Physician morale and the doctor’s voice [PODCAST]

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“It is dangerously unfortunate that the use of masks has been politicized in many parts of our nation. The Dakotas (or North and South COVID as they were recently called on Saturday Night Live) are far from exempt from this phenomenon. Likely, if Governor Burgum’s decision was less influenced by fear of criticism from his constituents and political retaliation, he would have required a mask mandate long before making it acceptable for infected individuals to leave their home. Masks have time and again proven to be safe and effective. It’s not a big ask.”

Sheetal Khedkar Rao is an internal medicine physician.

She shares her story and discusses her KevinMD article, “The problem with allowing COVID-positive health care workers to continue working.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Here on the show, we have Sheetal Khedkar Rao. She is an internal medicine physician, and she wrote the KevinMD article, “The problem with allowing COVID-positive health care workers to continue working.” Sheetal, welcome to the show.

Sheetal Khedkar Rao: Hi, Kevin. Thank you so much for having me. I’m so excited to be here.

Kevin Pho: We’ll get into the article a little bit, but first off, can you share your story and your journey to where you are today?

Sheetal Khedkar Rao: So, as you said, I’m an internist, board-certified, and I was born in India, but I moved here when I was 14 months old. I grew up in the suburbs of Chicago, and other than leaving for a little while for training and school, I ended right back up here to raise my own kids. I studied chemical engineering in undergrad, so I was kind of a nontraditional med student. I worked in pharma for a couple of years before I decided to pursue medicine. I got my MD at Georgetown, and I did my residency at the University of Illinois in Chicago. I’m married to a nephrologist, and I have two boys who are in elementary school.

After training, I stayed in academics for a couple years, and then I joined a large group, multispecialty practice, where I had been for the last eight years, mostly outpatient. In October, I decided to take a break from clinical care. There were a couple of reasons why my family kind of decided that that would be the best choice. There were two sort of big things. When COVID came along, like many other practices throughout the country, our group was given cuts in compensation. And then, in addition, my husband and I decided to keep our kids home for remote learning. Both of those things combined kind of shifted the balance for our family, and it just made more sense for me to be home to support them.

One other thing I want to add about myself that I think is interesting is that I’m an elected school board member in my community, so I’m pretty involved with that as well.

Kevin Pho: So, like you, I’m in primary care, an internal medicine physician myself, and we had cuts and we had partial furloughs, especially last year during the height of the pandemic. How difficult was it for you to transition outside of clinical medicine, and what are some of the challenges that you face in making that transition?

Sheetal Khedkar Rao: It was surprisingly challenging, because I think just being in medicine, the entire part of my life leading up to this has been kind of striving for something and working towards something. To sort of just put the brakes on that and focus on my home life was something that didn’t come easily. I kind of had a fear of not being productive enough, and just taking each day one at a time and restructuring my priorities has been a learning process.

Kevin Pho: So let’s transition now into the KevinMD article that you wrote. It was written last fall, and it’s titled “The problem with allowing COVID-positive health care workers to continue working.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Sheetal Khedkar Rao: Like many other health care workers, I was living in this bizarre dichotomy where, on the one hand, we had COVID and the reality of COVID and the sad deaths that were happening around the country. I had the immense fear of bringing it home to my family. And then also, I had my fellow colleagues, many of whom didn’t have adequate PPE, who were penalized, who sometimes were bringing their own PPE, and sadly, many around the country were making the ultimate sacrifice. And then, on the other hand, I would look around, and there were so many people in the world that just couldn’t be bothered to put a piece of cloth over their mouth and nose in order to save their own lives and just kind of lessen the burden on the essential workers out there. It was just a feeling of real kind of desolation and hopelessness and anger, a little bit. I had already been feeling kind of undervalued for so long, and it was just too much to feel that.

And then, being home, writing was a skill that I had wanted to develop, but I wasn’t sure what to write about. Then I read this article, I think it was on NBC online, about this governor in North Dakota who had required COVID-positive health care workers to come and see patients in the hospital. At that time, he had had no mask mandate, and he had still allowed indoor dining. This was just so ridiculous to me. It felt like so many of my colleagues had been sacrificing so much, and to ask this sacrifice in addition, not to mention the public health implications of that, just was beyond. For me, it sort of summed up everything that was wrong, and I just needed people to know about it. So that’s why I decided to write the article.

