In April 2020, New York City was under siege by a new pandemic, and Christian Rose, M.D., a San Francisco-based emergency room physician, was in his third week volunteering with a military medical unit that supported hospitals overflowing with patients. Night after grueling night, Rose intubated critically ill people, counseled panicked family members, and tried to support those dying of the disease frightened and alone. By the end of his stint, he felt exhausted, raw. Sensing Rose’s burnout, a fellow volunteer, a member of the Air Force, asked: had he received PTSD training during his medical education? The answer was no.
Of all the tragedies and injustices — large and small — exposed by the pandemic, perhaps few are as overlooked as the impact on physicians, nurses, and medical staff who cared for patients. Many labored for long hours on the front lines while worried about their or their families’ health, while acting as makeshift social workers and public health advocates, and while fighting for social justice. And they continued to serve and put themselves in harm’s way even as some Americans flouted directives to wear masks or avoid gatherings.
What are the ramifications of this pandemic year for medical practitioners? And how might the future of health care be shaped by the wounds inflicted on those we entrust with our lives?
Those were the questions Stephen P. Wood, a nurse practitioner and visiting researcher at the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, and his colleague Chloe Reichel, editor-in-chief of Bill of Health, Petrie-Flom Center’s blog, sought to explore in a recent digital symposium, titled “In Their Own Words: COVID-19 and the Future of the Health Care Workforce.”
Wood, who has spent much of the pandemic working in an intensive care unit, wanted to gather firsthand accounts from physicians, nurses, medical students, researchers, emergency medical technicians, home health aides, and others to learn their takeaways from the last 12 months. The hope, he says, was to spur discussion and inspire better policy for health care workers — and the patients they serve.
“Initially, I had a narrow view of what I thought the impact of the pandemic was, from my own experiences, but this project has opened my eyes to its broad impact on providers and the health care system in general, as well as on patients and families,” says Wood.
Beginning in mid-March, he and Reichel have published one essay each day on Bill of Health from over two dozen contributions received. On March 26, they also held a live discussion event on the same topic.
“The goal of soliciting these personal narratives was twofold: first, there’s value simply in having a record,” says Reichel. “We thought it was important to document the moment while we could. Second, we hope to learn from these accounts to shape law and policy.”
In one essay, Eloho E. Akpovi, an MD/Master of Science candidate at Brown University, pointed to the way the pandemic exposed longstanding racial health disparities, and called for a commitment to better serve Black, Indigenous and other patients of color. Molly Levene, a graduate student at Yale School of Nursing, decried those who called her and her fellow nurses “heroes,” then did little to support their emotional and physical needs during the crisis. Others wrote about the pandemic’s effect on cancer care, women in medicine, and society’s reticence to address end-of-life planning.
“For frontline workers, there was initially a great deal of fear, anxiety, and concern for our safety, which later transitioned to what we call ‘moral injury,’ as we wondered if we were providing the best care possible,” says Wood. “For physicians who were not frontline workers, such as oncologists, there was a sense of guilt that they were not participating.”
To Christian Rose, the emergency medicine physician who also researches in the intersection of clinical medicine, innovation, and humanism, the pandemic only worsened a long-simmering crisis of burnout in the field by forcing already-stressed medical providers to shoulder fresh burdens. In his article, “Scope Creep: Serving Many Roles, Health Care Providers Need a Supporting Cast,” Rose says that medical staff have not only faced shortages of personal protective equipment and long hours, they have also had to step in where other institutions have failed.
“I tell people COVID is a little bit like the apocalypse, which actually means ‘unveiling,’” he said. “It has revealed the flawed ways we managed our systems beforehand. And when you pull back the curtain, all these systems have broken down.”
In addition to the pressure from providing care to very sick patients, many physicians have taken on roles as public health advocates, social workers, and mental health counselors, says Rose, in an effort to address their patients’ full range of needs. This is, he says, in addition to extra tasks at home, such as monitoring their children’s remote learning and childcare.
And “with the events surrounding the deaths of Breonna Taylor and George Floyd, it became evident that no matter how much work they did in the hospital, [my colleagues’] efforts to improve the health and wellbeing of their community was nearly impossible without social activism,” wrote Rose. “So, when not intubating critically ill patients or volunteering their service in overwhelmed hot spots … some of my most resilient colleagues committed themselves to organizing and supporting #WhiteCoats4BlackLives protests or petitioning for legislative change.”
In Rose’s view, this has pushed some providers to the brink, which could lead to them exiting the field entirely. This would not only be detrimental to physicians themselves, he says, but also to patients who lose access to talented and compassionate caregivers.
“We should care because care will suffer. If your physician isn’t happy, supported, and feels safe in their job, much like how we can’t expect our patients to get their health needs met if they don’t have psychological and physical safety, providers will not be able to work as well and focus as much on you,” says Rose.
John C. Messinger, an MD candidate at Harvard Medical School, worried that the pandemic had stripped medical students like himself of critical interactions with patients. In his essay, “Learning During the COVID-19 Pandemic: The Importance of Humanism in Medicine,” he recounted how remote learning, coupled with new safety protocols and hospital restrictions, had resulted in more difficulty connecting with those receiving his care. While barring family members from facilities might be necessary to prevent spreading COVID-19, it had the downside of “hampering their ability to give texture to the lives of patients or to participate in their loved one’s care,” he wrote.
Further, Messinger said, the personal protective equipment meant to keep him safe, such as masks, face shields, gowns, and gloves, “obscure human expression and touch that are instrumental in communicating empathy between patients and caregivers.”
He hoped that medical education — and the field itself — would keep these important interactions in mind once pandemic rules were eased. “In times such as these, when all of our efforts fail to combat illness, human connection has more value than any medicine we are able to provide,” Messinger wrote.
Part of the Petrie-Flom Center’s mission, says Reichel, is to offer policymakers and advocates unbiased legal and ethical analysis of pressing questions in health care today — questions that have only become more urgent in the last year.
“Through this symposium, a diverse swath of health care workers told us what they think is wrong with the health care system, and what supports they need going forward,” she says. “We hope these accounts might create meaningful change in health law and policy.”
“I think there’s a lot to learn from this experience,” added Wood. “The hope is that this might highlight the need to re-envision the heath care work force and our preparedness for future pandemics. What the last year has exemplified is that we are a caring profession, and we want to care for you. What we hope for in return is that you care for us.”