Protect our medical trainees during the pandemic [PODCAST]

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“When I first heard about medical schools fast-tracking graduation for students and shifting young residents into high need areas to fight the pandemic of COVID-19, I thought of how panicked those students and residents must feel. Asking them to step in to fight a battle we don’t know how to win, and envisioning them witnessing the suffering and death of multiple people due to lack of resources and a broken system is terrifying. Asking them to risk their own safety and that of their families due to a paucity of protective equipment is beyond the pale. My more experienced colleagues whisper to each other that we too are afraid of serving on the front lines, but inevitably someone says, ‘I guess this is what we signed up for.’ The truth is none of us signed up for this.”

Deborah Edberg is a family physician.

She shares her story and discusses her KevinMD articles, “Words of courage for medical students and residents” and “Stop calling health care workers heroes and do something to help them.”

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 on the show, we have Deborah Edberg. She’s a family physician in Chicago. She wrote a couple of great KevinMD articles that have really resonated on social media. Each of them has more than several thousand shares on social media. The first article, “Words of courage for medical students and residents,” and the second article, “Stop calling health care workers heroes and do something to help them.” So we’ll get into both of those articles later on. But first, Deborah, can you share a little bit about your story and your journey to where you are today?

Deborah Edberg: Sure. So I grew up in Pittsburgh. I did most of my education on the East Coast, and then I came to work in Chicago. I have always been focused on underserved medicine, and I had gotten into education over the past couple of decades. In the past 10 years, I started a residency program on the West Side of Chicago with some of the Teaching Health Center funding, which is why this pandemic really made me start thinking about how this must be impacting residents and students who are just starting the journey of medicine.

Kevin Pho: And that segues nicely into the first article that you wrote, “Words of courage for medical students and residents.” I read a lot on my own site, as well as on various other physician blogs, about how medical students and residents are being pushed to the front line, and this may not be what they signed up for. So I was wondering, can you tell me the story behind your article, and why did you write it?

Deborah Edberg: Yeah, you know, I first started seeing, when we were in the midst of the panic, that what was happening in Italy and what had happened in China was going to come here, and some of the thoughts in New York about graduating medical students early. And I just know from having worked with residents that first year in internship how challenging that can be, especially in low-resource settings, especially when you’re not quite sure what you’re doing.

I wanted to think of a way to reach them, to offer them some comfort that this is new for us, that we still don’t know how to appropriately treat this condition. We don’t know how to manage it. And so they are not alone in that. But this being their first experience, they should recognize that bearing witness to what is happening is important, that it’s something that has significance and it has value. And that alone may be enough for many of them to get through that first part.

Kevin Pho: Now, you wrote that article back in March, and we are now talking at the end of May. So how have the last few months been for your interns and residents?

Deborah Edberg: Yeah, so I should have mentioned that I actually left that program a few months ago, because I have a new job to start a new residency program, but I have been in touch with them, and it’s hard. I think that they are feeling frustrated and tired and defeated. You know, they’re fortunate that they are protected in a lot of ways, that their program director has made very specific requirements as far as what their protective equipment is before they can round on COVID patients. But even then, the emotional burden has been a lot.

And I think that, considering that we don’t see an end necessarily in sight, it will be ongoing. And so I’m continuing to think about how we who are further along that path, especially in the educational realm, can support them and can help give them space to process what they’re going through.

Kevin Pho: So let’s go into some details on that. What are some of the things that residency programs can do to help support the interns and residents during this time?

Deborah Edberg: Yeah, I think that, really, it’s important to give space to share the experience and the emotional burden of what they’re going through. To, I think, go home, you know, I’m married to someone who’s not in the medical field, and he’s a wonderful, supportive guy, but it’s hard to describe what it’s like to sit at the bedside of somebody who is dying, who can’t have family members there, who we don’t know how to help. And so to be able to have space with other people who have gone through that same experience, I think, is critical. And so I feel like Balint groups and support groups are a crucial part of this.

I also think that it’s important to have time for them to call out, to say, “I can’t. I’ve reached my max. I need space to move on,” and to just have a few days off, and to have a system in place that allows for that, no questions asked: a jeopardy system, a wellness system, so they can just take time off and process. They absolutely have to have protective equipment, but they also should have some say in how schedules are made. They’ve got to have some sort of control in some aspect of their residency so they don’t feel like they are helpless. Share with them what the challenges are as far as caring for the patients, and let them be a part of the solution.

