COVID-19 is a war on two fronts [PODCAST]

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“I’m exhausted. As the pandemic rages on, the mental toll of dealing with COVID-19 has started to wear on me. As a practicing hospitalist in the Midwest impacted by one of the many hotspots caused by the meatpacking industry, I have spent a fair bit of time with this virus on the frontline. Some aspects of practicing medicine in a pandemic have actually improved, such as the increase in possible treatments and data to support those treatments. But one of the most stressful aspects of practicing medicine right now is the unexpected second front—the propagation of information from an increasingly vocal group of people who think the dangers of COVID-19 are imagined or manufactured.”

Clarissa Barnes is an internal medicine physician and can be reached at Dr. Clarissa Explains Healthcare.

She shares her story and discusses her KevinMD articles, “COVID-19 is a war on two fronts” and “To my health care colleagues in South Dakota.”

This episode is sponsored by Elsevier Health. Looking to update your personal or professional medical library? Shop Elsevier Health’s Holiday Sale and save up to 35% on your purchase of medical books! Plus, you can take an extra 5% off your order with code KEVINMD at checkout. Take advantage of the biggest sale of the year from Elsevier, the world-leading provider of medical books and reference materials. Shop us.elsevierhealth.com now through December 31.

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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 on the show, we have Clarissa Barnes. She’s an internal medicine physician, and she wrote the KevinMD articles “To my health care colleagues in South Dakota” and “COVID-19 is a war on two fronts.” Clarissa, welcome to the show.

Clarissa Barnes: Thank you so much for having me. It’s nice to meet you.

Kevin Pho: So we’ll get into your articles in a little bit, but first off, can you share your story and your journey to where you are today?

Clarissa Barnes: Oh, sure. Like you mentioned, I’m an internist. Currently I’m a hospitalist practicing in Sioux Falls, and in addition to my clinical roles, I’ve had a variety of different administrative roles, including being the medical director of our wellness program and doing some stuff in clinical documentation improvement, which has gotten me in contact with a lot of different physicians and other health care professionals across our system. And so a lot of what I write is really sharing the experiences, or the things that are common and tie us together.

Kevin Pho: So we are speaking at the beginning of November, and South Dakota right now has one of the highest per capita COVID rates in the country. Tell me what you’re seeing currently in the hospital.

Clarissa Barnes: It’s really an interesting duality, because on one hand, you see physicians and all the other health care workers really diving into their work more than ever before, because there’s just so much. There’s never any sort of onslaught. But it’s also, even if you ask them, “Hey, how are you doing?” they’ll often tell you that they’re OK, but you can tell that people are just getting more and more emotionally exhausted by the increasingly high volumes, the high complexity, COVID plus other diseases, and really no end in sight.

Kevin Pho: Now, in terms of support during the hospital, how are you in terms of supplies, and just the emotional support that you’re talking about for the health care workers?

Clarissa Barnes: Yeah, I mean, I think that supply-wise, we’re probably in a similar situation to everybody. We have what we need at this point, which has been good. So I think those several months at the beginning, when people were trying to figure out how we react to these new needs in terms of supply chain, were a good learning opportunity for us.

I think emotionally, a lot of what we do is we lean on each other, you know what I mean? You have a really rough day, and you share with your colleagues, because they understand what you’re going through. And so you do see a lot more camaraderie, as much as you can, because we’re still trying to distance, and we’re still wearing our masks, and we’re still doing all those things at work. But we’re really trying to lean on each other as much as we can.

Kevin Pho: How does what you’re seeing now compare to what you saw earlier during the pandemic? Because we’re talking about a potential second or third wave. So is there any difference between what you’re seeing now versus, say, March or April, around there?

Clarissa Barnes: Yes. So the first wave for us was really, I mean, where I’m at in Sioux Falls, we had one of those meatpacking plant outbreaks, so we were in the news the first time around as well. But at that point, the general public was still pretty afraid of COVID, so there were a lot of people still staying home. So even though we were really, really busy with COVID and that outbreak, the other stuff was not coming in. So at that point, we really got to focus on how we take care of COVID patients, what we do. It was very, very stressful, because you were still learning all these new medical things, because nobody knew what to do at that point. But at least you had the gift of time, because you could focus on COVID and you didn’t have to worry about the other things that were coming in.

Now we’re months and months later. Health care has been delayed, and people are coming in sicker than they’ve ever been. So now COVID is worse than it was the first time around, and we have all the other medical problems on top of that. So the good news is we’re more prepared, because we understand better what to do. The bad news is there’s no more of that time. There’s no more “Well, I’m only doing COVID today.” It’s really, you’re doing everything.

Kevin Pho: Sure. So let’s get into your KevinMD articles. You wrote a pair of them, “COVID-19 is a war on two fronts” and “To my health care colleagues in South Dakota.” Now, for the first one, “COVID-19 is a war on two fronts,” for those who haven’t read that article, can you just walk my audience through it and maybe share the story of why you decided to write it?

