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Speaking With Patients, Maine's Primary Care Physicians Work To Reinforce Message Of Precaution

Robert F. Bukaty
Associated Press
Medical personnel discuss patients that had been admitted for testing for the coronavirus at the entrance Central Maine Medical Center on Friday, March 13, 2020, in Lewiston, Maine.

Among those who are first-hand witnesses to the surge of COVID-19 in Maine are primary care doctors. They’re the boots on the ground working to dispel myths about the pandemic and encourage people to take precautions. And after seeing an increase in cases from Thanksgiving gatherings, they’re worried about what may happen during the Christmas holiday.

Primary care isn’t just about medicine. It’s about relationships. And Dr. Scott Schiff-Slater of Hallowell Family Practice works to foster those relationship in every visit.

“Almost with every visit, I ask people, ‘How are you doing with the pandemic, what did you do over Thanksgiving, and are you staying within your bubble?’” he says.

The answers to these questions help Schiff-Slater get to know his patients better. They also provide a window into people’s personal habits, which can have health consequences — especially during a pandemic.

“I think people are so tired of the pandemic that they’re expanding their bubble more and more, and more than we should,” he says.

Schiff-Slater says he spends a fair amount of time encouraging patients to limit the number of people with whom they interact. But patients often admit that they’re still getting together with people, even though they know they shouldn’t.

“We’ve had so many examples where people are really stretching it and getting into trouble with the virus. And I’m very worried about what’s going to happen over Christmas,” he says.

Consider the Thanksgiving holiday as an example. The head of the Maine CDC said last week that the state is squarely seeing the effects of Thanksgiving gatherings reflected in the recent acceleration of cases.

Dr. Chris Meserve of Mid Coast Medical Group in Topsham says he has had patients who are typically careful about their health test positive.

“And each of them explained to me how it happened over Thanksgiving because of a contact they weren’t so crazy about, but decided to do it anyway, and get together and have a meal, and sure enough, in each case, they said that members of the other party are now sick and now I’m sick,” he says.

In some ways, these decisions are not surprising, says Dr. Amy Madden. She practices in Belgrade as the medical director of HealthReach Community Health Centers. Madden says people tend to let their guard down when it comes to friends and family.

“So I would say the biggest misconception, and I think this is very human, is that we tend to not see the people who are closest to us as a potential person that could carry the virus,” even though, she says, those are the very people through which we’re most likely to come into contact with the virus.

When that does happen, one good thing that can come out of the situation is that it can serve as a learning tool, says Dr. David Preston, medical director of Thayer Internal Medicine in Waterville.

“People respond more to personal stories than they do the voice of authority,” he says.

And one of the misconceptions Preston says he works to expose is that it’s only older people who get sick and die from COVID-19.

“I tell them the story of a patient of mine last month who had a nephew, he was 40 years old. He lived in Tennessee. Was a fellow who thought everything was a hoax, that it was all a ruse by liberals to take away our freedom. Would go around without a mask into bars and so forth, and he unfortunately died of COVID. He got sick one day, and in three days he was dead. So I just relate that story. And I say, it’s real. It’s here,” he says.

People who are skeptical about the reality of the virus present the biggest conundrum for Madden. She says her approach is to plant seeds in the hopes that a different view will grow.

“I’ll usually ask people like, ‘What is it about wearing a mask that’s difficult for you?’ In a nonjudgmental way. Just trying to get at what that is for them personally. Not what they read on the internet. Not what they’re hearing from whatever social media, but what is it for you personally? And what would it take for you to change that?” she says.

Dr. Meghan Mamula, medical director of Brewer Medical Center says she finds that most of her patients at this point are resigned to wearing masks. Her biggest concern is small gatherings.

“Particularly in our geriatric population, they’re really sad and really lonely right now, and willing to take a risk,” she says.

People seem to feel, Mamula says, that if they just get together with a few people, it’s safe. But they fail to think about who those other people are coming into contact with.

“In Maine, we did really well and we made it look easy, unfortunately. And now we’re in a mess, and it’s not easy and I can’t get a sense of who is seeing that and understanding that and who’s not,” she says.

As 2020 draws to a close, there’s hope that 2021 will be better. But we still have a long haul through the pandemic, and primary care doctors are asking the public to buckle down to prevent the situation from getting worse.