The COVID-19 pandemic has taken the world by storm, causing upheavals in every area of life. Given the need to follow social distancing and other infectious disease prevention guidelines, physicians and other health care professionals have had to adjust their approaches to providing care. Depending on the setting in which they work, more physicians have been using telehealth and telemedicine platforms like Doximity, Amwell and other products to conduct patient visits without crowding their waiting rooms. As part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the Centers for Medicare and Medicaid Services (CMS) enacted a policy for telehealth payment parity. This policy change has enabled many physicians and other providers working in largely outpatient practices to stay afloat during this tumultuous time. However, many practices continue to struggle despite this accommodation.
For those of us training and working in health care, it is a foregone conclusion that changes in health care practices are inevitable and often occur at full pelt. As a fourth-year medical student, I have been straddling the line between undergraduate medical education and supervised residency training. This has given me a unique view of the multitudes of adjustments that programs have made in the wake of both the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME) recommendations. While many United States-based medical training programs have resumed mostly normal clinical rotation schedules, there remains enduring modifications, including a greater emphasis on telehealth training and prioritizing non-emergent care.
All of these abrupt paradigm shifts have left patients and providers alike scrambling to plan out procedures, routine health maintenance visits and screenings. With the Pfizer, Moderna and other prominent COVID-19 vaccine candidates proceeding rapidly through Phase III clinical trials and now being rolled out en masse, many are wondering what next year will be like for daily life. Sadly, the general population continues to be subjected to the inexorable spread of misinformation and disinformation with no equal in the history of our country. Effectively, physicians have become the front-line infantry in the war on science. While there are numerous reasons for the cultural shift toward distrusting science as an institution, the fact remains that physicians have to pick up the mantle and defend the paramountcy of rigorous scientific inquiry.
For several decades, the role of the physician has evolved from the traditional diagnostician, preventer and treater of human disease described in the biomedical model into a more integrated “biopsychosocial” practitioner. Current evidence suggests that much of human health is influenced more significantly by contextual factors like the social determinants of health than the direct receipt of health care. This relatively new understanding has challenged the notion of “physicianhood” and what it means to improve the health of entire populations and communities. With the influx of issues that the pandemic has brought with it, this new model for being a highly effective physician has become even more important.
Studies have demonstrated that skeptics of evidence-based recommendations will still trust their physician’s word on the importance of following those recommendations. For example, clinical research has demonstrated that patients who have strong relationships with their primary care providers are more likely to adopt challenging health behaviors, such as taking medications as prescribed. Additionally, adequate messaging around public health matters and health policy changes requires the input of physicians who have been in the trenches and can advocate compellingly for their communities’ needs.
For us to be successful, physicians have to be in tune with their creativity and adaptive leadership skillset. These adaptive leadership skills include emotional intelligence, organizational justice, development and character. The days of operating as a lone wolf without much oversight are long gone; we have to accept that we are irrevocably in a time of increasing integration. Although one could lament the loss of individual autonomy as a practitioner, I would argue that this age brings with it a wealth of opportunity for professional growth and innovation.
One of the most important areas for innovation lies in cultivating a greater capacity for emotional intelligence in our health care workforce. In the 1990s, Peter Salovey and John Mayer described the concept of emotional intelligence and how it was a cultivable trait involved in the awareness of and application of observed emotions to oneself and others. Well known for his work in this area, Daniel Goleman built on this body of work by introducing the foundational concepts of emotional intelligence: self-awareness, self-management, social awareness and social skills. Since then, robust evidence has demonstrated how emotional intelligence can be developed and how it matters more than past achievement or classical intelligence in many cases. As outlined in their book Leadership 2.0, Travis Bradberry and Jean Greaves show how emotional intelligence is the cornerstone of adaptive leadership, which enables excellence in leadership above and beyond the core leadership skillset.
What makes emotional intelligence so critical as the concept of “physicianhood” changes is that this psychosocial quality allows physicians to flourish in the vicissitudes of turbulent times, such as this raging pandemic. For example, one study of nurses showed how emotional intelligence moderates the stress-burnout relationship, implicitly serving as a potential resilience factor for those working in health care. Moreover, the qualities of the highly emotionally intelligent — and, per the late Stephen Covey, highly effective — person provide the necessary skills to work through and address the intense underlying fears and vexation of people who reject modern science and medicine. While it can be easy to look at their arguments and either dismiss them or become irate by them, it is imperative that we understand that everyone wants to live a good, happy and healthy life. This means we must develop as professionals and become more capable of tackling the issues that the recent social and political environment has precipitated.
What this year has made clear is that physicians must grow in areas previously underemphasized in medical training. To take on the challenge of online echo chambers casting aspersions on health professionals and the underlying fear many people have about what it takes to have good health, we need emotionally intelligent, adaptive physician-leaders. We have role models whose examples we should emulate all across our country. This skillset extends far beyond what the borderline pejorative “soft skill” might imply and likely will matter much more than our technical knowledge in restoring faith in and support of the foundation on which the house of medicine is built.
As medical students, we sometimes lose sight of our purpose for going into medicine and feel that we are exerting ourselves excessively with little feedback from our environment. It is important that we remember that, while we are living through the experiences that come with our training, our future patients are also living through their own experiences. The focus of this column is to examine topics in positive psychology, lifestyle medicine, public health and other areas and reflect on how these topics relate to medical students, physicians and patients alike.
Columnist, Medical Student Editor and Former Managing Editor (2017-2018)
OU-TU School of Community Medicine
Ashten Duncan is a third-year medical student at the OU-TU School of Community Medicine located in Tulsa, Oklahoma. A 2018-2019 Albert Schweitzer Fellow, he recently received his Master of Public Health (MPH) with an interdisciplinary focus from the University of Oklahoma Hudson College of Public Health. Ashten attended the University of Oklahoma for his undergraduate program, completing a Bachelor of Science (BS) in Microbiology and minors in Chemistry and French. An aspiring family physician, Ashten is currently on a National Health Service Corps scholarship. His research interests include hope theory, burnout in medical education, and positive psychology in vulnerable populations. Ashten is passionate about creative writing and what it represents. He has written pieces that have been published on KevinMD.com and in-Training.org and in Blood and Thunder and The Practical Playbook. Ashten is currently serving as Associate Author for the upcoming edition of First Aid for the USMLE Step 1.
The Lived Experience
As medical students, we sometimes lose sight of our purpose for going into medicine and feel that we are exerting ourselves excessively with little feedback from our environment. It is important that we remember that, while we are living through the experiences that come with our training, our future patients are also living through their own experiences. The focus of this column is to examine topics in positive psychology, lifestyle medicine, public health and other areas and reflect on how these topics relate to medical students, physicians and patients alike.