Clarissa Barnes: Yeah, I mean, that article really came out of the fact that what I was seeing in my own life in the hospital, and what my colleagues were seeing in the hospital, was one world, where COVID was very present, killing lots of people, very, very sick people. And then you would say, “OK, well, I’m working 120, I’m trying to learn all these new medical things, it’s very, very stressful.” And then you would come home and be like, “OK, well, I’m going to relax.” And relax may mean TV or social media or talking to your friends, and some of those people may be saying, “I don’t know what the big deal is about COVID anyway. It’s not even a thing. It’s all a big hoax, and you doctors are just trying to earn extra money by saying everything’s COVID, it’s not.”

And so there’s this disconnect between, “Well, that’s not what I’m seeing. That’s not reality,” but also knowing that there’s no way for some people to really know, because they’re not there with you. So how do we take what we see in the hospital and explain it to the general public so that they can understand what we understand, and also take care of ourselves and maybe not dive into those social media comments that really drive you nuts, because you can’t get anywhere arguing with some people?

Kevin Pho: So for those people who may not be taking COVID as seriously, are you talking about Facebook and Twitter, or people that you see in a grocery store, or even within your social circles?

Clarissa Barnes: It’s some of both. I think for things like Facebook and Twitter, there’s a tendency, and certainly I see it with some of my colleagues, where if somebody says, “Well, that’s not real,” you really want to argue with them. And realistically, that’s not very helpful, right? I don’t know that I’ve seen anybody change anybody’s mind by getting into the comments of a Facebook article with somebody. But if it’s somebody that you’re close to, if it’s a family member or a friend, and you can really have a conversation about “This is what reality is for me,” sometimes you make better headway in those circles.

Kevin Pho: So when you do share your story, and you share what you’re seeing in the hospital with those who may not take COVID seriously, what are some of their responses?

Clarissa Barnes: I mean, for some people, it’s actually very surreal, because nobody in the history of my life has been so interested in what I do, you know what I mean? People aren’t like, “Oh, how was your day at work today?” And now people are like, “What’s the hospital like? What’s the patient load like? What’s happening?” People are really, really interested. And so there’s actually a lot of appreciation, of understanding, because it’s very difficult, I think, for people to get a sense of what’s happening when all you get is a list of numbers every day: This is the new cases, this is the new mortality rate, this is how hospitals are generally busy.

It’s very different to talk to someone and say, “Well, I’m telling you what it’s like on the floor.” And especially if it’s somebody who knows you well, they tend to trust you a little bit better. There’s that weird mistrust of all media sources at this point, too. So if you can explain to people in a way, and through a person that they know, it actually is really, really helpful, and they do tend to be pretty appreciative of that.

Kevin Pho: Now, South Dakota was the site of the Sturgis Motorcycle Rally a few months back. When you were seeing that as a health care clinician, what was going through your mind?

Clarissa Barnes: Oh, no, no. I mean, it’s interesting, because in a lot of ways, for us, knowing what you know, you can see what’s going to happen. It feels very Cassandra-like, almost, sometimes, to be like, “Maybe getting that many people together is not the best idea. I wonder, maybe our numbers will go up afterward.” And then to be like, “Well, look, our numbers are going up. I’m not very surprised.” But also knowing that there’s nothing you can do about that. You can’t control what people are going to do. Even if they had decided officially to not have it, I think people probably would have still come. So it’s really just mentally preparing yourself for what is likely the outcome of what people are deciding to do.

Kevin Pho: Now, do you think that there’s a connection between the current high per capita rates and the motorcycle rally? Have they made that strong connection yet?

Clarissa Barnes: I’ve seen people try and make those connections. Some of that data is not as great as I think we would like it to be, you know what I mean? So I don’t know that anybody could say that for sure. I think part of it is it’s really complex, right? Because that rally happens right before people go back to school. So you have the rally, and then a couple of weeks later, it’s back to school, back to college, and a lot of businesses at that point stop doing as much stuff remotely. So it’s a lot of people mixing. I think at some point it’ll be really fascinating, a year, two years, five years from now, as we try and dissect what happened, as much as we can. But at this point, I think we don’t really know what came from what.

Kevin Pho: Now, from your standpoint, talking to a lot of skeptics, and I know a lot of physicians, especially on social media, talk to a lot of people who are skeptical of the pandemic, what have you learned over the past few months? Have you learned any tips in terms of communicating with people who may be a little bit skeptical? I know you mentioned that some of them couldn’t be convinced, but is there anything that you’ve learned to help communicate our message a little bit better?

