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Physician Advocacy In The Age Of COVID-19

Discussion in 'General Discussion' started by In Love With Medicine, Mar 24, 2020.

  1. In Love With Medicine

    In Love With Medicine Golden Member

    Jan 18, 2020
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    In “Why doctors should get political,” I focused on the need for doctors to voice their opinions in order to rally patients and inspire them to take control of their own health, but what about the responsibility we have to ourselves, our families, and our colleagues? Who will advocate for us as health care providers and especially for those on the front lines putting themselves at risk every day?

    In the midst of the coronavirus crisis, while the focus has been on eradicating the spread of the virus and practicing social distancing to flatten the curve, little has been done to ensure those on the front lines are well-prepared to take on this arduous fight. Health care providers across the country have been using their voices to urge leaders to take heed of their concerns regarding equipment shortages such as ventilators and lack of personal protective equipment. The COVID-19 crisis has also shed light on the grave inconsistencies within our health care system, ones that we knew were already present, but did not anticipate having to deal with on such a grand scale.

    My home state of New York, being the epicenter of this crisis is already invoking wartime imagery as many of my colleagues who work in ambulatory settings are essentially “drafted” to work in the EDs, ICUs, and inpatient settings throughout their hospital systems. They are being expected to handle situations they do not typically deal with on a daily basis, all the while doing it without proper protection. Having trained in NYC and being cognizant of the lack of support and equipment most NYC hospitals already struggle with, it’s no surprise that a pandemic such as this has created an immense burden on the health care system. This “all hands on deck” approach while necessary, has understandably engendered resentment and outrage amongst health care professionals who feel their protection is not being taken seriously. Over the last few weeks, we’ve seen the images of health care providers holding signs that read “we stay here for you, please stay home for us,” signed various petitions advocating for measures to help protect health care workers, watched as good samaritans pitch in and fashion masks designed to protect us and read the multitude of stories recounted by health care workers refused testing by their hospital systems when they come down with symptoms because “there aren’t enough tests.” Meanwhile, celebrities are getting tested for minor symptoms.

    The discrepancies within our health care system are made clear. The rich and powerful get access to testing merely because of who they are, whereas the health care workers on the front lines who need it the most are being denied. We are just expected to keep our heads down and continue working despite the conditions, despite the fact that we may go home to our loved ones and unknowingly infect them, despite the fact that we ourselves may be immunocompromised, elderly or pregnant, despite the fact that we do not have proper armor or ammunition to fight a war that seems insurmountable.

    Some of us even feel guilty for having concerns over our own well-being. We tell ourselves, “well, we signed up for this”-this selfless mission of medicine that teaches us to serve others, always put our patients first and provide equitable care. We were taught throughout our training to respect authority, make a good impression, achieve “honors” on our rotations, make personal sacrifices, and do it all without complaining. We are submissive to the demands of our profession. This is not the time however, to be submissive and put all our trust in authority figures because authority figures are not producing results. We must be a faction that breaks off from the commander and dictates our own trajectory.

    We’ve committed our lives to the well-being of our patients, but how can we make our patients better if we cannot take care of ourselves? How can we provide “equitable care” if we are deciding which patient’s life to prioritize because we do not have enough ventilators?

    We were given a window into what the very near future held by Italy’s account of the conflict health care providers were faced with. As quoted in the New York Times, Flavia Petrini, the president of the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care referred to the dilemma as “catastrophic medicine,” which requires a system of prioritizing which patients have the “best chance of success” and “best hope of life” considering the shortages of life-saving equipment facing the health care system. This does not sound like equitable care; this sounds like rationing of care to compensate for the failure of the system that was built to protect our patients and protect us.

    We need to stay healthy for our patients, but also for ourselves and our families. We need to mobilize the faction not just with regard to this pandemic, but by anticipating the arrival of others. So how do we advocate for ourselves? A great way to start is continuing our conversations amongst our colleagues and sharing experiences, looking to local businesses in our communities who are helping us procure masks and other supplies (several salons have already started contributing their supplies to local hospitals), and demanding more from our government going forward. Our government is prepared to increase spending when it comes to the military (in 2019, Congress authorized 716 billion in military spending), but health care workers are now in the midst of a devastating war, and all we are offered are substandard responses, “there aren’t enough tests,” “do what you can with what you have,” “wear bandanas” etc. Remember these moments going forward. Remember the failure of the system to support us. Remember the fear, the anxiety, the guilt for not being able to do more. Take these wartime memories and harness them into political power because we are far more powerful as a unit than we are as lone warriors.

    Jessica Kiarashi is a neurologist and can be reached on Twitter @jkiarashimd.


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