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“It is hard to understand and communicate the uncertainty that comes with evolving science, the changing recommendations as we learn more, the vaccine that didn’t do all that was initially promised. It has become even harder with the erosion of trust and civility.
Back to the poop. It stinks. It’s not pleasant to slip and slide in, and even today, I saw a bag hanging from a tree! Was that owner practicing his pitch? Trying to hit a squirrel? Or did she toss it to the heavens for God to catch? Only God knows!
Perhaps our way forward in these challenging times is to start small. Scoop up your dog poop and put the bag in the trash can. And if you are feeling kind, pick up the bag full of poop sitting at the side of the walking path. And please cover your nose when you are wearing a mask. Of course, wear a mask. Don’t forget to get online and order the COVID tests for your household. And please get your vaccines and booster.”
Therese Zink is a family physician and can be reached at her self-titled site, ThereseZink.com.
She shares her story and discusses her KevinMD article, “Dog poop, the social contract, and pandemic behaviors.”
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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. Today we welcome back on the show Therese Zink. She is a family physician, and she wrote the KevinMD article “Dog poop, the social contract, and pandemic behaviors.” Therese, welcome back to the show.
Therese Zink: Thank you, Kevin. So I was talking to you a little bit less than a year ago. I had just published a book, COVID Chronicles: How Essential Workers Cope, and I didn’t expect to be talking about that same topic a year later. In fact, I’m thinking of doing the second volume, because we’re still trying to cope. But of course, you and I have never lived through a pandemic before, so we are learning as we’re going. And as your blog post and your website show, essential workers are exhausted, and that’s what led me to write the story that you accepted.
So the story is about scooping dog poop. I have had a dog, and I walk my dog in public parks. And part of the reality of having a dog and walking in public parks, as opposed to just being on a farm, is that I scoop the poop to make it nice for everybody else, because nobody likes to step in it and carry it home on their shoe. And so if you have a dog, there’s really a social contract that you scoop your poop, although we dog walkers know that not everybody does. Should we remind them to? And then there are a few people who bother to put their dog poop in a plastic bag, but they leave it along the side of the path, and I always wonder what they’re thinking, who they think is going to come and pick that up.
So that led me to my story about the reality of the social contract for physicians or health professionals: that I agree to do my very best to care for patients, to deal with their illnesses, honor their wishes, and not take advantage of them, not do tests that may benefit me or do things that will benefit me, but it’s my professional behavior. And so many of us go into caring for patients at this very difficult time frustrated when patients aren’t getting vaccines, are not getting their boosters, are not wearing masks, or are going to large gatherings. And it really raises the question: How committed am I to that professional contract?
Now, I am not on the front lines. I’m not working in the emergency room; I’m not in the hospital these days. But I am working at a clinic in a middle school and high school, and we see plenty of COVID there, a more vulnerable population who’s more dependent on what their parents are having them do. But we see sick teachers, we see frustrated teachers and counselors, and it’s not a pretty picture at this point. And in the outpatient clinic, I have plenty of patients who refuse to take the vaccine or the booster that I’m offering them. So these are tough times.
In primary care, I’m used to living with uncertainty, which we seem to be doing a lot of right now, given that with COVID, we don’t know what science will tell us to do or undo, and that’s pretty hard to live with. And living with that uncertainty really requires trust. As a primary care physician, I walk with people through uncertainties about their illness. I send them to a specialist who doesn’t know what’s going on either, and the patient and I continue to walk through the uncertainties. But you have to have a basic trust there, and that’s really kind of what’s missing in our world today, and it makes it very difficult for all of us.
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Kevin Pho: Now, you mentioned that word, trust, and that word certainly is in short supply, especially during the pandemic. And you see a lot of confrontations between health care professionals and patients over issues like masking and a vaccine. Now, over the past year since we last spoke, tell me how you’re observing that trust being further deteriorated. Give us some stories or examples that you’ve seen in the clinical settings that you practice in.
Therese Zink: So when I have talked to patients about getting vaccines and they say they’re not interested, I always inquire why. And it’s no news to you that social media is a real problem in that regard, and people find lots of reasons to have the wrong information and to be distrusting. So that is a reality.
The other reality is there are some populations who have good reason not to trust science. We think of Tuskegee; we think of radiation experiments in cities like Cincinnati, Ohio, years ago. And I think there’s a lot of effort, I would like to call it good-faith effort, to inspire trust in those populations. But it is quite frustrating as a health care provider to see people who are more willing to believe some of the misinformation that is out there, and sometimes it’s a very emotional reaction. Right now we’re watching the trucker strikes in Ottawa, Canada, and in Detroit and even in Europe. And so it feels like a real erosion of that social contract or goodwill and caring about each other, as opposed to what I want or what I need.
