Today on the podcast we’re talking about choices, power and powerlessness in the era of COVID-19.
This is something that’s really been a very hot topic and I’m hopeful that by the time this podcast airs in a couple of days, maybe we will have made some serious progress in this space. Day by day we’re getting new guidance, new guidelines and people are making different types of choices.
In This Episode of The Career Rx We’ll Discuss:
- Fear and anxiety of health care professionals during the COVID-19 crisis
- Making hard choices about work, safety, and social responsibility
- How considering a broad set of possible outcomes can help you make tough choices
- Real examples of hard decisions our colleagues are making right now with COVID-19
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TRANSCRIPT AND SHOW NOTES
Hey there friends! Welcome to The Career Prescription podcast (aka The Career Rx). I’m your host Marjorie Stiegler.
Today is the day that the CDC said that they changed their stance from if you have a known exposure to COVID-19 that you should quarantine for 14 days. They’ve gone from that to say, if you have a known exposure, it’s okay to work as long as you have a mask if you’re a healthcare professional.
A face mask. Importantly – not a fancy face mask, not any specific kind of face mask, but just a face mask. Then, in that same sentence, they acknowledged that we have a serious shortage of face masks and so, therefore, recommending even something like a simple bandanna. This, of course, has not been demonstrated or approved as any type of personal protective equipment in the medical sense.
So this is really quite drastic and I think it’s worth identifying a couple of things.
Choices, Power and Powerlessness in the Era of COVID-19
A lot of health care professionals are experiencing a tremendous amount of fear and anxiety about going to work, about being exposed to COVID-19 and about transmitting to their loved ones. They’re also worried about contributing to the public health correct health crisis in general, in addition to thinking about their own families.
One of the things that I think worth highlighting about this is the reason the CDC has loosened these guidelines is not because they don’t think it’s necessary anymore, but because we don’t have enough.
They’ve changed their language to say that now you can be “allowed” to work (as I heard in the news). You could be allowed to work even if you were positive, so long as you had a mask.
This, therefore, allows your employer or your partners or whomever to justify continuing business as usual -even if you have a particular reason to be concerned about your exposure.
And of course, we know in many states, including in my own, there is now documented community spread, so you really don’t need to have had any kind of particular history or exposure in order to be at risk, right?
A person can be totally well appearing and still be contagious and perhaps never even get sick. If we’ve learned something from the sports teams that have tested their entire groups for COVID-19 regardless of symptoms.
So we know there’s a lot of fear.
Today I saw a live video post of media coverage from some folks that we know through some of our physicians, Facebook groups, on CBS and on other major media, pointing out that, we’ll have it, we’ll spread it – even before we know we have it.
Many Physicians Have an Internal Conflict
Between wanting to do their best for patients, show up and support their colleagues and live up to what they feel they should do as physicians. On the converse side which is that they might bring that home to their kids, elderly parents or to their spouses and endangering their family members.
So this made me think of a few things, and in particular, it made me think about that balance of power and of choice.
The other day I was on Twitter, doing a live conversation about the same topic, and some folks were answering back with their comments, saying that their employers had not given them a choice.
“My employer will not let me take time off if I wanted to take time off.”
I thought that is something that’s really worth flagging. A lot of people are feeling pressure in that way right now. As doctors, we do feel an obligation to call to duty and we do want to take good care of patients, but nobody has given us a permission slip to make any other decision.
To clarify, I am not advocating that you guys stop going to work. I am grateful for the people who are on the front lines going in and seeing patients every single day.
But, what I do want is for people who are feeling really fearful, let’s talk about a couple of truths…
You Have a Choice About How To Respond in This COVID-19 Epidemic
Whether your employer gives you permission or not, none of us have to do anything.
You do not have to go to work – you can choose to go to work.
When I say this, and not only just in this circumstance of COVID-19 but at my retreats, when we’re talking about career decisions, priorities and values, people will often say, “but I have to do this”. “I have to do that, I don’t have a choice in the matter.”
The Reality is that You Do Have a Choice
You probably have already done a risk-benefit analysis, and you’re choosing to do it because, at least for you, in your mind and in the moment, the apparent risk-benefit analysis for doing whatever it is that you have to do that is better than the risk-benefit of choosing to not do it.
So certainly you can say, I know that I’m not coming to work anymore until we have sufficient testing, sufficient personal protective equipment and sufficient policies (or whatever it is that would make you feel more comfortable.
We are pre-surge right now. I hope that by Tuesday when this podcast goes live, this is still the case. The ICU isn’t overflowing with COVID-19 patients. That’s not where we are yet and I hope that we don’t get there, but it’s certainly not where we are right now.
So given this context, it’s not like there’s a patient abandonment issue.
You Can Influence Decisions
There is a real opportunity to help influence the kinds of decisions that could be made right now to mitigate risk in terms of elective procedures, policies, what kind of resources are needed?
