Curbside Consult with Dr. Jayne 9/16/24

I haven’t heard much chatter in the informatics community about what the United States Surgeon General recently named as a public health challenge: parent and caregiver stress. Dr. Vivek Murthy called on legislators as well as business and community leaders to boost resources to support parents. He’s advocating a national paid family and medical leave program, paid sick time, and increased access to affordable mental healthcare.

When I’m mentoring young physicians, many of them are shocked to learn the limits of the current Family and Medical Leave Act in the US and how their patients may not be protected by it. They’re even more surprised to learn that they themselves might not be covered if they work for a smaller employer or haven’t been at their job for the prescribed time period.

As a physician, I see plenty of patients who don’t get paid sick leave and who earn demerits at their jobs if they don’t come to work, regardless of whether they’re seriously ill or not. I’ve also seen physician colleagues stumble into work while ill, either because they don’t have backup in the workplace or they don’t have paid leave.

One former clinical employer required sick physicians to find their own sick coverage, which is how I found myself in the emergency department in the wee hours of the night calling and texting to try to find someone to cover my morning shift because I was about to be wheeled to the operating room for an emergent surgery. That should never happen, but somehow it still does, and I’ve heard plenty of similar stories since experiencing it firsthand.

Murthy notes that the stresses of parents are passed down to children, adding to an already significant youth mental health crisis. He makes it simple: “If you really want to help kids, one of the things you’ve got to do is actually help parents.” The Surgeon General’s website goes into more detail and includes the Surgeon General’s Advisory on the topic.

Over the last several years, I’ve watched numerous colleagues and clients try to juggle work and home responsibilities, attending business calls while in the carpool line, and having children interrupt their work on a regular basis. Many people are operating without the safety nets of family and friends as job opportunities lead people across the country. He calls out the “culture of comparison” that is heightened by social media and creates unrealistic expectations for families. I tell the young parents I work with that when you have a day where your child wears clothes and is fed, you’re having a good day. They may chuckle, but I’ve seen few pictures of people just getting by on Instagram.

Many of the stressors that are specifically called out by Murthy are present in healthcare organizations, and by extension, in the technology organizations that support healthcare. He notes the difficulty in arranging childcare when you don’t have a predictable work schedule as well as the challenges in having leaders understand the complex demands that parents and caregivers face on a daily basis. Having spent a significant portion of my career working 12-hour shifts, I know how hard that juggling act can be. The fact that some healthcare and healthcare-adjacent employers expect workers to be able to compartmentalize that should be worrisome. When you find a company that truly values whole-person wellness and provides the ability to actually take time off for health and wellness without the specter of guilt hanging over it, it’s easy to see how that kind of organization can become a workplace of choice.

As organizations are finalizing their benefit plans for the typical fall open enrollment season, I encourage leaders to look at them through the eyes of various personas, much like we use personas to create software requirements. What would a benefits end user experience from your organization if they were a young single parent, a mid-career parent of busy pre-teens, or someone approaching retirement? How would those benefits feel different if one had a family member with additional needs or a significant medical condition? If there is paid time off, are there ways to creatively use it so that employees can maximize the benefit and not waste time? (Companies that require time off be taken in four-hour blocks, I’m looking at you.)

If you offer so-called unlimited time off, which I see most commonly in technology firms, is it truly unlimited or are there unwritten limits that you just don’t talk about? And regardless of how you’re tracking time off, is the culture such that people can actually take time away from work without being tethered to emails or texts? Will they have a mountain of work waiting for them when they come back, effectively discouraging them from taking time off in the future? Are there flexibilities to allow people to roll time off across calendar years so that they can bank additional time off for significant family milestones, or are they forced into a “use it or lose it” situation where they have to take time off when they don’t need it, but can’t take time when they do?

I challenge leaders to also look at the cultures of their organizations and how they may be contributing to worker stress. Do employees feel empowered to ask that meetings be rescheduled when they have conflicts, or are they encouraged to “figure out how to make it work,” which can lead to taking calls while driving, which is not only unsafe but also unproductive? Do you create a safe space where employees can share the stresses that they are under, such as creating a patchwork of summer camps and activities for their children when school is out? Do you manage meetings effectively so that people can leave on time, or are you creating an environment where people worry if they’re going to be able to pick up their children on time? There are a lot of small things that we can do to make things better for teams without spending a lot of money. Sometimes all it takes is being respectful of others and the challenges that they are facing and doing what you can to not add to the burden.

I’ve said in the past that public health isn’t sexy, and that’s why it doesn’t get a lot of funding or attention in the US. It’s not as glamorous as other medical pursuits such as curing cancer or performing a cutting edge surgery. But making changes that improve mental health is absolutely essential for our collective wellbeing. I encourage everyone to read the Surgeon General’s Advisory and to identify one thing you can do on your team, within your department, or in your organization to make things just a little bit better. All those efforts will add up, and although we may never know whose lives we’ve impacted, I guarantee we’ll make a difference.

How can we make public health the shiny object that everyone wants to pursue? Can we slap some AI on it to make it more compelling? Leave a comment or email me.

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