The Battleground, the Leaders, and the Development of Lessons Learned to Assist Future Providers in Healthcare

Through stewardship, we physicians have the power to ensure the future and integrity of our profession. We do this by accepting the responsibility to not only provide the very best care to patients now, but also to carry our experiences forward to teach the next generation.

Through stewardship, we physicians have the power to ensure the future and integrity of our profession. We do this by accepting the responsibility to not only provide the very best care to patients now, but also to carry our experiences forward to teach the next generation. Right now, we have in front of us an opportunity, with the COVID-19 pandemic, to take the gains as well as the losses experienced in this battle and provide the stewardship that will ensure our profession’s future.

COVID-19 has impacted our world and our nation in virtually every facet of our daily lives. It has left an impression on healthcare that we will undoubtedly never forget. From my perspective, I know that everything – from procurement of materials to sterilization of equipment; from the configuration of waiting areas, to the modalities of patient treatment and diagnosis; all these things and more will be permanently changed from what we knew to be routine just a few short months ago.

The story of this battle is far from over; I feel the most valuable teachings from this pandemic can be found in observing our leaders. The extraordinary circumstances brought on by this pandemic have pushed leaders in the realms of public policy as well as healthcare to mobilize small armies of people to do amazing things. By enacting safety policies and guidelines with unprecedented speed our leaders have tested the boundaries of our collective resilience. By quickly funding emergency procedures for research they’ve pressed our clinical and scientific knowledge so that vaccine and treatment candidates could be tested faster than ever before. Closer to me, my health system leaders kept the focus on clinician and patient safety as they removed barriers and remained transparent throughout the process. This, in particular, has had a profound effect on me as I saw the delicate balance these leaders needed to strike to make difficult decisions regarding employee retention, patient and employee safety, message integrity, and system solvency.

Stewardship

What do we learn from pandemics? While the focus of this pandemic is on our healthcare providers being able to stem its spread, the lessons we collectively learn are more important for our future leaders. They will inherit the economic and health care systems that are now being retooled in its wake. A lot is being debated about the moves that have been made by our local, state, and federal government leaders regarding strategies to cope with the pandemic. The debates, unfortunately, get very politicized and often leave out any meaningful conversation about how to do the best for the most people, while understanding that there are no perfect solutions. For example, the questions about re-opening the economy are rife with questions of the valuation of life versus the valuation of self-determination. Depending on who you ask, the answers to those questions can be wildly different. As it relates to clinical medicine, the debates ranged from using existing drugs in experimental ways to treating patients in reactive and conservative ways, knowing that in many cases that wasn’t enough. There have been no truly “right” answers in this pandemic mainly because we’ve been dealing with a bug that we don’t fully understand and which we can’t reliably stave off. Many of us have done our best to be present, brave, and at attention. Much like soldiers about to take orders from a commander.

As a physician working for AdventHealth Medical Group I have the privilege to win the trust of patients seeking care at our facilities. The principles of caring for the “whole person” which started more than 150 years ago, still serve us well today and ring truer than ever in light of the fight against COVID-19. The organization has always taken care of its employees (family), and this is the exact reason I did not hesitate to volunteer as a relief physician during the anticipated surge when asked. Would a soldier have the choice to sit under a tree eating an apple watching his troop fight? I think not! Being a physician is not only about serving the sick, but it is also about earning the trust of your colleagues and recognizing when they are in trouble.

Our campus leadership likely began this journey potentially ill-prepared for the potential healthcare catastrophe brought on by a fast-moving pandemic. Among the challenges were:

• Limited PPE supply

• Furious N95 fitting for clinicians

• Implementing UV lights to treat used N95 masks

• Training physicians quickly to be prepared to manage critical care patients

• Changing of lab sources on a routine basis to access the quickest turnaround for testing

• Continually changing cleaning guidelines

• Implementing a new platform of telemedicine

• Updating rapidly changing practice guidelines to follow both state and national recommendations

• Rapid planning of workforce shortages

• Shutting down hospital to visitors including family members of the gravely ill

• Planning the movement of COVID-positive corpses to a remote location so family could visit post-mortem

• Screening all personnel while trying to conserve already limited supplies of surgical loop masks