Kevin Pho: Now, as a residency director, it’s wonderful that you’re recognizing this problem with the medical trainees, but what are you seeing across the country from some of your residency director colleagues? Are all residency programs cognizant of the difficulties that our trainees are going through?

Deborah Edberg: I don’t know that that’s true. I do have some colleagues who work in different types of programs. I mean, I think in family medicine, we tend to focus a lot on the relationship piece, on the emotional piece, but not every residency necessarily has the space or the bandwidth to do that. I’ve seen some programs where it’s a little bit disheartening to hear that the residents are being put on the front lines and attendings are staying back, and the attendings are not rounding on COVID patients because they consider themselves to be in a high-risk group. So it’s almost like residents are being treated a little bit as if they’re dispensable, because they’re younger and possibly more likely to survive if they were infected. And while that may be true statistically, I think that is a really difficult message to deliver to your young residents coming up.

You know, I think that this situation is challenging in so many different ways, and I hate to judge how systems are choosing to address it, because there is no template or correct algorithm for this. But in my heart, I feel like protecting residents and protecting students is our number one priority as we start to navigate this.

Kevin Pho: Now, if I’m an intern or a resident, and I’m in one of those programs where I’m thrown on the front lines, and I’m not comfortable with some of the things I’m doing, what can interns and residents do to speak up? Because understandably, they may be afraid to speak up, and speak up against their programs. So what’s some advice that you could give to these interns and residents?

Deborah Edberg: Yeah, I think that’s a big challenge, because that is the case, you know. If you feel like, “If I speak up, do I put my job in jeopardy or not? I’ve worked my whole life to start this career, and I’m just starting out. What does that mean?” I think there’s power in volume. I think that for people to organize within their own residencies, and to get a sense of what people are doing in other programs across the country. I think it’s also hard as a resident: You don’t know what is reasonable to expect. Maybe you are expecting something that isn’t reasonable, but maybe you are. And so really check your concerns. If something doesn’t seem right, check in with other residencies across the country, with other residencies across different specialties, and just see: How are your programs handling this?

I think that, for me, anger should be further down the line. There should be questions that you can ask, you know: Why have we chosen to do this versus that? What is the problem we’re trying to solve? Are there other ways to get around it? Are there better ways to protect us? What are all the options? Can we be a voice in the decision-making? I think it’s using communication skills and leadership training to better understand, you know, to understand that, for leadership, this is new for leadership, too. Nobody knows what the answer is. And so ask the questions first, as far as how a decision was made, to understand all the restrictions and the barriers, and then ask to be a part of the solution.

Kevin Pho: Yeah, that’s great advice. I know that I read a lot of questions from these trainees, and I get a lot of emails from them, and I think that listening to that advice would certainly be helpful. So you wrote a second article on KevinMD, and it’s titled “Stop calling health care workers heroes and do something to help them.” So briefly, just tell me the story behind that article and why you decided to write that.

Deborah Edberg: Yeah, you know, as the pandemic was unfolding, I think that I just felt myself getting more and more frustrated that it’s happening at all. And I think, rightly, there was a lot of focus that I saw on a lot of the medical social media, which was: Get us more protective equipment, get us, you know, more information, we need to do the social distancing. All the focus was on how do we manage the situation that we were currently in.

And for me, I felt like we also need to focus on the fact that we should not be in the situation, that there was so much failure of leadership in our country that led to this, that we cannot discount, and we need to pay attention to it, because we need to prevent it from happening again. As citizens, we need to think about what we can do, how we vote for our leaders, how we consider science. But also, as physicians, we need to raise our voices, too, to make sure science has the first and foremost voice in handling a scientific crisis or medical crisis.

