We are creatures of habit, and predictable routine brings most of us rest and peace. We like knowing what to expect through rituals and patterns that mentally map predictably from unpredictable moments. That’s why physicians are known to “look at their schedule” for the day, or for the week. It provides us with a glimpse of what to expect, and thus frames our mind with some semblance of predictability. It is comforting to know what to expect for the day, and each doctor tends to create a schedule or routine for their clinical life that allows them to manage this tension. If you want to see a doctor look uncomfortable, change his schedule, his procedure day, his shift sequence, his staff support, or his workload.
Doctors are conditioned to be calm and logical during tense and unpredictable moments, but trust me, with the daily changes and challenges coming at them from COVID-19, they are feeling unsettled on the inside. Doctors ARE humans too, and the waves of change are disconcerting to them just like the rest of the planet.
The book by Spencer Johnson entitled “Who Moved My Cheese” nicely unpacks the idea that change is part of the human experience. The core message of the book is that things constantly change, so we must adapt. It provides a nice parable for us as we all experience our changing world.
Virtually every sector of our American culture is being forced to adapt to the menacing virus called COVID-19. Politics, Banking, Business (big and small), Healthcare, Education, Entertainment, Globalization, Food Industry-Farming, and Individual Liberty are just a few major categories that have had to radically adjust to this international pandemic that has especially impacted the US.
To be honest, it feels like the changes in my physician world are daily, and the persistent fluctuations wear me down. Although I tend to be an early adopter, and therefore embrace change more easily, the continuous waves of change empty my energy tank. I think that aptly explains my fatigue when I tend to be a high-energy guy. I am seeing fewer patients than I have in years but come home exhausted every night. Even this paradox creates tension for me because it defies my logical view of how patient volume-RVU and fatigue normally associate.
Looking to more deeply understand what is happening to me, I decided to create a diagnostic list of the changes, hoping maybe it would bring a deeper self-awareness of why I was feeling this way. So here it is, and perhaps it will resonate with you.
Professional and Personal Changes For Physicians From COVID-19
Patient Care-Staffing
I used to see my patients at one location within an integrated schedule that was a mixture of wellness, chronic disease, and acute care. I was surrounded by a team of healthcare professionals who all worked together to provide comprehensive medical care. It was efficient, effective, and energizing for me as I touched and talked to my patients one by one, and led my clinical staff.
Now, I only see and touch non-sick patients 2 days a week in person, I suit up in full PPE 1 day a week for sick patients, and a do a bunch of tele-visits the rest of the week. I miss touching my patients and connecting with their lives.
My physical location for the majority of my patient care is in someone’s else’s building (mine is now the FURI clinic) or my home. Being displaced reduces and disrupts many operational efficiencies, and is more unsettling than I expected.
We have cut back our staff with furloughs, moved some support staff off-site, and I am now working in some else’s building. Each of these alterations place unspoken pressures on me and my nurses. We have to handle every little detail that had previously been delegated to our team-mates while at the same time adjusting our clinical operations to the ever-morphing guidelines. We miss our medical home, we miss our nest, we miss our team, and we really miss our predictable routines.
Infection Prevention
Universal Precautions have always been part of our training and clinical experiences. Whether it be the more elaborate process in the OR, or the daily grind of the clinic, we are all used to being cautious. Doctors in primary care have long been known to have robust immune systems that compliment their infection prevention measures, and allow them to mostly evade infections. But this new COVID-19 is strong and elusive, requiring time consuming, and thoughtful cleaning, PPE, and hand location awareness all day long. You can’t let your guard down, while you breath through that uncomfortable mask that you have to tediously and carefully apply and remove. Then there is the constantly changing PPE protocols at the hospital that I attend. This seems to vacillate between PPE stewardship and rigid use to prevent infection spread.
Cleaning our personal tools like the stethoscope is critical, but the most important instrument, after our stethoscope, to remember is our pen. My habit has been to always have a pen with me, but mindfully breaking that habit, as well as repeatedly cleaning it after use has been challenging. They say it takes at least 30 days or more to form a new habit. I have not arrived there yet, so my brain is working overtime on these things numerous big and small things all day long.
Schedules
The staccato of rescheduling patients every day, adjusting to who is available to do face to face visits, which provider is at home, if the patient needs a FURI appointment, working in non-sick acute problems, and funneling all of my OB, pediatrics, and needed face to face visits into two days is extremely challenging. It requires me to think “where am I” and “where will I be tomorrow” all the time. Prior to COVID-19 I knew every trick for squeezing and adding patients into my packed schedule, now I feel lost.
Printing scripts for controlled substances (we are not set up to e-scribe them yet), work notes for COVID-19, downloading faxes, signing all the home health, hospice, dme, mail order pharmacy, etc. are no longer centralized to my one location. These tasks have to be batched on the days I am in the non-sick clinic, roaming in some else’s clinical space. Not a huge deal, but this change prevents me from “being done at the end of each day”. I am one of those people who like to start each day with a clean slate, and right now that is just not possible. When I start my day off behind, because I am cleaning up yesterday’s tasks, it stresses me out.
