Learn to surf

Recently, three hospitalists turned what could have been a webinar focused on venting into something positive and inspirational.

Sharmila Dissanaike, MD, FACS, FCCM, a hospitalist and a trauma, burn, and acute-care surgeon at Texas Tech University Health Sciences Center, Lubbock, Texas, Adaira I. Landry, MD, an emergency medicine physician at Brigham and Women’s Hospital, Boston, Mass., and Samir S. Shah, MD, MSCE, MHM, a pediatric-infectious-disease and pediatric-hospital-medicine physician at Cincinnati Children’s in Ohio, and editor-in-chief of the Journal of Hospital Medicine, joined Explore the Space podcast host Mark Shapiro, MD for a webinar titled, “Doctors, Hospitals, and the Resurgent Pandemic.”

Their honest discussion shed light on how physicians are faring as they face another wave of the pandemic, what they think about the future of the profession, and their ideas for positive change.

Staffing and training

It’s becoming the norm to work with new teams or new colleagues, seemingly on every shift. This can make it hard to develop team comradery, trust from working with someone consistently, and skills.

Dr. Dissanaike said, “It’s hard to feel like a team when everyone is brand new all the time. These people are new, presumably fast-tracked into their job. And with omicron—more people are getting sick. At one point half of our operating room staff was out sick. There are shortages of an unimaginable magnitude while the need stays the same.”

And what about the doctors in training during the pandemic? Hospitals across the country suspended elective surgeries at different points during the pandemic and many people put off any medical care, especially early on.

Dr. Dissanaike said, “We did everything through the pandemic. Our hospital was willing to support that. By keeping the doors open, our surgery residents were able to get their hours. I am very worried about students who trained at facilities that couldn’t stay open to surgical emergencies or in small towns where they couldn’t access surgical care.”

Lasting effects

The pandemic takes its toll physically and emotionally, and it remains to be seen what those effects will be a year, five years, even 10 years from now.

Long COVID is a real concern. So many frontline workers have had COVID. Thousands have died. For those who’ve survived, the effects are lingering. Dr. Dissanaike had COVID early in the pandemic, and though she says she recovered well,  a year later, she knows she gets tired more. She can’t help wondering how people who have COVID now—those who must return to work after only five days—are doing when more and more is being asked of doctors and nurses.

“What will the health care system look like if everyone who’s been in it can’t perform at the level they need to?” asked Dr. Shah. “If that takes health care workers out of the workforce disproportionately, we’ll have an even bigger problem.”

(Mis)information overload

Admittedly, the readily available misinformation and lack of cohesive messaging from the experts has created an us-versus-them environment—one these doctors try to combat with compassion and gentle redirection.

“It’s a struggle to tease out what’s good and valid information,” Dr. Shah said. “It’s so much worse now than it was two years ago.”

These physicians realize that trying to preach to people about science and medicine doesn’t work. Dr. Landry’s solution is to ask questions, give her patients bite-sized information, and try to get them to recognize where their misinformation is coming from. She admits that doesn’t happen often in the emergency department.

Dr. Dissanaike said, “The good guys have to be lucky 100% of the time and the bad guys only have to get lucky once. One mistake in science upsets the whole applecart.”

There’s also the issue of information overload. Dr. Shah said. “We’re still writing great COVID papers, but are people tired of reading about COVID? I get the sense that people want to move on a bit so it’s not all COVID all the time.”

The need for change

COVID-19 is likely the single most significant health event in the last 100 years, and it’s exposed a lot of chinks in our health care system’s armor.

When Drs. Dissanaike, Landry, Shah, and Shapiro talked about needed changes, they may have voiced it differently, but basically, they all said the standard to which we hold health care professionals is both ethereal and unattainable. Physicians have been conditioned to “take one for the team,” said Dr. Landry. They’re expected to be dedicated to the job, not call in sick, and self-sacrifice. “We’ll be in trouble when the altruism runs out,” she said.

Health care professionals need to be compensated and valued appropriately. But it’s not just about the money. All agreed that fair wages, student-loan forgiveness, and paid time off (for all, not just doctors) are good first steps.

“I’m not talking more money, but a more supportive team, humane work hours, a fair salary,” Dr. Dissanaike said.

People want to live their lives and follow their passions, not just work full time. “I’m hearing something frightening and reassuring at the same time—students across the country are saying ‘I want to be a doctor, but something else as well’,” said Dr. Landry. “I don’t practice medicine exclusively. I have time to reflect on the shifts I had. Before the pandemic, I worked full-time. I didn’t have time to reflect. Now I have a balance. I hate to use work-life balance because I don’t believe that exists. But there is more to medicine than practicing at the bedside.”

Dr. Shah said, “Doctors need time. Mental health is important. Mental health care should be an opt-out, not an opt-in norm.” The problem with that, he said, is there aren’t enough mental health professionals.

Riding the wave

Everyone deals with the pandemic in their own way—whether it’s new hobbies, sports, or activities. But health care professionals have had to deal with the pandemic on a much different level. Treating patients who haven’t been vaccinated, don’t believe in the science, or don’t trust medicine and physicians takes its toll.

Dr. Dissanaike said. “Going through the pandemic, it’s a little like the five stages of grief. I’m at the stage where I can either bang my head against the wall or I can just be. If you’re one of the only people masked at the grocery store—so be it. Raging against the machine just wears you out. You can either take your surfboard and try to run up the wave, or you can learn to surf.”

Dr. Shah agreed but added “We need spaces to vent. You see the sheer numbers in the hospitals—filled with patients with COVID. You see the actions outside of the hospital and then the results of it in the hospitals. It’s taxing.”

Dr. Landry said compassion is her answer. “I try to maintain a sense of compassion for those I believe are making the wrong choice. It would be easy to demonstrate my anger or frustration—an eye roll—the hardest thing is to try not to judge people. Try to rebuild that trust in medicine. Unvaxed people feel judged by our community. I start with compassion and understanding. We’re going to continue the conversation with them in a non-judgmental way. The day I’m not compassionate is the day I start to doubt if I should be a doctor.”

Despite the frustration, long hours, misinformation, and expectations, these physicians are hopeful and think things can be done to help physicians and to change the system and profession.

Where do we start?

“Testing centers on every corner,” said Dr. Shah. “And widespread distribution of high-quality masks.”

“Childcare on-site,” said Dr. Dissanaike. “Any employer that has x number of employees should offer on-site childcare. It’s expensive, but not THAT expensive, and it would make such a difference. Especially when schools are off and on. The big picture would be not corporatizing health care.”

Dr. Shapiro said student-loan debt forgiveness would make an extraordinary impact, not only on those in school now but on several generations. He also said physicians and health care professionals need media training. “Every attending needs to understand how to be interviewed, how to be on a podcast, on social media. We need a legion of people camera/media/editorially ready,” he said.

Dr. Shah and Landry added that controlling medical misinformation is imperative. Dr. Landry said, “At the very least, we need united information from scientists, physicians, and experts. We need cohesion.” Dr. Shah added, “We need to figure out how to hold purveyors of misinformation accountable. I acknowledge though, that’s a slippery slope.”

As for the big picture? Dr. Landry would like to see more physicians and health care professionals hold political positions and help create policy.

When the next wave comes, will you try to run up the wave or will you learn to surf?

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