This is a time that if you decided to make a decision to not go to work, to do elective cases or elective care in order to send that message that you’re not going to endanger yourself, your family or the rest of the patients.
Depending on your decision there are potentially negative consequences.
If you’re not going to show up for work, then perhaps you’ll lose your job or perhaps you become the catalyst that really changes things for the better, and you are a thought leader.
You might pay a super stiff social penalty. I know what’s in most people’s minds is that your colleagues might resent you, they won’t understand or they’ll think that you took the easy way out.
We have all of this internal narrative of what we think we will be met with.
Make a Choice That’s Right for You and Your Family
Then maybe you think you’ll have failed in terms of what is expected of you as a duty but in any case…
- It’s your choice to decide that you aren’t going to expose yourself to the risk of COVID-19.
- You aren’t going to expose your family to that risk.
- You will not expose the rest of the patients and health care professionals to the enormous risk of the spread.
As people don’t like to discuss this, but you as a healthcare professional could be making a health pandemic worse. We’re making it worse by going to work and agreeing to work under conditions that are unsafe and could be mitigated.
I acknowledge that when there’s a big, huge surge, you have these life-threatening conditions and everyone has the best protective equipment that still, the risk is not gone. However, there is a lot going on in The United States right now that is excessively risky, it doesn’t need to be that way, and different choices could be made.
So remember, you do have a choice.
Organizations Have a Choice About Work Environments During COVID-19
The other thing to point out is that the organizations you work with have a choice and they’re making one.
Perhaps they will evolve their choices over a few days or weeks, but they have made, in many cases, the choice to continue doing this kind of elective work.
Work without sufficient protective equipment where they are asking their clinicians (or perhaps making them feel like they have to) work in non-necessary healthcare functions. They are doing this without proper testing or protective equipment.
Organizations are making that choice. Why they are making it is obviously very complicated.
I don’t know all the answers and I don’t think I could have a short podcast that also brings into play economic solvency of a health care system and how the people making these decisions have real tangible incentives.
They have reasons, they have motivations, and they are making choices.
Just in as much as they can choose to ask you to work without the proper protection, without sufficient testing and without insisting on that, they could also make it more possible for you to have what you need to work in a risk mitigated situation.
But they’re making whatever choices they’re making, so you should also feel like you can make a choice. You do not need to feel like this is one-sided, that the health care system trucks on as it does and you’re the one who’s chosen to step back.
Choose to Advocate
You can choose what will hopefully become some thought leadership, even if it’s initially unpopular, it could still be the right thing to do.
You also have the choice to just do whatever you’re assigned regardless and while that may not help anything get better, that might be the right decision for you.
People are still showing up for work as health care professionals, despite very valid concerns – not only for themselves but for their families, for the overall spread and containment of the virus.
As a physician, you also have a responsibility to yourself, your loved ones, your family and also to society. So your decision, to show up when you are not being supported when things are not being managed appropriately contributes to that.
The decision to stay home is a very strong, potentially very unpopular one, with a list of consequences. However, this really advocates for the necessary changes to protect the health of everyone.
I have gotten some stories this week from a lot of folks telling me that they’ve made the hard decision to simply not go to work anymore. They have decided to remove themselves from the situation.
I want to reaffirm to anyone listening… Your life is your life. It is okay for you to make whatever decision is right for you.
That’s why it’s so important to have a very clear grasp of your personal values.
This helps to make these kinds of decisions with much less anxiety or guilt, even when they’re tough choices.
Define The Outcomes of Your Choices To Help You Make Tough Decisions
This is really no easy option in many of these choices and there is value and merit on all sides.
To make hard choices, having that very crisp and clear understanding of your values is really helpful and there could be consequences or repercussions.
All choices have outcomes, which can be both good and bad.
In times of stress and uncertainty like we’re dealing with right now, here is a suggestion:
- When making tough choices clearly articulate the potential outcomes.
- Then you can make choices around these anticipated outcomes.
Defining the Outcomes – Example:
I’ll give you an example, that’ll feel much more trivial compared to the COVID-19 crisis, and I think that’s good, as it helps us to wrap our heads around things.
Recently in the Schedule Detox Challenge (a 5 day schedule detox about reclaiming your time, your energy or autonomy and your boundaries.
One of the surgeons who did the challenge with us was resigning from a committee. This was an important hospital committee related to accreditation. It had been something that was a big win for her at the time and it was important to her boss. Anyway, she didn’t want to be on the committee anymore.
As she was, trying to resign, she had that usual apprehension that she’ll be somehow letting people down, that her colleagues will feel disappointment or even resentment. She also feared that she wouldn’t be able to resign because people will push back and try to renegotiate her back.
So, she had internal predictions of what was going to happen when she finally did resign and instead, the most remarkable thing happened. Something she would not have listed as a potential outcome.
Instead of having everyone expressing a lot of disappointment and frustration, what happened was the entire committee disbanded. They took a careful look at what they were doing, and the fact that she was resigning from it caused them to pause and say, what is the void that we need to fill now?