Clarissa Barnes: Yeah, I mean, I think the message should never really be, “This is my position, this is your position, I’m going to try and change your mind,” because I think if you’re trying to come in with the idea that “I want this outcome for you,” you’re setting yourself up to fail. If you really come into it like, “I have knowledge of things that you don’t know because I’m in a position,” you know what I mean, “you just don’t know. There are things that, if you’re not in the hospital, you can’t possibly have insight into. I’m going to share that with you.” And then in the back of your mind, you’re hoping that maybe that will change your mind about where things are. So I really approach it more as, “I’m sharing information about what life is like for me and for people like me working in the hospital,” and I hope that more information allows people to make better decisions.

Kevin Pho: And that segues nicely into the second KevinMD article that we wanted to talk about, “To my health care colleagues in South Dakota.” Now, can you share the story of that article and what message you want to share with your colleagues through it?

Clarissa Barnes: Yeah, I mean, at this point, we’re weeks into this second surge, and things are busier than they’ve ever been. I see different people, and I mentioned lots of different people in health care in that article, worried about different things, but I also didn’t see anyone publicly acknowledging what everyone was worried about. Does that make sense? Sometimes there’s a benefit in saying things that are unsaid.

And I think a lot of people felt like, even though they were working really, really hard, there were people at different levels actually speaking out into the media who were still saying, “Well, things are fine. We’re fine. It’s not that bad. The numbers are going up, but that’s just testing.” Even though we’re sitting here in the hospital going, “Well, it can’t just be testing, because we have more people in beds. Those people didn’t need tests to know that they were sick. They’re coming because they’re sick. There is an actual problem here.”

And so I think sometimes what I feel compelled to do when I write things is really to put a name to things that I see happening around me, because people really do want to be seen. They want to know that somebody’s recognizing what’s happening to them. And also, I really thought it was a good way to remind people that as hard as you’re working, you also need to take care of yourself. You can’t put 150 of yourself into patient care every single day and not burn out at the end. You have to do something for yourself, whatever it happens to be, whatever your relaxation is, because it’s a marathon, it’s not a sprint, and we still have a long way to go.

Kevin Pho: We’re talking to Clarissa Barnes. She’s an internal medicine physician, and she wrote the KevinMD articles “COVID-19 is a war on two fronts” and “To my health care colleagues in South Dakota.” Clarissa, so you mentioned a lot of clinicians are getting burnt out. You mentioned that they need some type of outlet outside the hospital, perhaps, to relax and decompress. Now, what are some other tips that you could give them to help prevent burnout? Because this is something I’m hearing a lot, especially on this podcast.

Clarissa Barnes: Yeah, I think you really do have to create not just physical space between you and the hospital, and if you’re not working, that’s great, but you also have to have some sort of mental space. We’re more accessible now than we’ve ever been. My work email is on my phone, people can call me, I line it, I log into our secure messaging app. There are multiple ways to reach me when I’m not in the building. And I’m as guilty as the next person of keeping them on all the time, because you’re like, “They might need to reach me for whatever, administrative or whatever.” But you really have to find a way to say, “OK, well, maybe it’s one day a week, maybe it’s half a day a week, I’m going to shut everything off, I’m going to be unreachable, and I’m going to do whatever I need to do to take care of myself, spend time with my family, whatever it happens to be.” But it’s really hard to disconnect physically in your house if you’re still emotionally back at work.

Kevin Pho: Now, from an administrator standpoint, and I have a lot of administrators who listen to this podcast, what can hospitals themselves do to help protect the mental sanity of their clinicians?

Clarissa Barnes: I think sometimes people underappreciate how important it is just to be recognized. I see a lot of administrators saying, “Well, I can’t fix the stress of the COVID situation right now, so I feel powerless to do anything.” But for physicians and other health care workers, even if you just go, “Hey, I know things are stressful right now. I see what you’re doing. I appreciate you,” that’s halfway there.

The second part is to notice what they don’t have, you know what I mean? If you’re noticing, “Hey, the hospitalists are not getting to go down to the doctors’ lounge during lunchtime and have food because they’re so busy,” maybe you need to bring food up to their room so they can just eat there. And that’s something that our hospital did. They recognized, “This is what people need. Let’s fill in those holes.” Do the things that they’re not asking for. You just need to pay attention. They won’t tell you, but you’ll notice if you’re around.

Kevin Pho: And my final question, Clarissa: What is your take-home message that you want to leave with the KevinMD audience?

Clarissa Barnes: I think my take-home message really is that this job is a calling. We don’t come to this job by accident. It’s part of our core identities. I call myself a physician; I’m not somebody who practices medicine. But at the end of the day, I’m the only wife that my husband has. I’m the only mother to my children. So you also have to take care of yourself and protect that other part of your life, because if you get too far into just that one thing, you’re going to burn out. And we can’t afford to have people so burned out that they leave medicine. We need everybody to come along with us. So take care of your patients, but also take care of yourselves.

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

Clarissa Barnes: All right, thanks again.

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