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Growing Something New in the Medical Culture

04/15/2021 6:00 AM | Anonymous

By Steven Reames

Throughout this past year, as the medical profession has been overwhelmed with responding to the COVID-19 pandemic, numerous voices have called for transforming medical culture. A couple of examples:

"The coronavirus disease 2019 pandemic offers health care organizations and state agencies a rare opportunity to rethink their approaches to the well-being of health care professionals—including reexamining long-standing systemic organizational practices, as well as modernizing archaic state policies that contribute to a culture of suffering in silence." Rethinking Wellness in Health Care Amid Rising COVID-19–Associated Emotional Distress, Bryant Adibe, MD JAMA Health Forum

"Would our transactional medical model coupled with our culture of ‘rescue medicine’ and ‘denial of death’ be receptive to such conversations? Hopefully, coronavirus will now allow us to address these questions since not only are they paramount in times of limited resources, but also they may explain why approximately half of all intensivists burnout." The Moral Lessons of Covid-19: A Call for Renewal, Salvatore Mangione, MD & Stephen G. Post, MD, American Journal of Medical Science

The thought of changing any culture is nothing to sneeze at. Even mindful or enlightened parents who have matured over the years understand the challenge of addressing longstanding family habits, patterns, relational expectations, and the like. I remember at my wedding, our pastor remarked that “marriages are like tiny civilizations that we establish.”  He went on to say we would do well to think about what kind of civilization we are creating, since our kids will re-create them in part in their own families.

What then of tackling the culture of a workplace, a large institution, or even the household of medicine itself, which has developed over millennia by millions of people? It is not like ethos of medicine was born in the U.S thanks to the 1910 Flexner Report nor by the Affordable Care Act 100 years later. While those two events had an enormous impact on the practice of medicine and education, what can any one individual hope to do?

We have seen in just the past few years how the power of amplifying voices that were previously muted can send seismic shockwaves through society. The #MeToo movement shone a spotlight on the pervasiveness of sexual harassment in business life as women began publicly sharing how they were exploited by powerful moguls and everyday supervisors. While the ripple effect of #MeToo does not immediately bring an end to this type of behavior, it certainly sent a cultural signal to men in authority in the US: you can no longer harass or assault women with the assumption of impunity. Women are not going be bullied into silence.

If you do a web search on the term “Stop Calling Healthcare Workers Heroes,” you will find a dozen or more articles on the topic. Simply put, physicians and those who work with them became quickly fed up with being called upon to work with insufficient PPE during the pandemic but lionized at night for their sacrifice. As Dr. Deborah Edberg put it in her KevinMD article,

The “war” narrative is an intentionally strategic message so that our fallen health care “heroes” will be reluctantly honored as sad yet acceptable sacrifices. But health care workers aren’t soldiers, and none of us agreed to risk our lives to do our jobs. It is noble to think so, and it is noble that so many have chosen to do so, but it is not an inherent part of the job.

Whether or not society or healthcare systems respond to the growing chorus on this topic remains to be seen.

This kind of movement in the culture in such a short time is tectonic in scope, but we must also not rule out the micro shifts that occur at the ground level. Last month, St. Luke's Children's Hospital pediatric trauma unit director Dr. Kendra Bowman described to me an innovation they are piloting. They have defined five acute adverse events in Epic that are potentially trauma inducing for medical staff in the department, such as a code, a dog mauling victim or withdrawing life support from a child. When one of these is charted, the alert pings the medical staff office so that they can reach out proactively to to those affected with an anonymous peer-to-peer support offer.

That solution alone is brilliant, and something which could be adopted or adapted in other situations. But it was Dr. Bowman's next statement that really got my attention. “The medical culture has shifted. Physicians are more apt to reach out proactively to peers outside of the formal P2P process when they know somebody’s had a tough week,” said Bowman. “We’re normalizing what it means to practice medicine and have normal human reactions.” She went on to describe that is the very act of working together on the Epic trigger solution that induced the departmental cultural change.

Vignettes like this demonstrate to me that cultural change can and should happen at every level and are not always the result of an effort to “change the culture.” Oftentimes it happens when we are simply working together for very pragmatic solution to a problem. That was certainly the case when ACMS put together policies and procedures around its Physician Vitality Program in 2016 and the committee continued to want to meet just to trade info on other related topics. The synergy created was palpable and continues to this day.

As stated before, because of COVID we have seen the trend in healthcare that allows for physicians to adopt a stronger ethos of self-care: "it's OK to admit you are not superhuman." The challenge for us now is to lock in such gains and that if it’s good for a pandemic, it’s good for everyday practice. By pointing out attitudes, behaviors, and policies that are or are not healthy for patients, physicians, or other healthcare staff, we create momentum towards a culture that honors everybody touched by it.

Rethinking Wellness in Health Care Amid Rising COVID-19–Associated Emotional Distress | Infectious Diseases | JAMA Health Forum | JAMA Network

The Moral Lessons of Covid-19: A Call for Renewal - The American Journal of the Medical Sciences (amjmedsci.org)

Stop calling health care workers heroes and do something to help them (kevinmd.com)


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