The Narrative with Matt Lewis is a blog series that explores the importance of human connection, relationships, and hope, topics central to the mission of 3rd Conversation and important for all of us during this time of uncertainty. As the chief storyteller of 3rd Conversation, Matt is an expert on the use of narrative as a tool for connection, teamwork, and leadership development.
This month’s interview is with Sarah Smithson (MD, MPH), Assistant Dean for Clinical Education at University of North Carolina at Chapel Hill School of Medicine and an Assistant Professor, Division of General Medicine and Clinical Epidemiology.
ML: The world is ablaze… there are literal fires we are working to contain, Ruth Bader Ginsburg passed, policing and social justice, plus a global pandemic. It’s all a little much. Generally, how are you doing?
This is a moment more than any other where I realize the value in feeling safe in my home, having the resources to put food on the table, the flexibility to work in-person or from home, and having my children transition well to their new reality of schooling. I really cannot complain at all.
It has also given me pause to think about what is really important.
With my clinical job, I have decided to try to stop feeling bad about the larger structural elements when the system doesn’t align with what makes me and my patients happy. I can’t get stuck in that thinking. Because while this is a moment of isolation for all of us, at the same time, now more than ever, I know we all really need each other. Focusing on leveling of my daily attention has allowed me to concentrate more directly and say to myself -- if I really enjoy spending time talking to people and that contributes to their health and wellbeing, then I’m not going to feel bad that their appointment is taking me 25 minutes instead of 15 minutes.
ML: Sticking with your clinical work, I have talked to multiple healthcare providers, and while COVID is certainly a universal experience, it is also so very different for everyone. With your work on the front lines of care at UNC, what has that been like?
We have all been affected. But you are right, there are very few people that will have had identical experiences.
You can’t say, or assume – well, you’re a doctor and this must be your experience with COVID.
For me, I have not been pulled away from my area of expertise, but that possibility has been on the table. However, I haven’t practiced in-patient medicine in 10 years. That said, I have the background and broad knowledge to move into that space if needed. But when faced with that possibility, I felt trepidation. That trepidation was not about being in a clinical setting where COVID exists, it was about the potential for me inadvertently to cause harm by being in a clinical space with which I was no longer familiar.
I haven’t been deployed there, yet– so my COVID experience continues to be largely the transition of my outpatient practice to a mix of outpatient and virtual care, which I have really enjoyed. Getting to see patients in their own setting, seeing their grandkids or their pets, getting a glimpse into their lives that I don’t get to see when they come into the clinical space. It’s been a more relaxed approach. They are also seeing me in my personal space, and that has felt like a more human connection. I have enjoyed the opportunity to do more telehealth.
ML: Telehealth has been one of the big paradigm shifts. What other shifting paradigms have been brought on by COVID?
Certainly, there is a dramatic financial impact from this pandemic. We have found ourselves, and will continue finding ourselves, making really difficult decisions about resources. For one of the industries [healthcare] that is most necessary during a global pandemic to be facing such dramatic budget shortfalls is hard to reconcile.
I’m saddened by the missed opportunities for clinicians to have more influence over the way our institutions and practices are reimbursed and the way that the care that we deliver is valued in our system.
We do this work because we really want to help our communities be healthier, and we can’t do that if we can’t employ staff, clinical team members, and keep the lights on.
Right now, we’re in this moment of extreme vulnerability and not well-positioned to have any leverage for many of the things we need, because we’re too busy doing our day jobs, fighting the clinical fight. Advocating beyond that daily focus feels nearly impossible.
Also, in medical education, there have been dramatic and ongoing paradigm shifts that happened in weeks that might have otherwise taken decades. It’s hard for me to imagine something other than a global pandemic bringing about that amount and degree of change.
We had to pull our students out of clinical rotations because we didn’t have adequate PPE (personal protective equipment). Our commitment as a medical school is, every year, to graduate competent physicians. That train needs to keep going or we will find ourselves with a dramatic deficiency of providers.
We really had to ask ourselves-- what do our students need to learn?
We launched a virtual course related to COVID, so that we felt confident we were moving them toward important competencies for graduation and we were able to do it in a way that was physically safe and pedagogically effective.
We’ve always said you need 4 years of medical school to be a competent physician. The pandemic forced medical schools to think– is that really accurate? It really pushed and accelerated a transition toward competency-based education and assessment.
ML: What I’m hearing is this fast, iterative change that wouldn’t otherwise have happened is hopeful. Are there other places where you are feeing hopeful?
I have hope that stripping away a lot of the excess helps redefine what is essential. I would love to say – we’ve had this worldwide epiphany in healthcare and now we can go forth and focus on the things that really matter. I don’t believe that’s happened, but the pandemic has given all of us a chance to consider and ask ourselves: What do we really need to be doing? Where is the value added? Because of COVID those questions are more consistently and more wholly applied to our daily work in medicine.
As a primary care doctor, I go back to the question of why do I do what I do? What makes me happy? What makes the patients happy and helps them feel value?
Mostly, I think it’s our connection to each other. I have found that the patients I have been seeing consistently – virtually, but consistently – over the last few months, I feel like we are truly going through this together. That connection with them, and them thanking me for listening, for being there with them through this – that is sustaining and ultimately what matters at the end of the day.
My hope is that maybe through all of this we have been better able to identify the things that we need and that matter to us, not just as individuals but professionally. If that could inform the way we continue to work after the pandemic ends, that could be very powerful.
ML: It sounds like investing in relationships happens organically even in your telehealth appointments and that has been a real source of hope. Any additional reflections on investing in relationships?
The most successful teams that I’ve been working with throughout the pandemic are the ones that are being very intentional about the connections within the team. A lot of the teams do check-ins every meeting, holding a moment to recognize and honor the spaces people are in and what they are feeling, then moving forward into the meeting with an understanding of the personal context.
It’s been so valuable to know that team members care and can share openly. Those are the teams where we’ve had the most success. Those are the teams where people are both pitching-in and, importantly, where people also feel like they can ask for help. I think it’s that intentional consideration of the relationships and of the individual value everyone brings to the work that has enabled us to be flexible and dynamic in the face of so much uncertainty.