COVID-19: Medical Issues and Responses

by Robert Frierson, M.D. & Steven Lippmann, M.D.

The SARS-CoV-2 virus emerged causing a worldwide pandemic in 2019. Many people in Louisville and the rest of Kentucky were infected during 2020 by its illness, called COVID-19. The population was worried and that bothered the healthcare community, including doctors. Robert Frierson decided in 2020 to formally poll his local physician colleagues about their concerns and hear what they suggested doing about it. 

Doctor’s feared exposure to the virus, transmitting COVID-19 to family members, and/or getting sick themselves; that emerged as one of the initial issues. There was disappointment by all healthcare personnel and the general public about insufficient supplies of personal protective equipment (PPE), even of facial masks or routine gowns. It seemed that we were not response-prepared for this type of viral contagion. Physicians were concerned about diminished ability to be in close clinical contact with patients nor with other medical personnel; families were blocked from visiting relatives, even during emergencies or terminal situations. Patients were even more upset by these separations, and these factors had a negative impact on hospital and clinic staff resilience and morale.

Rates of addiction and psychiatric presentations escalated along with affective illness and overdoses; many people with somatic conditions, fearful of COVID-19, also avoided medical contacts and were suffering from increased and untreated pathology. Societal apprehension concentrated on problems of quarantining with social distancing, along with concerns about employment, education, and unstable or inadequate life-style.

Questioning then focused on what to do about these issues. Doctors reported that talk-time with colleagues and extra consideration in dealing with healthcare personnel was beneficial. Maximizing social connectedness and advocacy in all spheres possible was helpful. They also focused more on enjoying support from the wider community at their “front-line” efforts and took gratification from providing effective healthcare. Also helpful was avoiding overly subscribing to COVID-19 news reporting. Caring for oneself was another benefit: assuring good rest, diet, exercise, balance with family time, and related matters. These responses lead to more satisfaction throughout the medical community and everyone, despite a continued pandemic. Hopefully, it facilitates effective administration of optimal health care for the remainder of the COVID-19 pandemic.

Challenges and Hopes in the COVID era:

For many of us, 2020 was pretty rough, with lots of unpredictability, uncertainty, fears and losses in different shapes and forms all around the world. Not knowing which direction to go and how to keep patients, families, and ourselves safe, was quite a challenge. We all had traumatic experiences at different levels taking care of patients and losing colleagues who were first line responders to COVID.

We all witnessed racial and ethnic disparities, massive unemployment, and protests. As per one of the JAMA articles, “The resurgence of anger at long-standing racism and racial inequities was added to the anxiety and tension of the pandemic, creating a combustible scene of national civil unrest.” There is so much we can talk about in the year 2020, but the good news is that year has concluded.

Changing the calendar is a very traditional and emblematic experience for me every year, learning from the past 12 months and moving on to the next 12 months with new hopes, is a wonderful opportunity to reconstitute the year ahead. As we are all stepping into the new year of 2021, we are starting to see a light at the end of the tunnel.

As Psychiatrists, we tend to see things more optimistically. Although the pandemic is still here, and now with the challenge of a more virulent strain and a rise in COVID cases, we are remaining positive (not covid positive 😊). The KMPA has always been standing upfront for our colleagues and patients’ mental health during this era of COVID. I call the era of COVID, an era of technology. KPMA has been very active and well connected during this phase by utilizing technology.

This year, mental health issues are skyrocketing. There is an increase in severity of existing cases but many more new cases. The increase in mental health issues in medical professionals is directly due to dealing with COVID deaths of their patients, long hours at work, risking their own lives, staying away from their families, etc. However, KPMA has provided colossal support to colleagues. Whether they are practicing inpatient, outpatient, university-based, or community-based practices, the KPMA was able to keep everyone updated with new and crucial changes throughout the year and arranged webinars and weekly meetings for the COVID-19 task force.

KPMA is well aware that the contemporaneous good news of the COVID vaccine being on board and still rising COVID cases has caused conflicting emotions at this point, but we are still optimistic and will continue to provide support to our colleagues for future challenges.

