CMAJ Blogs: From the sideline of the front lines
As Chair of the Department of Medicine at the University of Toronto, I have a bird’s-eye view of the tremendous impact that the COVID-19 pandemic has taken on our faculty members and staff.
We have more than 800 full-time faculty working clinically across six hospitals and another 600+ across our affiliated community sites. We are responsible for 20 residency training programs and train roughly a third of Canada’s specialist physicians, many of whom also teach, research and work on quality-improvement initiatives both nationally and internationally. It’s a big and truly awesome group of people.
Along with colleagues in other disciplines, our department is an integral part the “front line” of the COVID crisis. Our faculty and learners are providing infection control guidance and patient care in emergency departments, ICUs and in-patient wards.
My job is primarily to oversee the department’s teaching, research and other academic activities.
One of the major advantages of my role is that I have a broad overview of what’s happening across the hospitals and the healthcare system.
Without doubt, the lack of assurance that there will be the necessary personal protective equipment (PPE) to provide clinical care has been the biggest stressor for everyone. Hospitals have to conserve PPE to plan for the absolute worst-case scenario but this has exacerbated anxiety around workplace safety. Rationing of PPE is terrifying if you’re providing care on the front line.
I surprisingly don’t hear much from our department members about fear of becoming ill but there is major fear that they will bring that illness home to their loves ones. Many have had to move out, away from their families, only exacerbating the isolation, stress, and loneliness they are experiencing.
As teachers, there is additional fear that we will fail to provide a safe learning environment for our residents and fellows. It’s an extra burden of responsibility that our faculty members bear, which takes its toll on them physically and emotionally.
And while the public may be hearing that the numbers of patients in the emergency departments and wards is lower than usual – which is true – it is taking that much more time to take care of the patients that are there. The hypervigilance is unprecedented – are we wearing the correct PPE, has it been “donned” appropriately (and is it available)? Updating families who are unable to visit also takes time and care.
I see that members of my department are experiencing a form of emotional exhaustion that is both striking and unfamiliar. And while I am not directly on the front lines, I feel it too. It is the fear and anxiety of the unknown. And as this situation persists week by week, it can be overwhelming. We are working hard to provide resources to support the wellbeing of the faculty but these are folks who aren’t great at asking for help – and I worry they won’t. The aftermath of this pandemic may haunt us as a result.
If the clinical demands of the pandemic aren’t enough to worry about, some of our faculty members have expressed concerns that the quality of their teaching and other academic productivity won’t be up to expectations given COVID-19. How do I get the message out there that academic activities must, of necessity, take a backseat to clinical care right now? We get it and will rejig timelines, deadlines and expectations accordingly.
But it has not been all bad. As in any crisis, good can come from it, such as our ambulatory clinic care. It has largely continued during the pandemic but virtually. This is something I am personally delighted to see advance, and the pandemic has ensured that infrastructure needs to support virtual care have materialized in record time. I have also been heartened by the ingenuity of our doctors to figure out how best to do this in real time, including how to incorporate teaching into this new form of care. These activities will have enduring effects on care and learning that are needed.
Being away from the clinical hubbub is challenging for physician leaders like myself, both personally and professionally. I have always believed that a leader should step up to do what she expects others to do. But how can I be a “visible” leader and role model when physical distancing is required and PPE access is reduced? As I am sure many medical students are feeling right now, I too am desperate to be at the front line alongside my faculty members and residents. But I have been told (and understand) that my duty in this pandemic is not this – at least not now.
I miss the banter before and after departmental meetings. I miss seeing our staff. And I miss the flow of trainees through the department. I am very proud of my department and want them to know that we are working hard to ensure they are safe and well. Even if I am not there with them, I want them to know how much we care about them and how hard our department’s leadership team – faculty and staff – are working in the background to advocate for their wellbeing during this profoundly difficult time. Thank you to all the front line workers. I wish I were there but, from the sidelines, please know that leaders like myself care.