Physician Leadership is Essential
By Stephen Kennedy, MD, FRCSC
Today is 4/15/2020. In Washington State, we are 10 days following our peak resource use on 4/5/2020, and we are cautiously optimistic that our hand surgeons will not be called to the ER or the ICU, and that we may be able to resume some elective surgery in our semi-urgent patients in the coming weeks.
At the University of Washington, the leadership within Hand Surgery, Plastic Surgery and Orthopaedic Surgery rapidly implemented modified schedules within our residents and faculty to mitigate risks and preserve essential services at Harborview Medical Center, our Level 1 center for the WWAMI region. Our combined hand surgery section divided into two equal groups of faculty and fellows, with mix of plastic and orthopaedic trained surgeons. We provided in-person clinical care in alternating weekly cycles without overlap between the teams. Surgeons over age 60 were asked to serve as backup reserve as they continued to provide leadership, do telemedicine visits, and elevate trainee education using online options. The process was daunting, with many patients to be called and rescheduled, especially as it seemed that the news and predictions were changing every 12-24 hours, but the collaboration, communication, and trust of our surgeons and administrators made the process effective.
One lesson for me, personally and professionally, during a crisis but also in our “new normal” going forward, is that physician leadership is essential in our institutions and government. Fortunately at my institution, our physician leaders (Chairs, Program Directors) were attentive to faculty and residents, and advocated for them. Review of news reports and anecdotes from various institutions, however, suggest that this was not the case universally. When the crisis is over there will be time to consider the role physicians play in treating our own patients, protecting ourselves from illness, and differentiating what is appropriate practice from limitations due to scarcity of resources. If a surgeon reschedules elective patients based on their medical understanding of an advancing pandemic, are they “going rogue” if their hospital administrator didn’t approve the change beforehand? Are surgical masks “ineffective” at preventing transmission of respiratory infection in outpatient clinics, or is it more accurate that they have some effectiveness but are a limited resource? Is it appropriate to terminate a physician who criticizes the lack of personal protective equipment on the front lines of care?
For many physicians in the U.S., the peak is not over, and we may have rebound curves and ongoing challenges to come. How are we going to be affected by this, personally and professionally? Simon Talbot MD, reconstructive plastic surgeon at Brigham and Women’s, and Wendy Dean MD, psychiatrist, have reframed the concept of “burn out” of physicians to what is actually “moral injury”, and I highly recommend their articles on the subject. To best address future “burnout”, physicians need to continue to speak up and work together. Physician leadership through our institutions and societies is going to be more important than wellness interventions from our hospitals. I feel fortunate to be part of a highly coordinated and supportive group of hand surgeons, orthopaedic surgeons, and plastic surgeons, and I look forward to seeing continued leadership from physicians in the current crisis, and to follow in the “new normal” to come.