The Shattering of Medical Myths

Hi, my name is Dr. Emily Silverman I’m an internal medicine doctor in San Francisco. I’m also the creator and host of The Nocturnist, a medical storytelling live show and podcast that collected hundreds of audio clips from health care workers across America when the pandemic hit in the Spring of 2020. So, in addition to having my personal experience taking care of COVID patients in the hospital, I’ve been fortunate enough to hear the voices and experiences and thoughts and emotions of hundreds of health care workers across America as they dealt with this crisis.

I think one problem that really came up when the pandemic hit was how burned out the American health care workforce was before the pandemic even arrived. If you can imagine a situation where hospitals and clinics are chronically understaffed, and people are showing up to work and giving the best they can, but they are asked to do more and more with less and less. It leads to a tremendous problem of burnout and moral injury where you’re not able to deliver the care that your patients deserve. There’s really no gift of time anymore, there’s no ability to sit down with patients and get to know their stories; it’s just a lot of running around like a chicken with your head cut off trying to make things work and exist in survival mode. That became even more pronounced in a pandemic where the hospitals were getting flooded with patients, and there was just no buffer zone to absorb that kind of capacity. So that was one issue that came up.

The other issue that came up was the problems of medical culture. In medical culture we have this myth, the myth of the physician hero, the myth of the physician God, the myth that physicians are perfect, that they don’t make mistakes, that they know everything, that they don’t have bodies, that they don’t get sick, that they don’t need sleep, that they don’t need sick days, that they don’t need mental health care, that they don’t live with diseases themselves; these are all tacit assumptions that are built into the way health care systems are staffed, and the pandemic really shattered all of those myths.

I think, moving forward, one thing we’re going to have to do is realize that health care workers are humans too. They need to be supported, they need to come to the hospital and have the time and space to take care of themselves in addition to their patients. That means things like bathroom breaks, nutrition, moments of rest during the day; it also means having an iron-clad sick leave policy, and a culture where it’s okay to call in sick. Because right now very few physicians call in sick, and that became a big problem during the pandemic. Suddenly people were saying, “no really stay home this time,” whereas before it was almost a source of pride that a physician would show up to work sick. Usually because they didn’t want to burden their already overworked colleague by having that colleague take on double the work for them. Again, no redundancy whatsoever built into the system.

I also think that focusing on mental health and providing health care workers with resources and also encouraging a culture where it’s okay to seek mental health care for the variety of mental health conditions that physicians face; that includes things like burnout and moral injury, but also things like anxiety and depression. We know we’re going to have a huge wave of PTSD; we’re already seeing it among the health care workforce, and also things like the second victim syndrome and the distress that health care providers experience when there is an error or adverse event.

We really need to start putting systems in place to support our workforce and make sure they are given the resources to cope with the demands of the job; the emotional, spiritual, physical and intellectual demands of the job. So, moving forward I hope that we’re able to care for the caregiver, so that our doctors and nurses can show up to the bedside feeling healthy, energized, curious, refreshed and ready to take care of the American people so that we can have the great health care system that I know we can have in this country.