a fever wants to be tested, we’re going to have to expand that. We’re in the process of expanding our testing sites to make more testing available. We’re making sure that our PPE is well stocked. We are using our telehealth platform so patients can be evaluated without coming into the office, and then we can decide what to do from there. It’s going to be a challenge, but we’re three steps ahead right now, so we’ll be prepared for it. On a national scale and on a statewide scale, it’s important that everyone gets prepared.
ADUBATO: Is there one person at your practice in charge of obtaining and distributing PPE?
DR. BRAHMBHATT: Yes, we have a designated person—our Chief Nursing Officer. One of her roles has always been to oversee practice health and safety for all of our offices. She always made sure that everything was up to code, that we had all necessary safety supplies and that we were well trained on all of it. So it was natural for her to take charge of the PPE, ordering it for all our offices, distributing it, logging it and making sure we get the right ones. It is a big job.
ADUBATO: Beyond the clinical, administrative, organizational and business issues that you have to deal with, I wonder about the human and personal side of this. How have you managed this yourself?
“…I really think this was Mother Nature’s way (or whoever you want to call it) of telling us to slow down and just take one day at a time.”
DR. BRAHMBHATT: It has been a challenge. I think the first few weeks were probably the toughest. There was the stress about work, about constantly seeing sick patients, about not getting sick and not getting my family sick. And then there was the stress from being isolated, not being able to go anywhere and not being able to see my extended family. Not to get too philosophical, but I really think this was Mother Nature’s way (or whoever you want to call it) of telling us to slow down and just take one day at a time.
ADUBATO: Do you think mental health is tied to this pandemic?
DR. BRAHMBHATT: Yes, many mental health concerns have come up during this time. Of course, just the stress of getting COVID-19 has caused a lot of anxiety. But it’s also triggered mental health issues for people who need to be able to socialize. Isolation is a big deal for many people, especially for those in areas like where I am in Hudson County, where everyone is in an apartment, living on top of each other. That’s why you see towns like Hoboken make it a priority to have outdoor space available and to close streets for people to walk and eat outdoors.
At the same time, people who have issues with crowds or anxiety and going to work every day and commuting are now able to work from home, and that has actually helped some people calm their anxiety. So, I’ve seen it go both ways.
ADUBATO: To what degree are you finding, in the area around the Riverside Medical Group, folks wearing masks, socially distancing and not gathering in large indoor groups?
DR. BRAHMBHATT: It varies. I tend to see younger people in their teens and early 20s not wearing masks. Older individuals tend to wear masks. I think most of the businesses in general are doing a good job about enforcing safety practices, but it is difficult to prevent people from having gatherings at home. There are pockets of communities that are used to having large gatherings. I’m a little worried about the gatherings happening in indoor spaces and even family backyard gatherings. Once people are enjoying themselves and having fun, having a drink or two, their guards go down, and that’s what we’re seeing, unfortunately, now in New Jersey as well as in many other areas.
ADUBATO: I imagine that thinking about the future is a big part of managing one’s self and medical practice. Are you optimistic?
DR. BRAHMBHATT: Absolutely. I’m a glass-that’s-half-full kind of person, so for sure I’m optimistic.
ADUBATO: Thank you so much for sharing your insights and the experiences of Riverside Medical Group.