This sparked them to realize that the committee wasn’t actually needed.
It’s duplicative of efforts with other committees and other people also do not necessarily need to be spending their time doing this. Not only was she freed from that responsibility, but it turns out it had been something that could free up a lot of people from a responsibility that was not that impactful.
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I hope as you’re listening to this today, this exercise will impact how you list potential outcomes in the future.
So again, this example is a little bit trivial, but it’s a great example of someone acting boldly and bravely and ending up being seen as essentially a thought leader.
This is thought leadership because it caused a full reconsideration of the committee and it gave other people their time back.
What I’m seeing in a similar space here among health care leaders, health care clinicians and physicians are they’re getting involved in political activities and social media postings. People are sharing their strong physician voices in the media, raising the flag about insufficient testing, inadequate protective equipment and how this is a danger.
As a healthcare worker or physician, you have a few choices to really speak out about:
- Continue to just show up, feel fearful and feel out of control, or
- Make the decision to just not participate.
Speaking up and the decision to not participate are the ones that would likely affect some real change that would benefit all of society as a whole.
Standing up for Your Choice During the COVID-19 Crisis
As I’ve been talking about this, I’ve been getting some great comments through Facebook and Twitter and direct messages with people who have made some really tough choices.
Some examples I’d want to share:
Post topic: How people are handling the current situation of COVID-19…
A physician who had had prior exposure to chemo and radiation and was still feeling some immune compromise, though not sick, and said…
“You know, I just don’t want to put myself, my husband or my kids through this and I’m not going to go to work.” She asked, “Am I being selfish?”
She was feeling so, so guilty.
It was really heartening to see that the community was supportive saying, “you’re doing the right thing, don’t feel guilty.”
This physician is at increased risk, but even without that valid reason, she has just as much of a valid reason as any person to avoid this risk. She doesn’t need some special circumstance to want to live, to want to reduce transmission across society and to protect her family.
Post Topic: Let me know if you’ve decided to stop working with the risk of COVID-19.
I got a note from a person who said,
“I’m per diem. I usually work about 30 hours a week. I have got three small kids all under the age of six. One of them is an infant, and my husband stays home with them. I’ve decided not to go back to work until this has passed. There’s insufficient testing at work and insufficient protective equipment.”
She says which I just loved…
“There are promises I made to my husband when I married him, and I made promises to my kids that I would be there for them when I had them. I won’t jeopardize their lives because some administrator is concerned about the bottom line and not the safety of all involved. I cannot with good conscience put them at that risk and make that decision for them.”
I thought that was incredible.
She had a really clear value that was articulated in her message to me about why she’s making the choice she’s making, and it’s not an easy choice to make.
Often, we think that when another person is making a choice, we feel slightly envious. We wish we could make the same choice. But we turn internally and say, I can’t do that for myself. I could never make that choice.
We assume that other people have some mitigating circumstance that makes it easy.
But I listen to this story, and I think that it is uniquely difficult. It’s certainly no easier than for the rest of us. It perhaps is on the side of being more difficult than for most people. But in any case, she’s making the right decision for her.
Having Choice and Power During The COVID-19 Crisis: My Closing Thoughts
As doctors and healthcare professionals, we often have deep respect and good relationships with our actual co-workers, but when you think about the healthcare industry as the big machine that it is, it becomes very clear.
Why would I prioritize wrong decisions being made by that big machine compared to the personal commitments I have? The commitments to my family, my community and the responsibility I have as a physician leader to do the right thing.
I hope this is good food for thought for anybody who is still working in some sketchy circumstances where you really start to think that you could make an influence, beyond accepting what is unsafe.
As physician leaders, you’re the ones who are going to be able to mold that space and have influence over the right thing to do. Not only for you but for everybody.
I also hope this episode of The Career Rx has been helpful for you as you’re thinking about other types of decisions, perhaps more trivial decisions.
When things settle down and you’re making different career personal decisions, you can think back to the person who rolled off the committee, and then the committee ended up being disbanded. Or think of some different ways to consider the outcomes and to consider your own autonomy.
One of the best ways to manage fear and anxiety is to understand the degree to which you do indeed have power and choice.
All choices involve some outcomes.
Some of those outcomes may not be pleasant. You are, however, the one who will have to weigh in on the balance; whether or not a certain choice carries on with the status quo that’s being asked of you, versus a choice to disrupt it. Which one is right for you and which one is the right thing to do just from a broader, perhaps more ethical perspective.
I hope in the next episode we can have something more light-hearted, but I will continue to focus on COVID-19 and other timely events that are both important for your career, for your well being.
Take care of yourself and each other.
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Thanks for joining me on this episode of The Career Rx Podcast.
Please be sure to subscribe and leave me a review on Apple Podcast, Google Podcast or whatever podcast player you’re using to listen today. Also, be sure to send me your questions so that I can answer them and give you a shout out on a future episode.
Bye for now,
Marjorie
