Updated: Dec 12, 2020
Yesterday, I tested positive for COVID-19. Before I go any further with this essay, it’s important to say that I was tested not because of symptoms but because of a possible exposure. I don’t yet know if any of my family members are infected, but I will soon. Though my assumption is that my test result is a true positive (I’ve got plenty of exposure through my job), the waiting has given me to time to think about the statistics I’ve studied and what they might mean for me. For example, I know that if you test a lot of asymptomatic people for COVID-19, you will actually come up with a lot of falsely positive tests even if you have a very good and specific test (I won’t go into the math here, but it is true). Since I still have no symptoms at this time, I had my COVID-19 test repeated yesterday afternoon.
Regardless of what my repeat test reveals, there is for me a lesson here. It is that, in nearly all spheres of adult life, experience matters. Knowledge is good, but only if informed by experience. A good general example is the person who has book knowledge but who lacks real world experience. An example from my own life that I’ve discussed in this blog series is that of being a doctor in rural America. Another one from my life is the pain of reverse culture shock after serving in the Peace Corps. Another is being a parent. Another is testing positive for COVID-19.
What makes a COVID-19 diagnosis different for me than anything else on the list above is a grounded sort of fear. Becoming a small town doctor and returning from the Peace Corps and becoming a parent were all, in their own different ways, leaps of faith. But with COVID-19, I have a fear that’s born from experience. It comes from over two hundred days spent rounding on COVID-19 patients, from the many CT and chest x-ray and lab and vital sign reviews I’ve done, from what has over time become a mixing of experience with knowledge.
I don’t want this essay to be about a lab test. As I noted, I still have no COVID-19 symptoms at this time. I’m also fortunate to be in generally good health, and so the odds over the next week to two are on my side. What I want to talk about is the value of experience in health care, and how when you have a system based too much on knowledge and too little on experience the system suffers.
We have many examples of this in the COVID-19 pandemic. In the U.S. they range from the national to the regional to the local. There are presidential COVID-19 advisory boards without full-time COVID-19 clinicians. In my state, our government has mandated requirements for hospitals to stock 90 days’ worth of PPE for hospitals but there is no related requirement to protect outpatient workers. For many people in rural America, there is no national media voice that feels even recognizable.
Now imagine how different things would look if you added experience to knowledge in the examples above. On the local level, physicians who treat COVID-19 would speak to their communities about the dangers of the virus and the importance of adherence to public health measures. They would try to combat misinformation of every stripe with recognizable and trusted voices. They would work with their departments of public health to determine the best local use of PPE and testing resources. They would also work with their state governments to secure adequate access of these resources for their communities.
On the state and national levels, physicians who treat COVID-19 would also be part of the most important decision-making boards in the pandemic. In the example I gave from my own state, they would help give their colleagues on these boards a sense of the dangers that all health care providers (not just those working in hospitals) face and help prevent the kind of imbalanced PPE distribution that we’ve seen here in New York. On the national level, COVID-19 physicians would partner with both the media and our largest public health organizations. They would help their decision-making colleagues by providing not just a macro level view of the pandemic but also a micro level view through which to get a better sense of the day to day struggles of physicians and patients. The result would ideally be decision-making bodies that not only craft plans for developing new and distributing existing resources (vaccines, tests, therapeutics, etc.), but also decision-making bodies with a better understanding of the many local challenges to good resource allocation and a better understanding of how to create public health messages that really stick.
There is a hardness that sometimes sets in in medicine. It’s called compassion fatigue. Every doctor feels it and the best ones know how to resist it, but the feeling still returns. There is also a hardness that forms in many of us when we hear the same message from the same people too many times. It’s called tuning someone else out. We all feel it, and the more we turn on the TV or the radio or our computers the worse it usually gets. This, I believe, is what has long been happening in the pandemic in general and in rural America in particular. We are hearing from very smart people, but we’ve seen and heard from them before and, for me at least, it continues to feel like too few of them have the on-the-ground experience that I want. And while many of us may not be aware of it, I believe that this is also what often happens when there is too much knowledge and too little direct experience. People sense this, and at a certain point they stop listening.
I certainly hope that my repeat COVID-19 test comes back negative, but even if it does there will be an uncertainty that remains. For now, I am doing what all people in my situation are required to do. I am in quarantine. The outside world feels smaller and more remote. I’m thinking a lot about my family. The only thing that seems to matter is voices that care. We are all like this. At day’s end we want to hear from those who seem to know us. Whether you’re a patient struggling with a diagnosis of COVID-19 or a person trying to figure out how to make sense of a million messages coming at you all at once, the desire is the same.
There is no substitute for caring, and there is no substitute for experience. The best clinicians offer both. Sometimes it takes the fear of losing everything to feel the truth.