My patient Rob had contracted a COVID-19 infection in May 2021 with initial symptoms of sore throat, nasal congestion and myalgia. The fatigue started early and persisted beyond 6 weeks. He had returned to work and was pushing himself there and home, walking as far as he could in an attempt to combat fatigue.

When he logged in to our remote visit, Rob complained of fatigue among other symptoms. I immediately concluded that he was functioning below his baseline, and as a long-haul physiatrist, I began advising him on Graduated Exercise Therapy to gently ease the fatigue.

But some of the words and phrases he used – “working almost full time” and “exhausted” – made it clear that he was exercising well beyond his tolerance and suffering from fatigue from overwork. He worked 4 hours a day without any breaks. Immediately my recommendation changed – he didn’t need to convey what he was feeling. Instead, I was to advise her to take a break and incorporate breaks into her day. I also advised her to consider reducing her working hours.

The COVID-19 pandemic is the greatest threat of our time, creating an urgent need to evaluate and reassess our own practices and plan of care for our patients. Although prevalence data varies, some initial estimates suggest that the incidence of post-acute COVID-19 sequelae (PASC) – or “long COVID” – may be greater than 50% in adults who have already been infected with COVID-19. Unfortunately, there is no easy cure or medication for PASC, but to better understand the disease and help our patients recover, listening is an integral part.

As an assistant professor of physical medicine and rehabilitation, the most common theme I see in the clinic in “long COVID” patients is doubt about their symptoms. My approach has been to validate what they are going through, while eliciting a description of their symptoms and listening to them carefully. Only by first recognizing their symptoms can these patients begin to heal and return to their previous life and work.

However, a 2019 study analysis of clinical encounters in Minnesota and Wisconsin showed that clinicians interrupted their patients after a median of 11 seconds. And now, with healthcare providers facing compassion fatigue, public scrutiny, and overcrowded facilities, the opportunity for patients to be heard by providers may be even smaller.

With a poorly understood diagnosis and risk factors for PASC, and even less well-defined treatment options, meaningful listening to patients to understand the disease is imperative. It is also essential to be aware of the impact that pandemic exhaustion can have on relationships with patients. I admit that my own listening skills have increased dramatically throughout the pandemic, and this has become a fundamental part of my ability to manage these patients; my small part in this health crisis.

Until there, at least 44 health systems have launched post-COVID clinics to meet the needs of long-haul travelers where the initial assessment of patients is followed by consultation with a myriad of specialists. With the continuing challenges of the Delta variant, the number of clinics needed is expected to increase.

Most physicians know that the ability to elucidate, impart compassion, and subsequently develop a patient-clinician relationship is a fundamental pillar of medicine. But today, it’s more important than ever as we deal with more and more of the known and unknown symptoms of COVID-19 and the longest COVID. While the virus can spread silently, listening to survivors is paramount in dealing with PASC.

Farha Ikramuddin, MD, MHA, is an assistant professor of rehabilitative medicine in the University of Minnesota School of Medicine. She sees patients at a post-COVID clinic in the Twin Cities.


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