We humans survived on the grassy plains of East Africa millions of years ago by the power of community. The power of connectedness. Around campfires our primitive ancestors undoubtedly shared stories of triumph and tragedy, of success and failure. Stories of how to hunt, how not to be hunted by some predatory creatures.
Now let us fast-forward the tape several million years to see where we are.
Although the details are murky and the specifics are cloudy, it appears that sometime in November or December of 2019 some sort of biological event took place on the Asian continent. A viral plague most likely initially occurred in bats and then transferred to human hosts. This marauder called COVID-19 dramatically changed almost every dimension of human existence.
Like an asteroid destroyed the dinosaurs, the virus upended our world.
By March 2020, the global pandemic was reaching an apocalyptic transcendent trajectory resulting in millions of deaths and tens of millions of new cases. There was very little factual understanding of how the virus spread, yet entire subcontinents went into lockdown and shelter-in-place mandates.
The traditional brick-and-mortar corporate world became irrelevant as millions of workers were isolated in their homes.
The Impending Meltdown of the Healthcare System
We lost that communal glue; we lost the power to learn from each other. With the almost miraculous development of entry-level vaccinations and then a minimum of two or three booster shots, the tide has slowly turned and there is greater comfort in shedding the masks under some circumstances.
We now recognize that this pandemic will ebb and flow, but at least in the near term, life has resumed some normal pace. But not so fast. Let us address the law of unintended consequences and what it means for you and me and our families.
The conversation began in the midst of an early Monday morning workout on a bitterly cold Minnesota morning. We Minnesotans are a hardy group! As I was cooling down and stretching near the curb of my driveway, I felt a warm nuzzle from a dog on my neck and turned to see a neighbor, a prominent healthcare provider, holding the other end of the black Lab’s leash.
She is a highly respected researcher and clinician. But I was a bit surprised that she was not in the clinic, and she explained that she had a “comp day” following a grueling ten-day hospital-based rotation caring for complex patients from around the world. But our discussion did not focus on clinical care but on the inexorable disintegration of the healthcare system as we once knew it.
Over the nearly three years of the pandemic, the heroes and heroines of this battle have been the front-line workers, the boots on the ground, the first responders, the emergency room personnel, the primary care colleagues—some of whom lost their lives in this pandemic.
This was the fuse that ignited the defection of approximately 300,000 healthcare workers over the past several years. The death toll was relentless, the complexity of care was overwhelming, and now the workers who are left are faced with a crisis of trust because many of their decisions are now challenged by patients and family.
Moreover, there has been a steady drumbeat of defections from the technicians who are crucial for the running of MRI scanners, PET scanners, CT scanners, and other high-tech imaging interventions. Without their professionalism and insight, these machines sit idle. Much like a fleet of airplanes parked on the tarmac where the pilots have left the industry.
This crisis in healthcare delivery is not a what-if worst-case-scenario game or a theoretical issue for a PhD thesis in healthcare, but the situation poses practical implications for you and me and our families when under ordinary circumstances the scanners were readily available on a timely basis. Now there is often a wait of multiple weeks even up to months to have the imaging done.
The Pandemic Fallout Affects Us All
And there is another perspective of this “pandemic” fallout. The emergence of an armada of “travel nurses” who have filled the gap to some extent of the nursing ranks in clinical and hospital settings, which have been substantially depleted.
These are credentialed colleagues are paid far more than staff nurses working for your healthcare system. This pay disparity certainly can create tension and ill will. Moreover, the travel nurses may not be familiar with the culture in your hospital setting or know your electronic medical record system as thoroughly. And temporary staffing is not an asset in patient care. Guess who will be picking up the tab for their pay?
So my chilly morning chat with a front-line physician has revealed these take-home messages for us all:
We can no longer rely on the system to be there for us. We need to be proactive, preemptive, and follow established preventive guidelines because if we do become ill, we cannot expect the cavalry to ride over the hill and save us.
We need to understand when masks are appropriate (yes, still) and the lifesaving dimension of the flu shot and the vaccines against COVID for the vast majority of us.
This is not the time in history for high-risk “entertainment.” The ski accident, the boating misadventure, the hunting or fishing injury that once could be managed with efficient care may not be available for us in our time of need.
Andy Grove, the Intel entrepreneur, wrote a book entitled Only the Paranoid Survive. That is certainly true, but the paranoid do especially well when they are informed and make reasonable and intelligent healthcare decisions.
Be an empowered patient and know how to navigate your patient portal and review your medical records.*
Understand how to get the most from a telemedicine visit because virtual care is here to stay thanks to COVID.*
Use mobile apps to schedule appointments and renew prescriptions.
However, and you knew the other shoe would drop: Despite the electronic healthcare highway, there may be no providers left to turn out the lights. As skilled as we may become mobilizing the electronic gimmicks to monitor our health, if no one is left to care for us, “Houston, we have a problem.”
*The revised third edition of my book, How Not to Be My Patient, explains the ins and outs of patient empowerment and how COVID changed everything. I give specific guidelines on navigating a changing healthcare system including the telemedicine visit and patient portal and how to talk so your doctor will listen.