Much has been written on the social divides laid bare and amplified by the COVID-19 pandemic. Thankfully, the more divisive punditry and polemics have receded along with the COVID-19 mandates. And yet, as professionals in health care who have worked in direct patient care and in support of our clinician colleagues, we still see a broad gap separating the culture and worldviews of the people in health care and the broader public disconnected from clinical settings.
Consider the recent national data.
Despite high vaccination rates, with a new Omicron subvariant dominant in the United States at the end of August, there was a nationwide increase in hospitalized patients and occupied ICU beds. This spike continued unabated through September. Mercifully, the influx did not continue into October, but it seems not everyone was aware of this emergent COVID-19 wave – or wanted to be. As one frustrated state health care official admitted to us: Everyone believes we are in the endemic phase of COVID-19; good luck getting people to pay attention. This is not the only recent example of the distinct difference between the reality experienced inside and outside clinical settings. In January, hospitals across the country were reopening triage tents in parking lots and implementing emergency measures as a tripledemic of COVID-19, flu, and RSV spiked hospitalization rates. In conversation with an exasperated family nurse practitioner, she commented that while the rest of the country blissfully celebrated the holidays, in her emergency department the tripledemic was as exhausting as it was during the worst of COVID-19. Having already emerged from the fugue state of lockdowns, having navigated the “new normal” over the last two years, the layperson without a public health orientation was done with COVID-19.
If only wishing made it so.
We have personally experienced and witnessed the impact on our colleagues and health care ecosystem when we consciously or unconsciously avoid the ongoing impact of the last three years. After all, COVID-19 has already had, and continues to have, a seismic impact on our health care workforce and health care system. During the pandemic, the preexisting crisis of health care burnout increased precipitously. Now, demoralization is a sharply felt daily weight, and research from previous pandemics indicates that the psychological distress will continue into the coming years. Simultaneously, resources are scarce in health care. As one colleague recently wrote: With a workforce that is over-taxed and underpaid, the cash register of health care is broken.
What’s more, the literal safety of our clinicians is often cause for concern. To state the current reality plainly: the dam is breaking, or in some cases has already broken. On October 4th, largely because of these acute and persistent problems, the Coalition of Kaiser Permanente Unions organized the largest strike in health care history (limited to three days by federal regulation). Additional steps toward collective bargaining in health care (including work stoppages) are certainly in our future. So, while it is understandable to want to wish away COVID-19, placing it firmly in our shared rearview, it is not yet done with us. Moreover, this is not just a problem to be solved within the walls of health care— this rescue will require all hands.
For those outside of health care, when you do interact with the health care system – an inevitability, because everyone at some point will engage with health care either as a patient or patient advocate – you can provide space for our clinicians with a compassionately offered open-ended question: I know the appointment today isn’t about you, but I’m curious … how are you doing? Even this simple practice of engaging with the lived experience of others can be healing. When the dynamic of the patient-clinician relationship is inverted, undoing the set roles of a clinician providing care but needing nothing in return, authentic interest in the well-being of our clinicians is demonstrated. This direct curiosity and a willingness to listen, a manifest desire to witness well, acknowledges that our health care workforce has indeed been impacted in deeply felt ways that continue to unfold. We also encourage those outside of health care to volunteer at a local hospital or participate in a patient advisory board. Truly, the barrier of entry is low– it only takes the desire to want to get involved.
While mental health measures indicate that wellness is at an all-time low, self-care programs are not the answer. Health care professionals are trained to take on the problems of others and partner in solutions; they are not traditionally good at seeking help for themselves. We cannot rely on the personal resilience of health care professionals, and asking health care professionals to do more is an action of last resort. For those in leadership positions with an influence over resources, we implore you to make time (compensated) for clinicians to participate in shared sense-making, processing, and renewal. We suggest Commensality Groups, which have demonstrated impact, and other models for collective unburdening (the Balint framework is another example). Clinicians must also advocate for what they need. As the Surgeon General suggested in the report on health care burnout, stay connected and reach out for help. Finally, and importantly, as a trusted resource within health care, the clinician’s perspective is invaluable when shared. So, when a patient or someone else who lacks direct experience asks a version of the question: how are you doing? We invite all clinicians to respond with an authentic response that shares insight into the current state of health care. We know that all too often, clinicians only have the bandwidth to answer with— I’m fine. While this is a reliable reply that returns the focus away from the clinician, keeping the personal experience of our clinicians hidden and separate means we will never build relational power, and potential allies will never be recruited to participate in changing health care. Clinicians, we need to hear from you.
When a challenge is monolithic in scale (and health care problems are certainly daunting), a shared commitment to more intentional one-on-one interactions, even repeated many times in many places, may seem incremental at best. However, a single relationship between two people is the foundational building block of systems-level change. COVID-19 threatened, and continues to threaten, this foundation by separating us from each other. Now is a pivotal moment to seize the power in our interconnections at every level. After all, everyone is aligned in a shared desire to promote outstanding clinical care. And it is our collective response that will dictate what comes next.
Matthew Lewis, Alexander Mansour, and Sarah Smithson are health care consultants.
