By Steven ReamesIn the past
I have described the physician burnout epidemic as a raging river. Its features included safety nets designed to catch people before “going over the falls,” the need to teach individual survival skills (e.g. resilience), evaluating your raft and river guide for safety (employers and their leadership), and so on.
"The "rapid" pace of change in the healthcare industry is so volatile, so uncertain, so complex that it has created Class VI monsters ready to swallow doctors whole. In the past, this river used to have some dangerous places that could be anticipated and planned for, followed by smooth waters to recover in before the next rough patch. But no more – it is just one giant raging tumbler after another."
I asserted that I saw hope for reshaping the “banks of this riverbed” - that is, the medical culture - precisely because there was an abundance of water in it.
At least, I thought it was a lot of water at the time.
Amidst the Novel Coronavirus pandemic, we have all learned just how deluged our healthcare system can become. We are experiencing a worldwide flood of Biblical proportions that has the possibility of reshaping the entire healthcare landscape as we know it. In mid-spring 2020, it seems that the rising flood level has slowed a bit, the waters eventually will recede revealing new topography, and we will return to a post-COVID world where routine medical care can be resumed.
Hurricane Katrina Flood Waters - Source Wikimedia
Right now, the public understands that physicians’ fears of catching the virus creates enormous emotional pressures and double-binds. They are reading in news accounts that PTSD is a very real threat for EMS and hospital personnel who are encouraged not to even start resuscitation procedures on anyone without a pulse. And for the first time, a vast swath of the public is experiencing perhaps just a smidgen of what it has felt like to be in medicine over the past decade, including:
- the necessity of rapid adaptation amidst uncertain times
- muddled thinking and analysis paralysis because of the blitz of information to ingest and confusion about what the literature indicates
- mixed messages from public and private administrations
- a preoccupation with healthcare metrics
- the disconnection of relationships and reliance on technology to get things done remotely
- questions about how to care for children at home and parents who want to go out when you do not have time to do so
- insomnia, grumpiness, suicidality…
And so, everybody is encouraging everybody to reach and connect with others (while social distancing), to practice self-care, and to access mental health services without feeling like they are “the weakest link.”
Is this a seminal moment in medical history where we can permanently shed the stigma around physicians being human?
Alas, it was never “the public” who wagged their fingers at doctors admitting they were frail, imperfect, or struggling. It has always been our own medical culture created out of the uber-competitiveness of medical schools, the crazy work hours of residency in order to get to 10,000 hours of proficiency, and the large scale employers who ended up treating doctors like any other productivity worker. All of this, of course, is built on the foundation of traits that make for a great clinician but often lead doctors to a breaking point when too much is asked of them: conscientiousness, perfectionism, compassion, and the ability to assume life-and-death responsibilities.
Part of what defines a culture is who and what it rewards, celebrates, castigates, and punishes, whether overtly or discreetly. Admittedly, I can be double minded about this: I applaud the heroic and sacrificial efforts of physicians laying down their lives on the frontlines and at the same time encourage them not to give so much of themselves away that that end up depleted. The paradox of this challenge is maddening for physicians and non-physicians alike: how can you be awesome at your job without being so “extra” that you overdo it?
I do recognize that this is just the end of the beginning phases of this crisis. Most physicians still do not have the mental or emotional luxury of thinking beyond survival mode right now, and maybe not for a long time. But eventually, we will start picking up the pieces of healthcare in the aftermath of this disaster and decide just what to rebuild together. Right now, nearly every industry is talking about re-imagining a more sustainable pathway going forward and medicine should be no different.
Emboldened physicians may look at this opportunity to demand better conditions where they do not have to choose between working hard or dying because of their work, physically or psycho-spiritually. It is obvious to all that the lack of physical PPE for healthcare workers is a disgrace. What I hope will also be acknowledged is that “emotional PPE” is a requirement for this job too, so that heroic stoicism is no longer necessary to survive its hardships.
A different version of this article was submitted to KevinMD prior to this post but published after it. https://www.kevinmd.com/blog/2020/05/rebuilding-a-post-coronavirus-culture-of-medicine.html