EM Mindset: COVID-19 Edition – Why we must lead

Author: Jay Khadpe, MD (Associate Program Director, Emergency Medicine Residency, UF Health) // Reviewed by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)

“What you do matters” is the now famous tagline by Mel Herbert at the end of each of his educational podcasts. I always took the sentiment for granted, not always sure I truly believed it. But today, it takes on a greater significance than ever before. Almost certainly, there will be indelible consequences on our society from the current pandemic and new leaders will emerge to redesign how we provide healthcare while maintaining readiness for the next health crisis. The mindset of the emergency physician (EP) is uniquely positioned to tackle these challenges head on.

Looking back on the past few weeks, critical flaws in our healthcare delivery system were exposed. From lack of personal protective equipment to insufficient testing to limited surge capacity, the shortfalls identified have been numerous. However, working in a resource limited environment is nothing new to EPs. We do more with less all the time. Almost instantaneously, creative solutions to these problems began to disseminate, much of it through social media. Organizations like Get Us PPE or Goggles for Docs were created to try and get PPE to where it was needed most. Strategies for decontaminating N95 masks for reuse were shared on Twitter and blogs. Treatment algorithms for the management of hypoxemia including both noninvasive and invasive modalities were shared as we learned from each other’s successes and failures. It was inspiring to see the collective problem solving and ingenuity that sprung from such tragic circumstances. Don’t get me wrong, the healthcare system is not fixed and these problems still exist, but there is no doubt that we must play a big role in the solutions.

Why the Emergency Physician mindset?

1. EPs are in a constant state of readiness. There are no appointments in the ED and we never turn anyone away. We must always be prepared for the next trauma alert, cardiac arrest, or acute myocardial infarction. This can be an exhausting and anxiety-provoking mental state especially for those without experience. Our communities must be prepared for this pandemic to last a prolonged duration that will necessitate a mindstate of readiness. We can leverage our training and expertise to help prepare others for this new mentality.

2. EPs are master’s of logistics. We are constantly allocating scarce resources to optimize efficiency and quality of care for our patients. So many of the failures that we identified are due to a mismanagement of resources and a poor logistical strategy. We can contribute real solutions to better prepare our communities moving forward.

3. EPs excel in team environments. The ED is a world of interdisciplinary teamwork where we touch every corner of the healthcare stratosphere. We have honed flexible communication strategies that allow us to adeptly navigate the most challenging conversations with patients, families, and consultants. These communication skills will be crucial in establishing new policies and procedures that adapt to our changing healthcare paradigm.

4. EPs are leaders in crisis. One of the defining features of our specialty is expertise as resuscitationists. We are calm, poised, and maintain a positive attitude even in the most chaotic circumstances. Our team members look to us to give them inner strength and confidence to perform at a high level. The pandemic has created chaos on a global level that we are best prepared to step up and lead in the response.

As I write this, the pandemic is not over. Only time will tell whether this is the beginning, the middle, or the end. I am inspired everyday by the support, selflessness, caring, and generosity of EPs from across the globe. We all feel doubt, anxiety, and fear at times. Have faith in your team and your experience. This is why we chose emergency medicine. This is why we will lead. This is why what we do matters.