Curbside Consult with Dr. Jayne 10/2/23

In my clinical world, I’m starting to see more patients who are struggling with the symptoms of Long COVID. That’s not surprising, since current data from the Centers for Disease Control and Prevention’s National Center for Health Statistics published a report that indicates that nearly 7% of US adults have experienced the condition.

The data brief from the 2022 National Health Interview Survey indicates that nearly half of those individuals also said they had Long COVID symptoms at the time of the survey. To meet the definition of the condition, patients must have a set of symptoms lasting three months or longer after the initial COVID-19 infection. These can include fatigue, brain fog, dizziness, digestive symptoms, heart palpitations, changes in smell or taste, chronic cough, chest pain, and more.

Many of the patients I see have tried to explain away their symptoms, blaming them on the overall stress of the pandemic, problems with work-life balance, or increased demands from employers due to inadequate staffing. A number of patients also come in with similar clusters of symptoms, but never had a formal diagnosis of COVID, either because they were ill before testing was widely available or were ill later in the course of the pandemic and never tested. Ohers don’t meet the criteria for Long COVID, but are struggling with symptoms like memory issues, insomnia, and fatigue that can be associated with a host of other conditions, including anxiety, depression, and burnout.

Let’s face it, we’ve all been expected to do more with less, and that has ultimately taken a toll. Many healthcare workers, IT folks included, are looking for strategies to make sense of all they’ve been through during the last three years. They’re also looking to find a way forward that doesn’t put them in the office or bringing work home to the detriment of their family time. They’re looking for ways to cope and the mechanisms they employ aren’t always healthy.

While institutions are putting resources behind setting up Long COVID clinics and creating programs to treat those patients, it doesn’t feel like they are setting aside ample resources to deal with COVID’s collateral damage to the broader healthcare world. It’s no surprise that all of us have taken on a substantially larger mental load in recent years, so I set out to find articles that looked at the concept of mental load and mindfulness both before the pandemic and since. How much is this constant need to burn the candle at both ends really impacting us?

The first article I came across was in the New York Times archives from 2016, and caught my eye because of its title: “Think Less, Think Better.” It’s an opinion piece, but references a study that looks at how mental load can negatively impact one’s capacity for original and creative thinking. I’ve certainly experienced that phenomenon, when I’m juggling too many balls or putting out too many fires and as a result tend to fall back on tried-and-true solutions rather than trying to find novel ones.

The author’s research at the time indicated that “innovative thinking, not routine ideation, is our default cognitive mode when our minds are clear.” The study cited in the piece found that “the mind’s natural tendency is to explore and to favor novelty, but when occupied, it looks for the most familiar and inevitably least interesting solution.” Companies that make it a priority for employees to have unstructured time for creative or innovative pursuits seem to have figured this out. Still, there are plenty of companies out there where employees are just marching from meeting to meeting (whether virtually or in person) without time to catch their breath, let alone time to think creatively.

It’s one thing to try to make space for creative thinking when you’re working in the software industry or in marketing or sales, but how does that apply to actually seeing patients or supporting those who do? I wondered how these ideas might be applied to the healthcare IT space. In an August 2023 article in the Journal of the American Board of Family Medicine (JABFM) titled “Thinking and Practicing Thoughtfully and Thoroughly,” an editor’s note offered examples of some of the challenges of trying to meet the needs of individual patients at individual visits while simultaneously advancing the overall health of the community.

That sounds a lot like what many of us do in healthcare IT, where we try to meet the needs of individual clinicians while balancing them with outcomes desired by the overall technology organization. Like physicians, those of us that work the technology front lines try to find the colleagues who have fallen through the cracks and aren’t getting the support they need, and we also try to fix the overarching structures that might be causing strife. Lobbying an EHR vendor to fix faulty software is a lot more similar to lobbying Congress to fix faulty healthcare policy than I had previously thought.

That particular issue of JABFM offered numerous examples of work being done by physicians to try to improve patient care. I would bet that the majority of the research wouldn’t have been possible without dedicated EHR and analytics teams behind the scenes creating ways to capture the data, extracting it, collaborating with investigators, and more. The examples made me wonder if those who might be far from the front lines think about the impact they’re having with every template build or every SQL query that they do in their daily work, or whether they just think of it as one more thing to check off the ever-growing list of things to be done. Does the data analyst think of how many grandmothers, or sisters, wives, or daughters are in the data set that’s being pulled for breast cancer screening? Do they find a way to make the work feel more valuable, or is it just part of the grind?

In many healthcare delivery organizations, understaffing is present at all levels, at the bedside, in facilities or maintenance, in technology infrastructure, and in the teams trying to pull it all together. When they claim an ever-eroding margin, how can leaders of those organizations try to make space for staffers to not only be mindful about their work, but to have the time to explore their creativity and truly try to innovate? Even if you wanted your staff to spend 10% of their time working on novel ideas, how do you backfill those four hours each week? How do you decide what projects don’t get done when there’s already a backlog? I think the answer in many organizations is to just keep pushing ahead and not look for creative solutions, which ultimately will likely deliver the same results as we’ve been seeing all along because we’re doing what we did all along.

I’d be interested in hearing from readers how their organizations are tackling these phenomena. Are leaders able to make space for thoughtful, meaningful work, or is everyone just back at it, possibly working harder than they did a few years ago? Have people just checked out or left the healthcare space because what we’re asking them to do is untenable? Are your leaders working to find a way forward? Leave a comment or email me.

Email Dr. Jayne.