Recently 3rd Conversation’s Matt Lewis sat down via Zoom to talk with Brian Park, MD, MPH, Assistant Professor of Family Medicine, Oregon Health & Science University; Director, Relational Leadership Institute, about what it’s like on the front lines of the COVID-19 pandemic, what he’s learned about himself, and how the healthcare system can learn, heal and improve moving forward.
Matt: Thanks for meeting with us today, Brian. We appreciate your valuable time. I think question number one is: what is it like out there?
Brian: I recently stumbled upon SAMHSA's progression of natural disasters and I think it’s really relevant to the collective psyche here.
The first phase is complete uncertainty—or “pre-disaster.” You know disaster is about to hit and it's just utter confusion, disorientation. You're letting go of the things that you used to be doing to tend to this emergency and everyone's just trying to figure out their role in the chaos.
The next phase includes the honeymoon phase, where people start to really come together. These tiger teams [teams of specialists formed to work on specific goals] of diverse individuals are joining up to focus on the shared purpose, this common enemy. And eventually we start saying, "Oh, it's working." In this case the curve is flattening. Whatever it is we're doing, it's working, we're in it together.
But now we're entering this third phase, SAMHSA calls it the disillusionment phase, which is actually really just depression. They found that rates of substance use and mental illness goes up and this can last for months, if not years. But ultimately, what happens is you've taken away the common purpose and you don't know what's left in that wreckage. There's been this rupture and now what do you do to mend it? You've been in emergency mode for so long, how do we go back to business as usual? How much of this emergency response do we take into our daily work and our daily lives and how many new things are in our lives now? We've locally called this phase the “limbo” period and we have no idea how long it's going to be. A colleague of mine was saying:
It's like, you know you're going to get your finger cut off, but you don't know when, you don't know how much of it, you just don't know what to expect so you're constantly bracing for something.
For us in healthcare, that’s what’s sitting on our minds. We have been so consumed with putting all resources towards COVID to protect the public and our own health. We’ve been in this constant space of let's do it, ask questions later. And I think we're starting to see the financial fallout of that and how it’s intersecting with the national economic crisis. We're waiting for the furloughs, the layoffs, the pay cuts. The aftermath of this disaster. And how we pick up the pieces from there.
Matt: Your description is so powerful. This limbo state of uncertain undulation, you don't know which direction the wind's going to blow. Along those lines, how would you say clinicians are taking care of themselves during this limbo?
Brian: I guess that question assumes something that I'm not sure about (certainly for myself) which is that, we are taking care of ourselves. I think healthcare professionals are not doing so and not through the fault of any individual. The system and cultural expectations of medical education don’t program you to take care of yourselves or one another. With Covid specifically, there was this explosion of things that needed to be done: clinical workflows, the launch of teams developing protocols, social determinants of health teams, digital TeleHealth teams, etc. And a lot of us in healthcare are wired to just jump into them.
What's been hard for me is, I've been socialized by medical education and the health care system to believe so much of my self worth is wrapped up in what I do and what I contribute and the value I bring externally to the world. And I think that's led to a lot of us not being able to self-regulate and pump the brakes.
So I maybe about five, six weeks in, had this moment of, ‘oh my gosh, I'm so exhausted’.
Self-reflection, mindfulness, yoga and meditation, those are all great things, but only one small piece of the puzzle. So much of how we can spiritually, emotionally, psychologically take care of ourselves springs forth from the culture that we're in. And healthcare, it's an especially broken culture. The question is almost like, how do we take care of one another? Or, as Yashna Padamsee has observed: how do we move from “self-care” to “communities of care”? It's a question that has to appear right next to how do we take care of ourselves? Because within the clinician burnout conversation, what sometimes happens is the onus is placed on the individual level when it's actually a systemic issue, happening not just on a national but a global scale. So how do we support one another? What are the things that we can take from this moment of ‘Clearly, we're not doing a great job of taking care of one another’ and how do we use that as an opportunity to shine a light on it and change it?
The first week of our COVID-19 response, I sat down with some residents and said "Hey, what can we do to support you right now? I'm really concerned about resident wellness. And I feel like residents and learners are especially vulnerable to burnout." And we had 15 minutes of ideas and then one of the chief residents was like, "Brian, we're talking about a lot of good things right now, but I almost don't care if you do this now. What I care more about is whether you continue doing this after the pandemic ends."
And the aha moment for me was, why did it take a global pandemic for us to care about each other and the wellbeing of residents and the protection of providers and frontline staff? The burnout epidemic has always been there.
Matt: What I hear here is that in order for healing to begin in the future, we have to tell the truth now.
Brian: Yep. Locally we've been engaged in some efforts to provide platforms for folks [individuals within the medical profession, patients, and community members] to share stories. Once you start with the truth, then you know what you're dealing with, and you can move towards reconciliation. What we're hoping to do is get people to the truth and then from there we can figure out how we collectively work together to address whatever those issues.
Matt: And on that subject of hope, where else are you feeling hopeful?
Brian: Well, history has charted two paths for us and we know one path really well, which is that after SARS and MERS and H1N1, healthcare professionals experienced burnout and post traumatic stress for more than two years. I don't feel we're fated to that, that's just our default if we choose not to do anything about it. We have a choice here. We can collectively say, yeah it sucks that people burnout, but it's just the reality. OR we can acknowledge we've awakened to how important it is to take care of one another, how interconnected, interdependent we all are. And if that's the case, what do we do? And... we don't know. There's been no playbook or guidelines or protocols written for this, but if we think it's important, we damn well better try it. Just like we’ve done with COVID. We tried a bunch of stuff. Some worked, some didn’t. This is just as important. It's going to impact us for years, if not decades. We have to try. Because there's also just so many examples of how after immense pain humanity can heal and come back even stronger. And that gives me hope.
Matt: Definitely. And if we, the lay people, want to support you, the clinicians, in getting to a different, a better reality, how can we do so?
Brian: It's been really easy to point to healthcare workers as the ones doing all the work during this pandemic. But there have been so many people who've kept the fabric of our community intact. And we have to be thinking about how we're all making this thing work. So to start, just acknowledging that we're all a part of the community.
And secondly, within this community, we ALL have to also realize that we can't do any of this on our own right now. We can't protect our own bodies from COVID without other people participating too. In the coming months, if waves continue to hit, I could see people getting really frustrated with having to stay in and being told what to do. And we have to find ways to stick together despite that. The fallout of the next COVID waves will bring a lot of different problems, economical, racial, etc. And if we stay isolated from one another, if we lose that community we’ve found, it will be that much harder for everyone. The best thing that we can do for healthcare professionals is to think about what contributes to health, not just healthcare services, but what makes our community as a whole, healthy and well. COVID has cast a light on that, like no other time in my life.
We have so much that binds us, that makes us interdependent, intertwined, interconnected to one another.
And that’s how you help. By remembering, you, the individual, matter to the greater group.