How I Practice Now
When the Stress of COVID-19 Ends, How Might Practitioners Be Different?
John W. Harrington, MD
Children’s Hospital of The King’s Daughters
Harrington JW. When the stress of COVID-19 ends, how might practitioners be different? Consultant360. Published online November 25, 2020.
Health care workers and frontline staff cannot escape the fact that the pandemic has interrupted their lives and has taken over daily work and home routines. I am an academic pediatrician in Norfolk, Virginia, who has a daughter in her second year of residency as an internist in Chicago and another daughter who is a medical student at the Mayo Clinic in Arizona. So, I get a broad-based family view of how the pandemic is affecting current and future doctor’s careers.
We are all wrapped up in the ongoing drama of what might happen next and making accommodations for the unknowable. Multiple possible vaccines that may or may not get approval from the US Food and Drug Administration, masks and personal protective equipment (PPE) in and out of short supply, and exposures and quarantining that are disrupting finely tuned schedules. Having an intimate and personal perspective of the medical personnel allows one to really get a grasp of how overwhelming this pandemic is in terms of the stresses it is puts on both the young and old of the medical establishment.
When the pandemic started surging in February and March, many hospitals and academic centers responded with a similar playbook. Their plan was to focus on the patients, get screening into place, and conserve PPE. We braced for the onslaught we saw in Europe, where beds and equipment were running out. We were able to bend the curve for a while, but now instead of a full code, we have a progressive cancer that is getting worse for many institutions.
In the initial chaos and uncertainty, we essentially canceled all clinical teaching of medical students and placed them on the sidelines indefinitely. Some fourth-year students were actually deputized early and pressed into service in places like New York, where COVID-19 hit hardest, while others were essentially in shock about life plans simply being upended like weddings and graduations. However, for the majority of medical students, it was like a symphony that stopped playing in the middle of a concert. All classrooms became virtual overnight. There was no more longitudinal learning for first years in the outpatient clinics. The standardized patients and any direct contact with any type of clinical rotation for second-year medical students was put on hold.
The worst scenario was absorbed by third-year medical students who likely had 2, if not 3, clinical rotations that they would never do. So, some future physicians will have minimal to no experience in several fields of medicine. Yet, it is far from over. The current third-year medical students are essentially learning very differently than just one year ago with limited clinical exposure and more virtual didactics. The fourth-year medical students are now interviewing on Zoom and, if they do not decide to stay at their current institution, will have to decide their career path for the next 3 to 5 years with never having visited the residency program they are choosing. What has happened in residency?
Depending on what type of residency one chose, one is experiencing different levels of stress and in different forms during the pandemic. My daughter, currently a second-year intern in Chicago, is now experienced in taking care of dying patients with COVID-19 in the intensive care unit (ICU). Unfortunately, because she and her colleagues are exposed daily to aerosolizing therapies, many of them have been infected. Luckily, my daughter has not been infected, but this has made her the ideal cross-coverage resident during her electives, since she is single and lives alone. We are assuming she will not be home for the holidays because the COVID-19 rate of infections is quite high in Chicago, and that will only mean more deaths happening in the ICU 4 weeks from now.
Obviously as a father and older physician one worries about the mental health of his daughter seeing so much death early in her career and not given the chance to process. I also worry because when she does want to decompress with her coworkers, they still have to social distance from each other. This inability to relax is true for all of our residents now, and I fear that this will be a true mental health crisis that may occur during, or soon after, the pandemic is over. Residents are looking at their mentors for guidance and most of us have never experienced a pandemic.
I remember being a medical student during the height of HIV infections in New York in the 1980s. Most physicians wore double gloves, and the idea of universal precautions became our new mantra. Yet that high-alert state would generally decrease when we got home. Unfortunately, the stress of COVID-19 is all consuming. Physicians feel the duty to work, but then must also have the duty to protect themselves when not working. If by chance you do let your guard down outside the hospital and get sick, then you have let your colleagues down because now you have to quarantine, or worse, may have gotten others on the team sick. Having senior colleagues in high-risk categories because of their age adds to the dilemma we face each day when we take care of a sick patient or consider coming to work mildly ill. Yet all is not lost in the pandemic, as we are learning new ways to connect with our patients and how to bend but not break.
One of the greatest lessons we learn from our patients is resiliency, and this is helping carve the future for my closest physician colleagues. My youngest daughter is in medical school and has now decided to get a Master of Business Administration degree as she moves from her second to third year of medical school. She figures, since things likely will not be back to normal right away, why not take that as an opportunity to expand your possibilities? My oldest daughter has become more interested in maintaining and improving her mental health by leading a committee for her colleagues on well-being. I have grown to appreciate the benefits of tele-health and have used it to learn more about my patients with attention-deficit hyperactivity disorder and autism by getting a glimpse into their environment and helping them improve things like sleep hygiene and daily functioning.
We all can yearn for the days before COVID-19, but the opportunity to change, improve, or improvise from this life-changing experience will be what finally defines our response and shapes our future.