I am appalled at my colleagues. One recent study found that 79% of all primary care providers responded negatively towards patients who reported symptoms associated with long Covid. The symptoms dismissed mainly focused on brain fog, and cognitive effects from having had Covid. This is in contrast to another study finding that cognitive affects from Covid are a real thing, proven by brain scans and following biomarkers in patients who were hospitalized with Covid. 

From my own practice over the last four years, the effects of Covid over time for a certain segment of the population are definitely preserved. Brain effects were part of that picture. Almost all of these folks that I saw in clinic had a measure of cognitive deficit, or what almost everyone called brain fog. Why would you deny the patient report? It reminds me of the rampant male egos in sports who, after someone had an obvious concussion, would tell the athlete to “be a man” and get back on the field – “you’ll be fine!”. As if a brain injury has anything to do with being a “wimp”! I feel that this is a similar take on the long Covid patient complaint. It’s not real, it’s all in their head. Well, YES! It is in their head and it is a brain injury. Not caused by impact, but by the devious infiltration of a virus and the inflamation following. The idea that mental health complaints, like depression and anxiety, are somehow not in the biological reality of this syndrome is also a ridiculous interpretation of symptoms. Just because the brain is more complicated and misunderstood, doesn’t mean it is not biochemistry and a real medical issue!

We in the healthcare world all too often dismiss the patient and what they tell us because we do not understand it. This is an ego problem. This is a catastrophic choice that withholds treatment, empathy and possible help from those who are sick and looking to us for direction. 

What are the hallmarks of good communication to avoid this kind of blunder?

• Listen completely and attentively
• Ask open ended questions
• Be curious
• Summarize throughout and ask if you are understanding correctly
• Use a warm and open tone as well as body language
• Self check: bias, presumptions and leave them at the door
• Be honest, realistic and patient

To the health care provider: remember who you are at the core- A scientist who takes in all evidence and then makes a decision based on review of all the possibilities. A detective who knows that bias can render the real criminal innocent and a bystander guilty. A priest whose words are powerful and can communicate grace and kindness, or venomous condescension. Step up to the plate and do the right thing, and stop blaming the patient for your ineptness. 

To the patient with these symptoms: Hang in there! Your symptoms are real and this is a horrible situation. We do not know what to do yet but scientists and the medical community are working to figure it out. Talk about options to try with your primary care provider and look to be included in a study. Many are ongoing all over the world and your participation could move us forward to a better understanding of this disease. 

I will step down off the soap box now…

Link: https://www.medscape.com/viewarticle/new-evidence-suggests-long-covid-could-be-brain-injury-2024a10002v0?