What keeps otolaryngologists up at night: 6 perspectives

Otolaryngology is a growing field that's faced unique challenges amid the COVID-19 pandemic. Six otolaryngologists told Becker's ASC Review about what keeps them up at night.

Note: Responses have been lightly edited for length and clarity.

Nicole Aaronson, MD, pediatric otolaryngologist at Alfred I. duPont Hospital (Wilmington, Del.): With respect to [COVID-19], the big thing that keeps me up at night is the idea that there are sick people who are not receiving treatment because they or their parents (in the case of my pediatric patients) are too afraid to come into the office. I worry that their disease processes will become more advanced without appropriate intervention. With respect to otolaryngology in general, my big concern is what will happen to healthcare in the U.S. overall. What I don't want to see is a system where care is rationed and I can't provide my patients the care they need because they don't fall on the right side of a cost-benefit analysis. I also don't want to see a system in which physicians end up allowing the government to dictate to them how to perform care.

Kenneth Altman, MD, chair of otolaryngology at Geisinger Health System (Danville, Pa.): The need to improve access for care, delivery of best practice and creating a seamless patient journey. Outside of the largest cities, there's a paucity of specialists, and patients often have to travel great distances to see the right physician. Other barriers include our complex health insurance system, varying family social support and education. As a result of these limitations, it's very difficult for primary care to keep up with all of the new practice guidelines and consensus statements in every specialty. Another issue haunting everyone is the need to create a seamless patient journey through their cycle of care, which may involve multiple providers spanning distance and across different healthcare institutions with a variety of electronic health records.

Daniel Eichorn, DO, resident otolaryngologist at Philadelphia College of Osteopathic Medicine: When the pandemic forced many specialty practices to decrease their patient volumes, and patient appointments were limited and offices were functioning at partial capacity, where did all of those patients go? Were they self-triaging? Were their conditions not "that serious" to begin with that they only came to the office if it was convenient but now that a pandemic hit they decided they didn’t need to be seen? (I doubt that is the explanation but it is a thought I have.) 

What will the [personal protective equipment] supply look like this winter if there is a resurgence in cases, a hospital surge and a need for advanced airway management that otolaryngologists can offer including endotracheal intubation or a tracheostomy?

Kiley Trott, MD, assistant professor at Yale School of Medicine (New Haven, Conn.): [I'm] wondering how COVID-19 will continue to affect my practice and larger healthcare organization and how best to respond and stay nimble.

Stacey Ishman, MD, otolaryngologist at Cincinnati Children's Hospital: Aside from the lack of coordinated effort for the pandemic, the number of undiagnosed and/or untreated children and adults with obstructive sleep apnea worries me. We estimate that 90 percent of people with sleep apnea are undiagnosed, and the health consequences of OSA include loss of concentration and focus, heart and lung disease, and reduced quality of life. 

George Wanna, MD, professor of otolaryngology and neurosurgery at Icahn School of Medicine at Mount Sinai (New York City): In the first months of the pandemic, the sheer number of patients requiring emergency treatment and intervention was incomprehensible. 

Although the Mount Sinai Health System took immediate action to protect the safety of our patients and our medical personnel, including cleaning and sanitizing our facilities and providing the proper PPE, many patients were (and still are) fearful about going to a healthcare facility or hospital to be treated. Even though we have done everything within our control to create a safe treatment environment, it has been challenging to convey to our patients that it is safe to obtain medical care so that they feel confident enough to leave their homes and obtain treatment.  

The health and safety of COVID-19 patients and front-line medical care providers required our immediate and urgent attention. As a physician, I knew that delays in receiving prompt medical treatment and intervention would exacerbate ENT conditions that would normally be easy to resolve. As a skull-base surgeon, I was keenly aware that without urgent intervention, the lives of patients who were not COVID-19-positive could be lost.  

On a personal level, throughout the pandemic and particularly during the first few months as the virus was rapidly spreading, I was very concerned with the safety and well-being of my wife and children. Although I took the necessary safety measures with patients, utilized the appropriate PPE, and disrobed and showered before hugging my wife and kids, it has been a very challenging and disconcerting time for me as a physician, a father, a husband and a human being.  

More articles on surgery centers:
Viewpoint: An otolaryngologist's perspective on COVID-19
Top priorities for ASC leaders today and in 2021: 7 key trends
10 facts and statistics on otolaryngology | 2020

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