Addressing Patient Anxiety During COVID-19 Pandemic

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Amber Luong, MD, PhD, was examining a patient with severe chronic rhinosinusitis and nasal polyps last summer when she asked the patient how she was doing. The woman burst into tears.

Dr. Luong, professor and vice chair for research in the department of otorhinolaryngology at the John P. and Katherine G. McGovern Medical School of the University of Texas Health Science Center at Houston, had just scoped the patient, a woman in her 60s with aspirin-exacerbated respiratory disease and a history of multiple sinus surgeries; Dr. Luong had done her most recent revision.

“Everything looked pretty good,” Dr. Luong said. “Her frontal sinus common cavity was healthy and open. There was no inflammation. There was no pus. She looked even better than the last time I scoped her.” But the patient was having bad frontal headaches again, and something just seemed off. It all came to a head at her appointment.

At a time when things have been off for many of us, otolaryngologists are seeing patients whose symptoms may be caused by disease or, alternately, by the resulting anxiety and depression that has accompanied the pandemic. In addition to deadly outcomes for more than half a million Americans, COVID-19 has also brought many months of uncertainty, social isolation, and grief.

Through patience and perseverance, some physicians have been able to help patients who are struggling beyond the typical otolaryngology issues. Here’s how they do it.

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Cristina Cabrera-Muffly, MD, an otolaryngologist and residency program director at the University of Colorado (CU) School of Medicine in Aurora, said one of the things she tries to teach residents is to pay attention to how a patient makes them feel during an encounter. “When I find myself feeling anxious or depressed during a visit, it’s often my signal that this may be coming from the patient and that I need to address their feelings,” she said.

This exact situation had happened during Dr. Luong’s appointment. She found herself thinking more about how uncommonly quiet her patient seemed than about a recurrence of sinus disease. “As soon as I asked what was going on, she started crying and let it all out,” said Dr. Luong, who soon discovered that it had been five months since the patient had seen the grandchildren she used to babysit every week. “I told her that sometimes these feelings can cause symptoms that mimic chronic disease, like headaches, sinus pressure, and pain,” said Dr. Luong.