• Reusing PPE until severely soiled

During this crisis I found an enormous amount of pride in being affiliated with an organization that took care of its patients and health care providers equally. It has not been without some challenge, but step-by-step, full transparency and unfaltering leadership have provided us a vessel to navigate treacherous waters. As a physician leader, I’ve learned lessons over the last few months that I can freely discuss here, with the intent to carry to future physician leaders should a similar crisis be encountered down the road. Among those lessons are the necessity for maintaining close communication with hospital administrators and medical staff colleagues. The rapid pace at which this pandemic escalated begged that sort of collaboration. In addition to the close communication, having an honest and open dialogue with leaders was imperative. During this crisis, difficult conversation brought on by honest and sometimes opposing viewpoints regarding the demand for PPE tested the bonds we make in good times to see us through these bad times. I learned a valuable lesson in the prioritization of care – something we weren’t taught in medical school. Our practice priorities changed quickly when the government silenced elective procedures, and in-person visits disappeared because of social distancing recommendations. We began to think about our patients and their care differently than in the pre-COVID-19 paradigm. Finally, the most valuable lesson was in learning to lead as calmly and steadily as possible. Leaders are looked upon to make some of the most difficult decisions in the face of chaotic and frightening situations, often with ungratifying and unglamorous blowback.

Because of the work we did during the peak pandemic activity and the lessons we learned, we succeeded in flattening the curve of COVID-19 cases in Central Florida. It is imperative, now more than ever, that we continue to demonstrate love and care for one another. Much like soldiers who take an oath to defend a nation or like elected officials who swear to serve a constituency, physicians take an oath to protect their communities and serve them tirelessly and with compassion. Despite the different roles we play in society, there must exist a common denominator; service and stewardship.

Recently, I asked colleagues of mine – leaders in their fields – how they considered themselves stewards of service. Dr. Mark Hertling, Lieutenant General, U.S. Army, Ret., recounted to me his experiences as commander of American forces in Europe where he noted,

“I would often ask those in other armies about their oath. Many could not remember their oaths; those who did described how the words centered on defending "the motherland," "the fatherland," their named country, their president or their king. Israeli soldiers are slightly different, as their oath - once taken on the top of Masada as a reflection of the long and violent history of the Jews - vow to "put themselves between their people and the sea." But our country is the only nation where the soldiers vow to defend a piece of paper...ideas.”

This resonated with me because of the simplicity of what our soldiers vow to defend. It’s very similar to how, when I began my studies in medical school, I took the Hippocratic Oath stating, “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing.”

Dr. Omayra Mansfield, Chief Medical Officer at AdventHealth Apopka and AdventHealth Winter Garden describes the similarities between oaths taken by law enforcement and medicine:

“… as having a shared ethos. When we take our respective oaths, we aspire to hold ourselves to the highest standard of professional behavior, even when times are the most challenging.”

This insightful comparison underscores the tensions we must navigate when things in our fields are most challenging. A pandemic like this one we have experienced reminds us that we must lead others – especially the sick – through these challenges with confidence and compassion.

Finally, Florida Congressman Rene Plasencia had this to say about going above and beyond his call of duty.

“As a legislator my only constitutional requirement is to pass a balanced state budget annually. But personally, I believe in helping others. Whether elected or not, I always try to find ways to help people in need. As a member of the Florida House I am able to leverage my relationships with state agencies, other levels of government and/or private sector partners to help the people I serve.”

Congressman Plasencia’s dedication to his constituents is much like my commitment to my patients and to preserving the future of my field. The words of this handful of leaders describe the linkages between their calling to serve others and the fearlessness with which they lead; something I’ve seen throughout the COVID-19 pandemic.

I am truly grateful for the commitment my friends and colleagues show in their respective fields. And despite our potential differences, one thing we have in common is the passion to serve, the commitment to protecting those around us, and the courage to fight this battle together. All these qualities are necessary in leaders. Because of what I’ve seen throughout the challenges of COVID-19 I have been inspired to redouble my commitment and effort as a physician to serve and heal. I feel energized by the leadership I’ve observed through this crisis. I hope to model the values of stewardship and service as I continue my career journey, so that the future of medicine can be a beacon of hope in our communities.

Charlene LePane, D.O., MSPH, FACOI, FACG, FASGE

Gastroenterologist

Celebration Hospital

AdventHealth Medical Group

Central Florida Gastroenterology & Hepatology

*Article Edited by Suzanne Espinosa BA, MSHIA, CPHIMS