key: cord-304874-pjdedw7w
authors: Grant-Kels, Jane M.
title: Invited response to the comment on “Dermatology Residents and the Care of COVID-19 Patients”
date: 2020-04-21
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.04.072
sha: 
doc_id: 304874
cord_uid: pjdedw7w

nan

I am greatly appreciative to Dr. Basil Patel for his comments 1 on the dermatoethic's piece entitled "Dermatology Residents and the Care of COVID-19 Patients" 2. As someone who is intimately involved with dermatology residents at two universities, I am personally very aware of residency concern and fear over this pandemic. I will address each of the issues raised by Dr. Patel.

Although the fatality rate for those aged 20-49 is lower, I recognize that any risk, when it is personal, is terrifying. I did not mean to imply that fear was not appropriate. Your assertion that theoretically upholding the Hippocratic oath should make the fatality rate irrelevant has some merit. Although physicians, as you state, do not need to be martyrs, they need to fulfill their professional responsibility the same as a fireman running into a burning building. There is now personal protective equipment (PPE) that reduces the infectivity rate substantially which if worn properly should be reassuring. I agree that having PPE available is crucial. Peggy Noonan penned an editorial in the Wall Street Journal published April 11-12, 2020. She reflects upon the "…selflessness of doctors and nurses, for instance, and how they do their jobs because it's a calling. This tells us what bravery looks like, but also what a vocation is, and how a vocation is a spiritual event." 3. I am very sensitive to the fact that many residents are young with spouses and children.

The risk of returning home after caring for infectious patients is something I did not mention but was acutely aware of. The need to be concise and conform to the word limit of a letter prevented me from raising this issue.

Finally, you raised the issue of power dynamics and that residents have little leverage.

This implies that attendings are not fulfilling their obligation to care for these infectious patients. Emergency room and hospital attendings (many of whom ,at many hospitals, include called-up dermatology attendings) are potentially jeopardizing their well-being just as you are. I hope that all are pitching in during this national emergency not out of fear that their contract will not be renewed but "to fulfill the key human desire to be part of something -'to be part of Team Humanity, to be useful." 3 I am pleased that you are proud to be helping your community and I am confidant your community is grateful to you. Those at the front line caring for these patients are

heroes. This pandemic has tested all of us. I am hopeful that out of this trial we will grow as physicians and human beings. Thank you for your service.

Comment on Dermatology Residents and the Care of COVID-19

Dermatology Residents and the Care of COVID-19

A holy week amid a national tribulation