Preparing and Helping Patients Deal With Self-Isolation

March 20, 2020

What do we tell patients regarding the pandemic both in terms of office policies and preparations for self-isolation and quarantine as well as dealing with uncertainty?

Other videos: Patient Care in the Age of COVID

In this video, John J. Miller, MD, discusses self-quarantine components of the COVID-19 pandemic with Heidi Anne Duerr, Associate Editorial Director of Psychiatric Times. Dr Miller is is Medical Director, Brain Health, Exeter, NH; Editor in Chief, Psychiatric Times; Staff Psychiatrist, Seacoast Mental Health Center, Exeter, NH; Consulting Psychiatrist, Exeter Hospital, Exeter, NH; and Consulting Psychiatrist, Insight Meditation Society, Barre, MA. He is Editor in Chief of Psychiatric Times.

Heidi Anne Duerr, MPH (HAD): What are you telling your patients regarding the pandemic both in terms of your office policies and preparing for self-isolation and quarantine as well as dealing with uncertainty?

John J. Miller, MD (JJM): I tell my patients the same thing I told my wife and my son and the same thing I tell my family and friends-that is, the situation literally is changing daily so stay tuned. I personally visit the CDC website on a daily basis so I am getting up-to-the-minute accurate information. In New Hampshire, we have a public health website that I also access daily to see what is happening in our state.

The big thing is staying inside, staying in the house, not going out, avoiding large crowds-the things you're hearing everywhere from everyone. The biggest challenge for us is convincing young healthy people to realize that even though they are at low risk, they may not even know they're infected. If they visit an elderly friend or parent or go to a store or someplace where other people are that are higher risk, they could be the transmitter of the virus.

It is really the action or inaction for all of us to protect each other. We need to think beyond our own needs and expectations and take care of the country as a whole. That is going to be one of the biggest challenges-convincing the young and the healthy to flatten the curve and prevent more infections regardless of their own risk.

HAD: Are you seeing more panic and anxiety in your patients at this time or are things pretty much the same?

JJM: A few of my patients who have significant anxiety disorders are actually doing quite fine with it. They say they have been dealing with anxiety all their lives, and for them, they are seeing people who are not normally anxious get nervous. Now that us just my own experience with a few patients and I'm sure it's going to differ everywhere you go. I’ve found that initially I was surprised by that, but the other side of the coin is whenever you delve into the unknown and you're not expecting it, anxiety is going to be there.

HAD: What do you think the impact of self-isolation and everybody working at home is going to be in the long run?

JJM: To start out on a light note, I read an article that said that the population that is having the most difficult time adjusting are all the pets at home. Our dogs and cats and birds and fish wonder if something different is going on because everyone is around.

On the more serious side, households where one or both of the primary adults are usually working and out of the house during the day, children and adolescents are at school, and young adults are working or in college-all of a sudden everyone is home taking virtual classes or working in virtual environments. So now you have a whole new kind of family culture that has developed literally overnight. Instead of everybody having schedules and a lot of time away, everyone is in a small contained area, probably fighting for the computer screens. Everyone is trying to do things virtually. I can only imagine that in some situations, it is going to be incredibly stressful.

It is going to be a good opportunity here for family self-therapy, learning to work together and cooperate and how to re-experience the core family just being with itself all the time. So there is a silver lining in there, but it is a huge adjustment. It is going to be very stressful and we still don't know how long this will continue, which I think is another piece of stress.

This is a whole new virus the experts don't know about, yet it is a slow learning process. We all have to be patient and respectful of what is asked of us and appreciate the hardworking commitment of the scientists and the epidemiologists. We then follow on the directives of the primary health care providers that are getting their mandates from the people who are overseeing the whole management of this pandemic.

Have more COVID concerns and clinical tips? Email us at PTEditor@mmhgroup.com. We may share your stories, queries, or thoughts in a future editorial or even as a standalone piece. Check out our COVID-19 Resource Page for Psychiatrists.