I think that as physicians, we tend to sit back often and say, “Hey, we’re doing enough just taking care of patients on the ground and people on the ground.” But it allows space for people who don’t have the experience or the education that we have to be the forefront voices. And so really, I just wanted to bring that focus back. I felt like, you know, I don’t want to be considered a hero. I feel like in a lot of cases, health care workers are instead being martyred. I mean, we don’t have a choice but to go to work every day and do what we need to do, and the fact that we’re putting ourselves at risk and our families at risk is not OK. And that hero narrative almost makes it seem like it’s OK. I just felt compelled to be that voice, to let health care workers know, you know, you are seen, and we are all here together in this, and we need to make sure that on the other end, this doesn’t happen again.

Kevin Pho: You talk about a failure of leadership, and I think one of the great tragedies is that science is being politicized. Wearing a mask is being politicized. Now, you’re in primary care, and I’m in primary care as well, and I’m seeing more patients who are dubious of science, dubious of the severity of the pandemic. So when you’re seeing these patients in the office, what kind of advice can you give to your fellow clinicians on how to approach these patients?

Deborah Edberg: Yeah, it’s tough. I mean, my patient population is primarily an underserved African American population, geriatric. And to be honest, my patients are pretty scared, and most of them are just hiding out in their apartments. But they have family members who are younger who aren’t necessarily observing social distancing or masking. Many of them don’t have access to masks, and social distancing in many situations isn’t necessarily even an option for them. So there are definitely challenges there.

I think where I get challenged more about masking and social distancing is in my personal life: friends and family members, or people that I know on social media, because they don’t see it. You know, the weather looks nice. It looks nice outside, and I’m in Chicago, and we are still surging here. And yet as soon as the weather gets nice, the lakefront is packed, and people in my neighborhood are running around, and I see kids running in packs, and it is frustrating.

And I think that the more that we can continue to be the voice of reason, because I know I, and I’m sure everybody who is a physician, is kind of the resource for our friends and family, to say, “Hey, what do you think about this?” I have a cousin who is very conservative, and right when this was rolling out, she was in Florida, and many of her friends were saying, “Oh, this isn’t going to be a thing.” But she called me to say, “What do you think?” And I said, “It’s going to be bad. You should go to your house and stay there until we have more information.” And so I think there is a certain note that you can hit with people that doesn’t alienate them but draws them in a little bit better.

I think it’s important to show compassion. I think it’s important to understand that sheltering in place, as much as we joke about it, is not easy. It’s really hard, and hard for people in many different ways. You know, I’ve got little kids here who are trying my patience with their homeschooling, and there are people in abusive situations and people with mental illnesses for whom staying in your house is really, really hard. We need to validate that. We need to validate those challenges, and then re-emphasize: And yet, this virus doesn’t care. We just need more time. This is not forever. We don’t need to stay in our homes forever. As far as the masks go, who knows how long that will be, but that doesn’t have to limit your ability to do the things you enjoy. That actually could give you some freedom to do the things that you enjoy.

And so it’s helping people reframe it in a way that shows compassion for their perspective, but yet continuing to reinforce what the science tells us, and to guide people in the scientific process. You know, I have a lot of people who say, “Well, a month ago, we were told this, and now we’re told this.” Yeah, that’s normal. That’s as we gain more information. That’s OK. You’ve got to stay current on what the latest information is and why we have that information, and just be that voice of reason for people.

Kevin Pho: I think your last point is wonderful, the fact that this is all new for everybody. It’s new for the scientists as well. What we knew a month ago is not, may not be true now. A medicine that may or may not have worked a month ago certainly doesn’t work now. So I think adding that nuance, adding that reason, and the fact that this is changing almost on a daily basis is something that we certainly have to emphasize. So my last question: What’s the take-home message that you have for the KevinMD audience?

Deborah Edberg: I think, you know, assuming that most of your audience, although not all, are medical professionals, I think that this is our moment to step back into the sunlight and to be the information that the public needs. I think to have platforms like yours and others, to start writing, to speak up, to talk to newspapers and media outlets, in whatever way that we can get our voices heard, and to have consistent messaging is critical, because in something like this, we need to be the resource that people use to get their information.

Kevin Pho: Well, thank you so much for sharing your insight. Deborah Edberg is a family physician in Chicago. She wrote two wonderful KevinMD articles, “Stop calling health care workers heroes and do something to help them” and “Words of courage for medical students and residents.” Thank you so much for joining us on the show.

Deborah Edberg: Great, thank you for having me.

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