Guest Blog: Perspectives on How COVID-19 Has Affected Psychiatric Practice in New York City

As part of PRMS’ ongoing commitment to behavioral health, we are pleased to feature Doctors Asha Martin, Alan Rodriguez Penney, Gabrielle Shapiro, and Olga Koblova, members of the New York County Psychiatric Society (NYCPS), as guest bloggers this month, to reflect on how the COVID-19 pandemic has affected their psychiatric practices over the last year.

How did COVID change the residency experience for you? What lessons have you learned from your unique experience?

Dr. Asha Martin: During the COVID-19 pandemic, I was in my third year of residency and had a panel of outpatients whom I saw on a regular basis. In the outpatient world, things swiftly shifted from in person to phone to telehealth. Each setting had unique challenges that I needed to conquer. My brain was full of questions, doubts, and uncertainties. How can you measure the effect in the room via a phone call? How can you ensure patients are taking medications and receiving appropriate lab monitoring? And how do you explain to patients that you will be terminating with them and answer the question of 'Does this mean I'll never see you in person?' My co-residents and I grappled with these things and became an important network of support for each other.

Just when I thought I had a handle on the outpatient psychiatry world, my work was shifted. The pandemic progressed and the fight against COVID-19 became an "All Hands-on Deck" scenario. I was asked to re-deploy to internal medicine and treat patients on the COVID positive and negative units. When I first started, I was terrified of going back to internal medicine. Again came the internal mountain of questions, "Do I know anything?" and "What can I offer as a psychiatry trainee?" and "Will I be responsible for the death of someone's loved one?"

While on service, I learned that as psychiatrists, we can really provide a unique lens to patients and family members who are struggling with the uncertainty of the virus. Not only was I able to treat patients, but most of the reward came from speaking to family members and providing updates and acting as a container for their often-intense emotions. I was able to take the skills I had developed through my psychiatry training and adapt them to the field of internal medicine. And it turns out that I remembered more medicine than I initially gave myself credit for. So to answer the question of how the experience changed me, I learned that I am more resilient and skillful than I initially imagine and that I should always challenge my what if’s and how’s. I was reminded that I have a wonderful set of colleagues that I can lean on for support when I feel stuck.  And lastly, I learned that one should never get too comfortable.

How has working with your patients changed during the COVID-19 pandemic? How have you adjusted?

Dr. Alan Rodriguez Penney: I am a community psychiatrist and serve people who are currently or formerly homeless through a non-profit organization. We switched to remote mental health services early in the pandemic, as we work at multiple sites with a very vulnerable population. Not having to commute during the height of the epidemic in New York City helped reduce the risk of infecting my patients or myself with COVID-19, and I was able to reach people whom I normally would have difficulty finding onsite through phone or telepsychiatry. Telepsychiatry has become an important tool to improve the likelihood of reaching my patients. The majority of my work is remote, with occasional onsite visits to administer long acting injectable medication.

What has it been like practicing – specifically in NY, which was at an early point a large COVID hotspot for our country? Knowing what you do now and having lived through 17+ months of the pandemic, what advice would you give yourself back in February/March 2020?

Dr. Gabrielle Shapiro: My practice turned completely virtual and my patients adjusted very well to it. If advising myself from February or March of 2020, I’d say take social distancing and masking seriously and really look at what priorities you have in your life that have to do with family and work life balance.

What has it been like practicing medicine -- specifically in NY, which was at an early point a large COVID hotspot for our country?

Dr. Olga Koblova: The beginning of the COVID-19 pandemic coincided with the scheduled rotations in internal medicine during my intern year. The COVID-19 pandemic was an enriching experience for me. 

First of all, it was the test of humanity and professional responsibility, when I had to suppress my own fears for my family’s and my personal safety. The N95 masks were worn unchanged for a week officially, and nobody was guaranteed they would be able to renew them in a week. PPE was obviously very limited at that time.

It was a very tragic, but unforgettable experience. I was given an unexpected chance to practice my Advanced Cardiovascular Life Support (ACLS) skills daily. It was the time when I had my very first case to pronounce my patient dead. I was one of the connecting links between the patients and their relatives, who were not able nor allowed to visit their dying loved ones.  

It enriched me with getting a sense of community when I witnessed the friends and strangers crafting masks, printing face sheets on personal 3D printers, and donating hazmat suits for frontline workers. The restaurants were donating food to medical workers with great love and care. The hotels were opening their doors for medical workers to protect their families, although not without undesired isolation and separation. 

​Finally, my family and I contracted the coronavirus despite all protective measures. However, the pandemic left me feeling really grateful and extremely lucky for gaining immunity as the final happy outcome without any major losses.

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