The night of March 19, I finished what was supposed to be a 12-hour shift. It had turned into a 14-hour shift mainly because I was there talking to nurses and fellow doctors, people coming and asking me about the shortage in personal protective equipment (PPE).

Immediately after that shift (one during which I had worn PPE), I tried to reflect on the experiences that my team and I were having as part of the response to the COVID-19 pandemic.

One of the things that came to mind is something that I would share with all providers. It’s abundantly clear that the COVID-19 response is an exercise in two things at an operational level: adaptability and communication.

Communicate to Build Trust

 

Even outside of a crisis, communication is vital at every single level of healthcare, but now it’s even more important. When I'm interacting with each of my providers, and they're texting me at all hours asking me about PPE shortages, it is incumbent upon me to communicate why there is a shortage, what we are doing and how we are responding to it. That level of transparency is crucial.

One thing that non-clinical people and non-emergency medicine providers may not know about emergency medicine physicians is that they are adaptable. On the frontline, we have to be able to be prepared for change. However, adapting is more difficult when you're having to do it at an operational level. In any aspect of life, adapting to doing something different is difficult, and it’s scary because it typically represents unknowns and is associated with obstacles.

That difficulty is why the first thing that I ask my providers to do is communicate with me. How a team communicates is a big part of developing trust between team members, and that trust is essential if frontline clinicians are to overcome the challenges that COVID-19 brings. If people think I'm hiding information about PPE shortages or hiding information about how scary this situation is, I'm not going to build that trust with them, and the communication breaks down.

It is all about the relationships: relationships with fellow emergency medicine physicians, with our nursing staff, with our administration and with Envision. There has to be trust there before you believe what's coming out of people's mouths and before you feel that people are actually working hard for you. As such, I have tried to provide that with my clinicians.

Be Transparent at All Levels

 

Providers have to know that they have administrative and executive support. Frontline providers aren’t always interacting with administrative staff and executive leadership, which can lead them to assume that those people aren’t being as active as they should be. As I’ve been working with hospital administration and Envision to dig into operational issues, what I have been finding is that everybody is committed to doing the best that they can.

In many ways, every person I have interacted with has absolutely dedicated their lives to trying to help the situation. I find very few people who haven’t. It’s important for our providers to hear that because they don't have the opportunities to see that firsthand.

Confront Fear, Embrace Your Ability to Help

 

This is a crisis, and it’s a scary one at that. However, I am not trying to candy-coat it to any of my providers. Everybody has different things that they are scared about. My team has multiple providers who are pregnant. They have questions about unknowns for which there is no data, and we do the best we can to answer those questions. Those individuals step up every day, and they're working.

My career has taken me to developing countries and third-world countries. One thing I have come to learn is that what people want more than anything in life is a sense of purpose. Oftentimes a sense of purpose comes from the sense that they are able to contribute, yet I've come to realize it's actually hard to contribute. There are people that struggle in life because they don't have that sense of purpose or contribution, and that search can burn them out.

Life presents very, very few opportunities in which you have the potential, the capacity and the skillset to have a massive impact on a large number of people in direct and indirect ways, but that’s what we have on our hands right now.

It's very odd for me to speak about COVID-19 response as an opportunity because it's scary and it doesn't feel like an opportunity when you're going into work and actually dealing with it. I won’t script anybody's response to this crisis, but what I will ask is that you reflect on the chance we have here, on how this crisis will affect your life beyond these moments, because as frontline providers, we have the ability to step up, to have an impact on society and on how the world looks from this day moving forward. We’re that little bit of glue holding everything together here. As we look around and see everything unraveling, we're the last thing that isn’t following suit, and if we come unglued, there really isn’t much left. That's scary, but I tell my providers that as well.

These are such punctuated situations of pivotal change that I don't think any of us understand how much it's going to change us forever. How we respond to these moments as the frontline providers will define us for the rest of our lives.