Robert McLean, MD: Discussing Coronavirus with Patients

March 12, 2020
Patrick Campbell

The incoming president of the American College of Physician offers advice on communicating about the realities and myths of coronavirus with patients.

Robert McLean, MD

By now, it is clear that the coronavirus outbreak is impacting the day-to-day lives of almost everyone in the US—including physicians and clinicians across all specialties in medicine.

While the constant stream of information from the CDC and other agencies go a long way in informing practicing clinicians on the transmission, symptoms, and care recommendations, one of the most prominent challenges in handling the pandemic is effectively communicating with patients.

Whether patients reach out to a medical facility concerned about themselves or a loved one, a clinician’s ability to navigate the ensuing conversation can have an immense impact on how a patient acts and reacts to the current outbreak. Unfortunately for clinicians, it is not always clear how to approach these conversations and there is no ‘How To’ guide for discussing pandemics with patients.

With this in mind, HCPLive® reached out to the American College of Physicians for more perspective on how clinicians could best handle the situation given the constantly evolving scope of knowledge surrounding coronavirus. The following is a portion of the subsequent conversation with Robert McLean, MD, a practicing rheumatologist and incoming president of the American College of Physicians, on how physicians should handle the coronavirus.

HCPLive: How should physicians and clinicians approach conversations with concerned patients about coronavirus?

McLean: I think one of the points that many of us make is to underline that there is uncertainty over how widespread this is. On the basis of that and what we do know in some of the other countries, and the number of people who have tested positive medical testing, but we're not all that sick—I think we can rest a little bit better knowing the hospitalization rate and the fatality rate is not something like Ebola. It’s a relatively low number but it's higher than what we know from the flu. People need to realize—for example, influenza this year, I think something like 30-40,000 people across this country have died of influenza and the fatality rate is somewhere less than one less than 1%.

So, hundreds have been diagnosed with having it but, in all likelihood, there are many more who have had it and had a mild case. Until we have testing we don't know. Based upon some of the International numbers, some estimates are that the fatality rate might be upwards of 3.4-3.5% was the last I heard.

That is clearly higher than flu and that is not something to mess around with—especially when a large percentage of the affected people seem to be largely elderly and people who have other significant chronic illnesses. So the reassuring part is to say listen, "it looks like the people who get really sick end up not doing well are part of that group".

The concerning thing is if you are in that subset, you need to be really careful and not go out. I'm not saying you have to quarantine if they haven't been sick or had any contact, but I think it is prudent to not do lots of public exposure, especially in groups that are unnecessary until we have a better handle of it.

So, prudence and caution—especially in those categories—a little bit of reassurance for the younger category, but concern. From what we've seen, it looks like some of the younger folks have milder illnesses.

The problem is that those younger, milder people if they are in contact with grandma and grandpa at home, could actually be giving it to them. This is one of the reasons why healthcare facilities, hospitals, and nursing homes are now really not allowing visitors. They are concerned about these relatively minimally symptomatic people really who don't think they are at risk bringing it in. When you look at that nursing home in Washington State—they had so many cases it just kind of spread like wildfire.