At this point, we do not know how the post vaccine world will look like. We are all aware that we have to be more flexible to the new changes and the improvements.

I would like to share this phrase that I read, “There’s always times when we think we can’t manage another minute, and then we do…..We just keep going.”

Stay safe and healthy!

Best Regards, Sajida Zubi Suleman, MD, DFAPA Vice President, KPMA

Update on Kentucky’s Psychiatry Residency Programs

University of Kentucky by Dr. Sandra Batsel-Thomas

It is an exciting time of growth for the University of Kentucky Psychiatry Residency Program.  We started a new Integrated Child and Adolescent psychiatry track this year that allows applicants to match into the Adult Psychiatry and the Child Psychiatry Fellowship at the same time.  It also allows for more training in pediatrics and pediatric neurology.  The first two interns started in this track in July.   We also are staring recruiting this year for our newly improved  5 year combined Internal Medicine/Psychiatry Residency Program.  This will have 2 residents a year and will be a great complement to our Triple Board residency program.

We had 8 new interns start in our various residency programs this July.  We have 4 in our categorical program, 2 in the Integrated Child and Adolescent Psychiatry track and 2 in our Triple Board program.  We also had 4 new child and Adolescent Psychiatry fellows and one new Addiction medicine fellow start in July.  In our Categorical Psychiatry program and Integrated Child track we are holding true to our mission to train psychiatrists who want to stay and practice in the region.  Of our new interns – three are University of Kentucky COM graduates, one is a graduate of the University of Pikeville COM, one Lincoln Memorial University-DeBusk COM in Harrogate TN and one is a Kentucky native and a graduate or St. George’s University School of Medicine.

University of Kentucky @ Bowling Green by Dr. Todd Cheever

The University of Kentucky College of Medicine started a Psychiatry residency program in Bowling Green, Kentucky in 2016. Currently, there are twelve residents in the general adult program. At the conclusion of this past academic year, two residents graduated from the program. Both are now working in Tennessee as adult psychiatrists. Two residents were accepted into Child & Adolescent fellowships programs – one at the University of Colorado in Denver, and one at the University of Kentucky in Lexington.

University of Louisville by Dr. Geoffrey Jeyasingham & Dr. Greg Wykoff

The University of Louisville Psychiatry Residency Program began its new academic year in July and welcomed nine new PGY-1 residents to the program. The program completed another successful match and filled all nine available positions. The new intern class is comprised of five females and four males. Six of the nine are US medical school graduates and four have already passed their USMLE Step 3 exam. The average Step 2 score of the class is, once again, well above the national average for incoming Psychiatry interns. We have thoroughly enjoyed working with our interns thus far and anticipate they will continue to prove a wonderful addition to our department.

Although the pandemic has certainly affected our lives both at work and at home, our residency program has continued to prioritize residents’ education. To do so, our program has transitioned from weekly in-person didactics to virtual learning experiences via apps such as Zoom and BlueJeans.  This transition began in early March and has continued through the Summer and early Fall.  To accomplish this, residents have taken a greater leadership role in teaching their peers and facilitating a more active learning environment. While there certainly are some elements that are missed from the on-site learning experience, virtual didactics have provided several benefits.  Among these are increased safety and convenience, as well as improved opportunities for collaboration.

Finally, the program has continued to embrace the role of telepsychiatry and telemedicine in providing patient care. The University of Louisville has been at the forefront of implementing and utilizing telepsychiatry services for patients throughout the state of Kentucky for many years, and this history has proved to be very helpful in adjusting to a primarily telepsychiatric clinic. We anticipate that our program will continue to prepare residents to provide outstanding psychiatric care both in person and virtually as the practice of Psychiatry continues to evolve.

 Regarding community outreach, our program is excited to announce we have a new partnership with Park Duvalle that will allow PGY-3 residents the opportunity to work closely with an underserved and historically marginalized portion of the community.  We anticipate that this experience will help our residents to gain a greater appreciation for outpatient care at the community level, and feel experience at Park Duvalle will strongly complement other clinical experiences at the University of Louisville and Veterans Hospital.  