Kevin Pho: So you talk about the effects of the pandemic on the health care professionals and how their morale is deteriorating. Now talk to me: Since we last spoke, how is that lack of trust affecting the psyche of medical professionals today?
Therese Zink: So I think some are quitting. We have a lack of nurses. Burnout is a real reality. And the group that I have a lot of contact with these days, because I am teaching, are pre-med students and also medical students. The pre-med students are still very idealistic and very excited about caring for people and helping them be healthy. But a group of them is doing a project on burnout. They are doing a survey of burnout at a federally qualified health center organization here, and they are asking themselves, “Why am I signing up for this profession? I’m paying lots of money to go to medical school, years of study. Is this really what I’m going to be getting into?” And they still have high hopes.
So I think that reality is frustrating to the students. How will they move forward? One asked me yesterday, “How will I keep myself?” You know, “no” is a good word, and moving forward, self-care is important. But the systems are stressed and strained and also need to find ways to assure the health of health care workers. So that erosion of trust, erosion of public goodwill, is really a challenge these days, and there are no easy answers, unfortunately.
Kevin Pho: So when these students come to you and ask about that tension about going into a profession that they have to work so hard for, but it’s a profession where so many physicians are burning out, what kind of answers do you give these students to try to resolve that tension?
Therese Zink: So I think I help them understand kind of the challenges of health care today, that in some ways it’s a big business and that there are motivations that may not be for the best interest of the patient. I think we talk a bit about uncertainty and what it means to live with uncertainty as science evolves. My career started with AIDS, and we were only beginning to identify the virus. We had none of the antiviral medications. In fact, when I learned to draw blood, I didn’t use gloves, so as a resident, I had to learn to start IVs and draw blood with gloves, which of course you’d never think of not using now. And there is advice that I gave 20 years ago that was the wrong advice. So I think it’s part of understanding how science works, that it’s an evolution. So that would be the one point.
The other point is the importance of self-care: that you want to do your homework, you want to always be learning, because medicine and science are changing, and you also need to answer ultimately to yourself and to take that personal time, to say, take those sick days if you’re sick, don’t go into work. And some of that is not new advice. It’s just a reminder of what we have been saying for years and how it’s more important than ever these days.
Kevin Pho: We’re talking to Therese Zink. She’s a family physician, and she wrote the KevinMD article “Dog poop, the social contract, and pandemic behaviors.” Therese, we’re speaking in the middle of February, and it seems like we’re entering a new phase of the pandemic, where a lot of states are slowly starting to open up again. And I want to get back to that issue of trust. Can this be a turning point in how we can regain the trust between health care professionals and patients? And what are some ways that you would suggest to help regain that trust that’s been lost during the pandemic?
Therese Zink: So I think open, honest communication and developing relationships with a primary care provider, or your primary care provider, and realizing that we are part of a society, and in being part of a society, we do have some obligations. And we are not out of this pandemic. We know that COVID will replicate into something else. I know it’s quite frustrating for patients to get vaccinated and boosted and get sick when they were told that they were not going to get sick. In fact, many of the health care workers are now needing sick time that they didn’t need six months ago, because they have done everything that they were supposed to, but they have gotten sick.
And so I guess the advice that I give: If we’re supposed to wear masks, do wear masks. I know I still will continue to do that, of course, in the health care setting and when I am in areas gathered with lots of people whose status I don’t know. I wear my mask at the gym. And people should still get vaccinated and get boosted and honor the advice that the best science that we have right now is giving us, realizing that we are in a process of learning as we go, which is a hard place to be. It’s hard to live with uncertainty when we’re a world that really likes things to have clear boundaries, and it’s just not how it’s going to be right now. And Kevin, hopefully we won’t be talking about the same topic in another year.
Kevin Pho: And my final question, what are some of your take-home messages that you want to leave with the KevinMD audience?
Therese Zink: So I would encourage people to, yes, wear a mask if you’re told to, to get your vaccinations, and get boosted. You can sign on for your own home tests at the federal website. Many states are also making testing available, so you can make sure you’re safe to be with family and friends. And spread a little kindness. We need that, and we need to share that with each other these days.
Kevin Pho: And how can people reach you?
Therese Zink: Yeah, so I have a website, Kevin. It’s theresezink.com, and that’s T-H-E-R-E-S-E-Z-I-N-K. Thanks for talking to me again.
Kevin Pho: Therese, thank you so much for coming back on the show and sharing your time and insight.
Therese Zink: Thank you.
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