Kevin Pho: So tell me about the reaction of some of your colleagues. Did the people around you feel very similarly in terms of how health care workers were treated, telling sick health workers to come in and contrasting that with restaurants and bars still staying open? What was the reaction of the people around you?

Sheetal Khedkar Rao: It’s very two-sided when it comes to restaurants and bars, because it is a business and people need to survive, and I get that. So that’s where that public health implication really collides with people needing to provide for their family. But then also, being involved with the school and really wanting to prioritize school being safe, knowing that that was more of a priority than restaurants and bars, added another little twist into it.

So I think most of the people I know, and I think I know a good amount of physicians, as many physicians do, and just a lot of people in the community I live in are educated, and I think people understood it. They understood it was complicated and it wasn’t an easy answer, but we have to do what we have to do for public health, so that we can be as safe as possible.

Kevin Pho: So you wrote this article back in November, and we’re speaking now in the middle of March, and vaccines are now underway, and there are some schools that are reopening. Tell me how the landscape has changed since you wrote that article back in November to now.

Sheetal Khedkar Rao: So it has changed. There’s a lot of hope now with vaccines, and the faster we can get that moving and get more people vaccinated, we can win this race against the variants, and so that’s very hopeful. I do know that there’s a lot of fatigue, and there are a lot of people that are just tired of all of it, and so that is another kind of race that we’re against, with the variants hopefully not winning the race.

And I think that we have data now, too. In the beginning, in March, no one knew what was going on, and unfortunately, there wasn’t a lot of consensus between a lot of the guiding bodies. You’ve had the WHO saying one thing, the CDC saying another thing, the AAP saying another thing. So it was really hard to decide what to do, and you just wanted to err on the side of caution. But now we have data from schools showing that when everyone’s masked and you have a certain amount of distance, you don’t see a lot of spread in the school. And we also see the downside of keeping kids home, and so that’s a public health factor that needs to be taken into consideration, too.

So it’s a very heated battle, and understandably so. It’s very emotional, and there are many sides to everything. But I’m glad to see that there is more guidance now, that we’re taking the data that we have gleaned from this last year and applying it forward. I mean, school is essential, so we need to, but we need to do it safely.

Kevin Pho: Have you seen an improvement in the morale of health care workers and how health care workers are treated within the last few months?

Sheetal Khedkar Rao: Morale, yes, absolutely. I think that just with the vaccine being out there, people are feeling lighter. They feel like they can be inside each other’s homes if they’re all vaccinated, in small groups and safely, and that is very meaningful. It’s been a rough go. My husband’s practicing, so I hear all of his stories still, and I just feel like it’s a little bit lighter. I feel like he’s a little bit lighter, and a lot of our friends and family as well that are in medicine feel the same way, so that’s really good.

In terms of the treatment, I think you said, of health care workers, everyone recognizes the sacrifices, and I think a lot of people have been sacrificing over this past year as well. I know it’s a little bit different for those of us who are seeing patients from the very beginning. And so I would love to see, you know, on one hand, we have people calling health care workers heroes, but on the other hand, they are maybe doing nonessential things in an unsafe way still. So that’s still kind of there. It hasn’t gone away during the pandemic.

Kevin Pho: You’re obviously a physician, but you’re also a school board member. Can you share a little bit of that experience?

Sheetal Khedkar Rao: Yeah. Well, it was eventful, I can share that. When I signed up to run, I thought that would be maybe calm seas. We had a referendum in our area, in our district, that had passed, and that was a really big deal, and so it didn’t look like there was too much on the horizon. And then came COVID. So it was definitely challenging, but I did feel grateful to be able to contribute, having the health care background. It wasn’t really something that I thought I would use in that way, and so I was grateful to be able to contribute to the reopening.

But you really see all the sides being on the school board. You get to know the administration and all the behind-the-scenes things that happen. You’re also a parent, so you’re seeing that side. You’re also a community member, and you’re also a health care worker. So I had to bring all those hats into it and put it together as best as I could. It’s definitely been challenging but interesting, and I’m grateful to be able to help in that way.