Overall, we feel that despite the many unanticipated setbacks related to the Covid pandemic, University of Louisville is well-situated to continue to adapt to the rapidly changing landscape of modern psychiatry.  We continue to attract an increasingly strong pool of applicants for residency and are working to improve the quality and variety of our clinical experiences, including our long history of promoting telepsychiatry and virtual learning.  As such, we believe the future of U of L Psychiatry to be bright, and believe things will continue to improve as time goes by, even in these uncertain times.  

Burning Out?

Are doctors burning out? Yes, indeed. In recent years, physician burnout is becoming a growing national issue, even a public health concern. Work-related stress heightens personal dissatisfaction, cynicism, and frustrates feeling accomplishment. That can result in compromise of professional function and home relationships. Depression and/or anxiety sometimes follows and the risk for substance abuse is greatly increased. Denial of such problems and feelings of inadequacy exist even when there is overt evidence to the contrary.

       Burnout negatively affects patient care and productivity while doctors become less professionally engaged or understanding of their patients. That also impacts physician recruitment, retention, and early retirements. <br>


Why is this? Loss of professional autonomy, too brief time with patients, and very cumbersome electronic medical record keeping are a big part of the problem. The intrusion of so many insurance company regulations; pharmaceutical access refusals; and similar hospital, billing, or other bureaucratic burdens at providing medical care harms the spirit and energy of doctors. Ethical and financial asymmetries between physicians and their leadership add to the dysfunction. Inefficient, rushed office practices are another concern. This is especially so since group practices are often controlled by outsiders and/or the influence of money making.

What to do? Intervention can follow two pathways: the local, individual approach and the organizational focus.

Every practitioner should be personally proactive at awareness for signs of trouble. Self-care and office management adjustments can help. Colleagues and office staff ought to be alert to aid one another and if indicated, to suggest outside assistance. The same applies within group practices. Less “bottom-line” objectives probably would be beneficial.

Medical schools and residency training programs should offer more guidance on these matters. Providing more staff assistance at data entry, transcription, patient follow up, and medication prescribing hurdles or reconciliations would free doctors to perform patient care.

Having a much shorter, focused, and simplified electronic medical records system is a great place to start remediation. Medical organizations should take a more active role in such corrective measures. Legislation can assist, particularly to facilitate reform of institutional rules and regulations; however, this requires physician input and advocacy. Universal, affordable health care and greater access to prescribed medications would also reduce stress. Obviously, this takes coordinated cooperation by many people, medical and health care organizations, big companies, and our government. Easier said than done.

Good luck!

Steven Lippmann, M.D.

Clinician Resilience and Well-Being Resources


Dr. Steve Lippmann is a Distinguished Life Fellow of the APA and is recently retired tenured Professor at the University of Louisville School of Medicine. He volunteers much of his time now working with refugees and victims of war. In his free time, he enjoys traveling with his lovely wife to visit their grandchildren.

TMS for Adolescent Depression Research Study – Participants Needed

Integrative Psychiatry is excited to announce the beginning of recruitment for participation in a research study to evaluate the safety, acute, and long-term effectiveness of transcranial magnetic stimulation (TMS) with depressed adolescents, age 12 to 21. Integrative Psychiatry is one of twelve leading TMS centers selected to participate in the first randomized, blinded, sham-controlled study of the NeuroStar TMS System with depressed adolescents who have failed to respond to at least one adequate course of antidepressant pharmacotherapy. 


The study included three phases. 

All participants will receive extensive psychiatric evaluations and close follow-up during the study and the TMS treatments are provided for free. In addition, a daily stipend for travel expenses will be provided. 

For further information on this study protocol and enrollment criteria, see CliniclaTrials.gov, Identifier NCT02586688. https://clinicaltrials.gov/ct2/results?term=NCT02586688&Search=Search 

 Contact Alex Schrodt, Study Coordinator at 502-930-7881 for more information.