IN EARLY MARCH 2020, Dhaval Desai, MD, returned to work from a 10-day paternity leave to find a transformed practice. The director of a hospitalist program in Atlanta, he was immediately thrown into preparations for the novel coronavirus that was dominating the news.
But he’d been a resident during the H1N1 flu outbreak and, as he writes in his new memoir, “I was always secure and protected. Why would this time be any different?”
His book, “Burning Out on the Covid Front Lines: A Doctor’s Memoir of Fatherhood, Race and Perseverance in the Pandemic,” published this month, details just how catastrophically different covid turned out to be.
Dr. Desai describes the waves of surges, the desperate search for PPE, the constant chaos of changing evidence and management strategies. There’s the scramble to find childcare for two working parents, clinicians burning out and leaving, patient suffering, and tense standoffs with patients who refuse known treatments.
“The pandemic made it clear that the system was not going to automatically take care of us.”
Dhaval Desai, MD
Within months, he was struggling with depression, admitting so first to his wife and then his primary care doctor. In the book, he’s upfront about how medication and talk therapy have made it possible for him to continue to work.
Early in the pandemic, news of the death by suicide of Lorna Breen, MD, “rattled me,” Dr. Desai says, and served as a stark reminder of how much can go wrong when doctors don’t seek help. He is donating all author proceeds from sales of the memoir to the Dr. Lorna Breen Heroes’ Foundation. Dr. Desai spoke to Today’s Hospitalist.
You include an anecdote from before the pandemic about a colleague of yours, a Muslim woman physician wearing a hijab, being berated by a patient who doesn’t want your colleague to treat him. You suggest that one thing that came out of the pandemic is a much more robust zero-tolerance policy to patients being abusive to clinicians and staff.
Prepandemic, we had an unofficial policy, but everyone kind of skirted around the issue. That really changed when institutions had to step up against workplace violence and abuse.
In the book, I call it “twin pandemics”: We were dealing with covid and then the systemic racism where African and Hispanic Americans were so disproportionately affected by this disease. Clinicians and staff members in the hospital who were minorities also kept being targeted. Now, there’s a strong zero-tolerance policy in place, and the pandemic had a lot to do with that.
It also sounds like the pandemic changed you a lot as a leader. You became much more direct about asking for things your group members needed, including that zero-tolerance policy, but also hazard pay and more FTEs.
Probably before the pandemic, I was a bit more collaborative and accommodating, always trying to be aligned with the health system. But the pandemic made it clear that the system was not going to automatically take care of us.
Advocacy was key, and I realized that I didn’t mind challenging the system in a constructive way. I’ve learned that the worst people can say is no, so that was a growth phase.
Given such widespread burnout, a lot has been written about how institutions need to promote wellness, not push it off on individual clinicians. Has your health system introduced resources to help your clinicians and staff?
They’re starting to, but the question is, how do you do it? What’s the right recipe? I’m not sure anybody’s figured that out yet because it’s such a layered problem. You really have to take bite-sized approaches, which is frustrating because you’re trying to fix the big things. But you can’t until you fix the small ones.
One example is hospital credentialing. To destigmatize mental health for health care workers, the first step should be in credentialing and licensure paperwork. Many states have followed recommendations to no longer ask if physicians have a history of psychological or mental health issues.
The only question should be: Are you currently impaired? Other questions are just a barrier to getting help. and I have many physician colleagues who won’t seek help because they’re scared of the ramifications professionally. We still have a long way to go.
You also describe how hard it was to give up the image of perfectionism that you had of yourself.
I think that’s part of physicians’ personalities. We want to be perfect, and we’re not trained to fail. We are trained to be correct and fix things—so when things aren’t fixable, it’s very challenging. Most of us put pressure on ourselves to have things run as smoothly as possible. But I ultimately had to accept a place that would never be 100% smooth and where we’d need to do our best, even if it didn’t feel great.
You write that it will take a great deal of time for U.S. health care to recover from the pandemic. Do you still believe that?
The health care system is not in any shape recovered from everything we’ve gone through, and it is going to continue to be a challenge. We’re still being asked to do more with less, and I don’t think we’re going to get back to where we were.
We have to adjust to where we’re at and build up from there. We still need to focus on health care workers and invest in them, especially with all the new talent that’s here. We also need to reprioritize how we retain and sustain our workforce by helping them find joy in practice and by focusing on keeping them well.
Crises often allow for innovation at a faster rate. Read how covid has changed practices?
Phyllis Maguire is Executive Editor of Today’s Hospitalist.