Kevin Pho: We’re talking to Sheetal Khedkar Rao. She’s an internal medicine physician, and she wrote the KevinMD article, “The problem with allowing COVID-positive health care workers to continue working.” Sheetal, share something that you’ve been passionate about recently, especially during the pandemic.

Sheetal Khedkar Rao: Well, I’ve been passionate about social media, which is something that I never thought I would say, because I’ve always had a love-hate relationship with social media. I mean, I think it’s pretty easy to see the negative side of it. It’s kind of a black hole where time goes to die, and I think a lot of people get pathologic FOMO, and it can skew our self-worth in a way that’s not productive or healthy.

But when the pandemic hit, I think some of those physician Facebook groups, like PMG, and there was one local to my state, that allowed us to crowdsource management and data were so irreplaceable and so therapeutic in a very unique way. I found myself turning to them, and that’s when I started seeing social media in a new light.

I remember, actually, around this time a year ago, I started a WhatsApp group for something like 80 local physicians that are friends of mine. We had critical care, primary care, ER, and we even had a couple administrators on there, surgical subspecialties, every kind of doctor. We were all sharing our experiences, and these were people that we knew, so it was a little bit different than one of these Facebook groups. But it was just really important, because we had lost our face-to-face contact, and it was such a dark, kind of scary, unknown time that being able to connect in that way was really helpful. That’s where I think social media can be really helpful, for something like that.

I also think that physicians have a PR problem, and it’s not necessarily all our fault. Misinformation and disinformation are a big part of it. For example, when Trump accused doctors of falsifying COVID diagnoses for money, you and I know that there’s nothing further from the truth. However, there were large amounts of people that believed it, a significant amount of people.

So I’ve come to the conclusion that we need to harness social media to help connect with people and let people know that we’re human, whether that means writing an op-ed and amplifying it, or just putting out real facts to battle the misinformation that’s out there, or even just being a human. I think that those things really help patients see where we’re coming from, and that helps us be better healers, because they trust us more. So I think that social media can be really powerful in that way, and physicians having a voice is something I’m definitely passionate about.

Kevin Pho: Now, do you see the pandemic being a turning point when it comes to physicians’ acceptance of social media?

Sheetal Khedkar Rao: Yeah, actually. I feel right now that there’s kind of a renaissance happening in medicine. I think that physicians are writing more and speaking out more. They’re looking within, and they’re really kind of demanding more from work and from life. I think that the pandemic has laid bare so many weaknesses in our society, whether it is health care or racial inequities, or if it’s that essential workers need to be able to make a livable wage, or if it’s the way that we treat our environment, which is going to be leading to more pandemics in the future if we don’t do something about it. So all of these things, I think physicians are well positioned to speak on and have some authority on, and so I do think that they should.

And I think that physicians tend to be perfectionists, myself included, and my message is that perfect can be the enemy of good. Don’t let judgment from others or even yourself silence your voice, and use it, because you never know. It can actually help you just as much as it can help solve some of the big problems out there.

Kevin Pho: If there’s something that you know now that you wish you knew back before the pandemic started, what would that be?

Sheetal Khedkar Rao: I wish I had known more about the business of medicine and all the stuff that you have to do outside of the patient visit. I grew up seeing the best parts of being a doctor. My aunt and uncle practiced in the ’80s, and that was kind of just the golden age of being a doctor, at least for physicians. I know they worked hard, but they loved their job, and their expertise was respected by society. So I thought, you work hard, you are smart, you care for people, and boom, that’s it.

But then I started practicing, and there’s so much more: billing, coding, charting, authorizations, the endless MyChart messages and lab results. You just start feeling like that guy from Greek mythology who pushes a boulder up the mountain and has to wake up and do it again every single day after a while. And I know it’s not futile work, but you can’t help but feel that way after a while. So I wish that I had known that, had been more mentally prepared for that, and kind of understood that ahead of time.

But in the end, the good side of patient care is irreplaceable. There’s nothing like going to bed knowing that you helped someone, or that you added years to their life, that you found something that they didn’t know was wrong with them and they’ve been searching for forever. That will never change and will always be a privilege and a blessing. I just wish that all the other stuff didn’t have to cloud the practice of medicine.

Kevin Pho: Thank you so much for sharing your time and insight, and thanks again for being on the show.

Sheetal Khedkar Rao: Thank you so much for having me. It’s been a pleasure.

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