Public Health
Who is charge of managing and leading in this COVID-19 crisis? Is it the White House, the CDC, WHO, Congress, the individual states, or someone else? As hard as I tried to identify a concrete chain of command within the US for pandemics, I couldn’t come up with one. There are just so many stakeholders within the federal, state, and local governments in addition to a slew of associations, businesses, and organizations who are speaking simultaneously.
Instinctively, physicians look for authoritarian voices within the public health chain for guidance. But there are so many voices that speak to us each day. They include television, social media, email, radio, and all manner of digital feeds which all communicate critical guidelines to the health and inter-related economic features of this pandemic. The voices are from the stakeholders in our circle of authority who all seek to interpret where we are, and where we are going. It can be hard to listen to each one every day, and then try to distill the information down to practical steps for our medical care and patients.
Sheltering in place, social distancing, quarantines, and such have all become normalized concepts that start to get fuzzier as we talk about local and national stats, surges, mitigation curves, supply challenges, and 3 phased recovery plans all simultaneously.
Most physicians are used to being at the top of the authority chain within their clinical space and within their patient population. But now we are displaced from this role as we are mandated social and clinical changes that are rolled onto us day by day. We are forced to adapt and deal with them in the same real time experience that the general public is fed the information. It’s a little nerve racking, and can place us in awkward positions with patients who might walk into an exam room with more up to date news than we have had time to absorb that day.
And don’t get me started on the fake news and social media banter that we have sort through as well. This includes questions about the latest “cure” for COVID-19 that has been discovered by some non-scientist who has out-smarted the world’s medical experts. Truth can be hard to find in this age.
Home
I have written about the numerous changes that occurred for physicians in their homes as part of the process of protecting their families form the virus.
For me, I have taken the aggressive step of moving into our guest house to safely separate from my family, due to the fact that I am working on the front lines.
It is the right move, but this is a massive change for me with some associated psycho-emotional hardships with it. I definitely don’t sleep as well without my wife, and I really miss interacting with my kids. The loss of physical touch with my inner circle, leaves my love tank on the empty side.
Income-Personal Finance
I’ll have to admit, I haven’t thought a lick about the stock market and it’s undulations. My financial planner has taught me to stay the course at our long term plan and ride out both the ups and downs. So I do it, and don’t even look at the numbers.
My accountant rapidly helped me get the CARE Act SBA loan application into our local bank for my medical business. I just got notification yesterday that all the government funds had already been used, so they hoped I would get in the next wave, if congress adds some more money to the pot. So much for small business support from the government as billions of dollars have been scarfed up.
I am financially independent, so the reduction in my productivity and income will be noticeable, but inconsequential. I have prepared for this season by having no debt, as well as having passive income that provides monthly checks. I will simply be thankful for what I earn during the pandemic, no matter the amount. I don’t expect anyone else to fix it. To me that is part of being a business owner in a free market economy.
If you are struggling with some personal financial adjustments, check out this blog for some suggestions.
But the hardest part is to see the negative effect on my staff in terms of hours reduction and needed furloughs. It is gut wrenching to experience this with me team-mates, especially knowing how marginal some of their personal finances are. We keep doing all that we can to allow as many staff to maximize their hours, and stretch them. As the weeks go by, and the losses mount, I expect more reductions will occur. sigh.
Healthcare used to be considered relatively insulated from recessions and economic downturns, but we have discovered that pandemics can break that glass.
As optimistic as I want to be, I think it will take as many 6-18 months for us begin a robust economic recover, which will likely run parallel to the development of a vaccine.
Entertainment
In Northern Indiana we tolerate the winter with the anticipation of Spring. Spring brings the opportunity to freely roam from our home to all sorts of date night spots in our vibrant little town. I have really missed being able to go out with my wife on dates to those entertainment options that range from music, art, dramas, and sports. Screen time does not fill my tank the way sensory arts do.
I do enjoy all types of American sports, and I have found that I miss a mindless and relaxing evening of watching a Cubs game or basketball game in the evenings and weekends. Cancelling football would make me gasp. But this is where my wife has the upper hand, because the Hallmark Channel is always available, regardless of a pandemic.
Faith Life
My faith life is deeply personal and I find it to be a source of hope, comfort, and an anchor during these crazy days. Knowing that God does NOT change provides rest for me as I let him lead me quietly in His shadow.
But I do miss assembling with others in my faith community. I long for their relational support associated with being life on life as we all navigate these changes. My faith is strong, but it’s missing an important human touch each week.
Isolation
Due to sheltering in place and carefully trying to protect my family, isolation has become normative. My work family has dramatically changed, my biological family is now across the street, my faith family is no longer meeting (beyond the Pastor on a screen), and my patients only see me behind a mask. For a relational guy like myself, isolation is a necessary change, but it tends to stop the flow of energy from others that fill my tank each day.
Change is inevitable for each of us. The scope of changes due to COVID-19 is unique to each person, but also common to many.
We must anticipate the changes, adapt to them, and learn to embrace and enjoy them. Do so and you won’t just suffer less stress and unhappiness, rather you’ll enjoy more success and fulfillment in every part of your life.
Change often represents the end of something, but more importantly, it also represents a beginning as well. COVID-19 has created this dynamic in all of our lives. Although, we all long to “go back to normal”, the intra-COVID season, as well as the post-COVID days, will probably be forever different.
What change has been hardest for you? What change is has created the most opportunity?
Dr Inc.
