April 21, 2020

Health Care

Since medical school I have had an interest in the culture of medicine. I have been an amateur anthropologist, watching how the modern “health” care system dehumanizes both patients and the people working in the system. It is a sad and pervasive problem, egged on by the corporatization of healthcare. As a colleague once said “self care is at odds with the corporate goal”. I myself have been victimized by the system, and have suffered burnout and what we are now calling moral injury. Moral injury is similar to what war veterans can have; when one witnesses, is unable to act, or can’t prevent an event that goes against deeply held moral beliefs. This is hurtful to physicians and others who go into medicine with the desire to help. Doctors take the Hippocratic oath to do so, but find themselves in situations at odds with their values.

Lately though, the ship has been turning ever so slowly to look again at these issues and help clinicians find meaning and joy in their work again. This is one of the projects I have been actively working on for the past year. We are making slow and steady progress. Just like with addiction, admitting there is a problem is the first step.

And then comes a pandemic. Here in Seattle, we have slowed down our work on this topic to focus on what we were trained to do. That part is good. We are lucky here. But in cities and countries with overwhelming number of cases the situation is dire. When hospitals and our country put these workers in dangerous situations without proper equipment, that is moral injury. We are not caring for the carers. This is unconscionable. Putting their lives at risk without proper PPE is a failing of our country and we should be ashamed. Afterwards, these heroes will need crisis care to feel whole again. We owe them that.

We owe them our thanks and support now. This is good article about talking with them about their experiences. It uses the “ring theory of grief” which gives a wonderful framework to support them, or you, if you are in the middle of this crisis. We also owe them our staying home and hanging in there, until the risks go down. We want to avoid overwhelming the system so they stay safe, both physically and mentally. That is true Health Care. We are all in this together.

Wash your hands.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://www.washingtonpost.com/opinions/2020/04/17/how-not-say-wrong-thing-health-care-workers/

https://www.medscape.com/viewarticle/927859#vp_1

https://www.ncbi.nlm.nih.gov/pubmed/19683376

https://www.bloomberg.com/opinion/articles/2020-04-10/coronavirus-psychological-crisis-looms-for-medical-workers

https://time.com/5817435/covid-19-mental-health-coronavirus/