Rebuilding a post-coronavirus culture of medicine


In a previous article, I have described the physician burnout epidemic as a raging river whose 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 health care 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 coronavirus pandemic, we have all learned just how deluged our health care system can become. We are experiencing a worldwide flood of Biblical proportions that has the possibility of reshaping the entire health care 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, and we will return to a post-COVID world where routine medical care can be resumed.

Right now, the public understands that physicians’ fears of catching the coronavirus and bringing it back to their families create enormous emotional pressures. They are reading in news accounts that PTSD is a very real threat for EMS and hospital personnel when appropriate medical and personal protective equipment is not available. In fact, everybody is encouraging everybody to reach out to others to connect (while social distancing), to practice self-care, and to access mental health services without feeling like they are “the weakest link.” 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:

  • the necessity of rapid adaptation amidst uncertain times
  • muddled thinking and analysis paralysis because of the blitz of information to ingest
  • confusion about what the literature indicates
  • mixed messages from public and private administrations
  • the disconnection of relationships and reliance on technology to get things done remotely
  • a preoccupation with health care metrics
  • questions about how to care for children and parents when you do not have time to do so
  • insomnia, grumpiness, suicidality

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 who admitted 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, however overtly or discreetly. This crisis presents the opportunity for permanent and lasting change that allows physicians to renegotiate just what they are willing to put up with following such a cataclysm. Think of the massive shift in the employment and empowerment of women following World War II.

I believe that there is room for people to live sacrificially in their calling as healers and make room for rest and recovery from it. But it will require physicians to pick up the pieces of health care in the aftermath of this disaster and decide just what they want to rebuild in partnership with them. They will need to define and demand new goals for the industry they work in. They will need to assess the new topography of the land as waters slowly recede and choose how they may want to practice differently. And they may even have to face off with the toughest person to please in the whole equation: themselves.

Paddle forward!

Steven Reames is executive director, Ada County Medical Society.

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