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Essential Versus Non-Essential in COVID-19: One Fellow’s Perspective

My last editorial started with, “Medical school has been weird.” 

That was six years ago. Today, as I sit down to write this piece, I again want to start with: Fellowship is weird right now.

I’m a soon-to-graduate allergy and immunology fellow and the circumstances surrounding the COVID-19 pandemic have catapulted every single physician into uncharted, and sometimes strange circumstances. Meeting patients for the first time on the internet, unable to physically examine that patient, telehealth malfunctions so you can’t even conduct the visit, the list goes on. 

While our attending physicians have been trying to figure out how to navigate patient care during this unprecedented time in medicine, as a fellow with just a few months left in training, I don’t have a clear answer for what my role in an elective subspecialty is supposed to be right now. 

This feeling has been very unsettling. I’m not on the front lines in primary care offices, or emergency rooms, or intensive care units. I’m not caring for acutely ill hypoxic patients that need respiratory support. I’m not gowning and gloving for the few patient encounters I still have. I’m not in New York, or California, or Washington. 

I am trying to keep my patients with asthma and immunodeficiencies well at home. I am trying to address their worries about if they should fall sick with COVID-19. I am trying to provide reassurance to my food and environmental allergy patients that their allergies won’t kill them and that they need to buy into social distancing measures so we can do our part to flatten the curve. I am trying to regularly check on my friends who actually are on the front lines. I am washing my hands even more, to the point where my eczema is on the verge of becoming unforgiving. 

But despite what I am trying to do, I’ve been left with this feeling that I’m not doing enough. I chose to extend my training by entering this particular fellowship, but now when there’s a pandemic and the world is suddenly so different, I feel so non-essential. Should I be using my board certified pediatrician skills to work on the front lines? It’s only been three years since residency graduation, but am I even qualified to work on the front lines? Does my Hippocratic Oath and personal desire to serve in this time of need outweigh the risks it poses to my family? Isn’t everyone doing that? Would it be selfish if I took this time to starting writing again? 

I don’t have answers to these questions and I’m still trying to figure out where my subspecialty training will fit into this pandemic — if at all. And I’m sure those of us nearing fellowship graduation are all trying to define new roles for ourselves while keeping our respective patient populations safe through this crisis. 

While I thought fellowship was supposed to be the last step of my training, right before I stepped out on my own as an able, thoughtful and confident subspecialist, COVID-19 is quickly forcing me to reflect on my previous ideas and to reconcile with what today’s clinical reality looks like. I will likely graduate with telehealth visits as the norm and minimal patient encounters, but I hope I can find some clarity and certainty in my abilities as an allergist and immunologist to keep seeing and treating patients — whatever form that takes. 

Image credit: Wait Your Turn Here by Travis Wise is licensed under CC BY 2.0.

Farah Khan, MD Farah Khan, MD (1 Posts)

Fellow Physician Contributing Writer

Virginia Commonwealth University School of Medicine

After completing a pediatric residency, I've been enjoying fellowship in allergy and immunology at Virginia Commonwealth University. My main interests include primary immunodeficiency, severe asthma and food allergy. When I'm not in clinic, I enjoy cooking with my husband (usually while chasing our toddler around).