Professionalism of Clinicians and Healthcare Leaders During a Pandemic

How do we define clinical excellence during a pandemic? A few weeks ago, we were seeing patients in the office and N-95 masks were sitting in boxes in the hospital supply closets. Now, HHS has relaxed HIPAA, many states are under stay at home orders, and we’re scrambling to redefine our role, and to figure out how to deliver excellent patient care under less than ideal circumstances. Healthcare systems are not known for being nimble, and large organizations, used to rolling out changes over months to years, are being asked to make changes on a scale of hours to days. Many of us are experiencing a sense of whiplash from the changing guidelines, and as recommendations for personal protection are being relaxed for political/financial/pragmatic reasons and against scientific evidence, moral distress is peaking. Many with personal health risk factors, sick family members, or a myriad of other reasons, are weighing whether it is safe to go to work, and if not, how to protect the careers they have spent decades developing. Right now we need leadership who can rise to the occasion, be supportive of their workforce, and take the long view amidst crisis. Now, more than ever, we must not sow discord among ourselves, but instead support our colleagues as much as possible while many of us face some of the most difficult choices of their lives.

COVID-19 is an unprecedented test of our healthcare system and of the values we hold most dear. How can we practice humanism when our very lives are in jeopardy? It should be no surprise to us that during a global pandemic, this tension is higher. Right now, many clinicians feel compelled to serve in any way possible. Some physicians over 60, or with medical comorbidities, cite the Hippocratic Oath as they continue to see patients in person and demand others do the same. Others, feeling uncomfortable with the risk, are asking to work from home.

Unfortunately, those voicing such concerns are frequently finding both their leadership and peers dismissive, or even worse, judgmental about which personal reasons qualify for exemption from in-person duties. While some shift in workforce will be necessary to contain this disease, it is essential that the decision to be on the front lines be voluntary, and that those who choose to go there be supported with adequate PPE, housing, nutrition, and psychological support. Anything less than that would simply turn nurses and physicians into additional patients.

Many administrators tell clinicians and staff members to go into the office so that they can bill higher facility fees. They do so despite what we know of high rates of asymptomatic transmission in the community, even though we have safe alternatives such as telehealth available. Not risking unnecessary exposure and conserving PPE right now is our moral imperative. Just as we are minimizing the number of team members physically going into rooms with COVID-19 patients, so too must we minimize trips outside the home for outpatient clinicians and clinical support staff. There will always be some tension between how we define an “essential worker,” and some members of the team will ultimately be needed for in-person care, but we should not feel bad asking the person already in the room with the patient, to hand them a tablet, so that the other individual does not risk exposure. For the in-person work, whenever possible, we should be asking for volunteers, and offering appropriate hazard pay. We should not be increasing the exposure risk of a greater number of individuals under the guise of fairness. Whenever we can continue to support our patients from a place of safety, we should do so. Disregarding this imperative for financial gain, being an accessory to such disregard, or even condoning it, is an unconscionable violation of our oath to “do no harm.”

Clinicians are banding together across the country on social media to share information and best practices, a beacon of light across the darkness. We know that innovation is possible because it’s happening in other places. We must learn from each other quickly, before it’s too late. Maybe your own institution has never imagined rounding with a tablet over video, but for many hospitals in rural communities, this has been the reality for years. There are leaders out there who put safety first for their clinicians and patients. They are preserving a vital physician workforce into the future. They have been allowing phone check-ins before the billing codes were figured out, and have been encouraging people to work from home, even if this might generate less profit for the institution. On a good day, face-to-face patient care might feel like the clinically indicated best option. Now, however, the best care should be the care we are able to deliver while minimizing risk to ourselves and to our patients. We have the tools available, and we must not allow perfect to be the enemy of good.

I call on all chairs of departments, medical directors, and program directors to think creatively about maximizing the safety of your workforce. Create as many telehealth clinics as you can. Let mental health clinicians answer calls from front line healthcare workers in distress. We must stop pointing fingers at each other. More than ever, we must understand that preserving our humanity and ideals may be increasingly challenging, and could become outright impossible without empathetic mutual support for each other.

Provide those who wish to volunteer on the front lines with the appropriate PPE and training to do so. For those willing and able to work remotely, enable them to do so. Instead of pointing fingers and judging each other’s motivations, each of us should strive to provide the best care possible, in the way that we deem the most appropriate, while working towards building our clinical capacity to meet the needs of all the patients trapped at home. Clinical excellence in a global pandemic means doing what needs to be done, and that is different for each of us. It requires bold innovation, reinvention, and adaptability to quickly evolving circumstances.