I fear I’m on an island in an ocean full of change.
Can’t bring myself to dive into an ocean full of change.
Am I losing touch, am I losing touch now?”
He said, ‘Why why, what a terrible time to be alive
If you’re prone to overthinking, and
Why why, what a terrible time to be alive
If you’re prone to second guessing’
But hey, pretty smiling people – we’re alright together…“
– “Pretty Shining People” – George Ezra (2018)
Having recently wrapped up an eventful locum up north, I decided I would take advantage of the gradual reopening of the province and attempt to get my COVID hairstyle corrected at a local barbershop. Mandatory surgical mask at the ready, as I drove to my destination, I caught myself wondering what I would say when the similarly masked and gloved barber inevitably asked what I did for a living.
Do I admit I am a rural general practitioner and accept the likely deluge of questions and conversation around SARS-CoV-2? I could already hear the questions – do you think we all need masks? How bad is this virus, really? My relative has diabetes, are they at risk? Have you looked after anyone with it…?
Do I engage in this conversation – or do I pretend to be something else? Could I pull off being a software developer? Car salesperson? Professional gamer? Anything not related to healthcare?
I pondered why my mind went to these thoughts. I’m not trying to hide anything in particular, and I am certainly not ashamed of being a physician. A part of me is tired of talking about this pandemic for sure, and perhaps I do not want to be trapped in yet another conversation about it. Another part of me, however, is keenly aware that as a physician, perhaps more than others in healthcare, anything I say or do with regards to this crisis carries extra weight in the mind of the public at large. That is a lot of stress to add to what I hope is a simple haircut.
The role of physician necessarily carries a lot of responsibility. Though the emphasis in the last decade has been towards team-based care, patients and allied health care providers look towards physicians for expertise and leadership, especially in a critical situation or crisis. Indeed, the CanMEDS framework that defines the core competencies of our profession enshrine these two attributes in particular. The pandemic has heightened the world’s attention toon the words and conduct of physicians to an even greater degree.
Excellence in these roles during this trying time is exemplified in the conduct of Dr. Bonnie Henry over the last few months. The downsides of the responsibility to live up to these expectations are demonstrated in the particularly harsh public response to perceived errors in judgement related to the same crisis both in Canada and abroad.
In this environment, saying or doing the “wrong” thing and being a doctor potentially carries great repercussions for both oneself and others. This is made even more stressful when the “right thing” to say or do is constantly changing as evolving knowledge about this new virus guides our response to the crisis. Even pre-pandemic trying to keep up with and evaluate practice-changing medical knowledge, in general, was challenging – especially in emergency medicine and primary care.
With the flood of sometimes conflicting and occasionally flimsy information on SARS-CoV-2, the challenge to avoid losing touch with the guidelines and provide the most accurate evidence-based information to our patients has become even more difficult. Combined with the previously mentioned responsibilities and expectations, this creates an environment where it is understandable for many physicians to second guess, overthink, and simply remain silent on issues their patients and the public are grappling with, for fear of being found to be wrong later.
In this environment, saying or doing the “wrong” thing and being a doctor potentially carries great repercussions for both oneself and others.
Luckily, in addition to the BC Centre for Disease Control and Public Health, many physician-led organizations have stepped up to help us stay up to date with all of the changing information. Locally this includes the BC Emergency Medicine Network, and at a national level, the Skeptics Guide to Emergency Medicine and EM Cases podcasts and website have also proved to be invaluable. Many international CME providers have also stepped up to the plate to help physicians and allied healthcare professionals stay up to date – I’ve personally found EM:RAP resources (free to access) particularly helpful.
Following the leadership of Dr. Henry, physicians and other community leaders around British Columbia organized town hall meetings and public service messages unifying and tailoring the local response to the crisis. All these efforts, ranging from virtual meetings to radio broadcasts to signage at the local hospitals, in addition to many other factors have undoubtedly contributed to our province’s excellent response and outcomes in this pandemic so far. These actions exemplify the leadership and expertise and excellence in communication becoming of our profession at its best.
But this crisis is far from over. Though we are restarting elective surgeries, and restaurants and barbershops are re-opening, the ongoing threat of “the second wave” continues to loom. Though as individuals we may feel inadequate in our ability to lead, inform and stay informed ourselves during this time of change, I believe as acute and primary care physicians we have a unique responsibility to do the best we can to educate ourselves about this crisis, and in turn, educate and model behaviour for our patients in all settings and roles, professional and personal, we find ourselves in.
I believe as acute and primary care physicians we have a unique responsibility to do the best we can to educate and model behaviour for our patients in all settings and roles, professional and personal, we find ourselves in.
As we prepare for what comes next, I am convinced that if we continue to unite and support each other across the province, country, and world, though individually we may struggle, we will do more than alright – together.
What has your community’s response to COVID consisted of, and did you get involved in any public way? Do you agree with the idea that individual physicians have a unique responsibility to model behaviour and educate the public, or do you think that should be left solely to those in public health? Do you consider yourself a leader in your practice environment to your patients, the staff you work with? What about in your personal life with your family, friends, and the public? What resources have you used over the last few months to stay informed?
Disclaimer: The views and opinions expressed in this blog post are those of the authors and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.
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