Reflections – Lessons from a pandemic
by Mayowa Osinibi
2020 is a year for the history books. The Australian bush fires seem like an age away, and COVID-19 may have changed the way that health care is provided and received forever. Currently, as the daily death toll from COVID begins to fall, and we settle into our new way of working as healthcare professionals; we exist in this liminal space. Liminal, a word I learnt during lockdown ‘relating to transition’.
From this pandemic many of us will have our own stories of how our personal lives have changed, reflections of our wins and our losses. But as healthcare professionals, how do we learn to exist in this space, a place of transition, and still thrive?
As hospitals shifted their sights to essential service provision, junior doctors were informed that they would be reassigned to frontline medical roles. This meant that I would spend another four months in ED, a job that I had enjoyed but a rota I definitely did not. Every couple of days, something seemed to change, new work schedules, new workflows, segmented departments in attempts to pre-empt and manage staff risk, disease burden, and potential critical care demand.
As I reflect on my own experiences, what lessons and new practices will we take with us moving forward? And how has my local hospital sought to adapt to the current climate? As key workers, many people often commented that it was a small blessing to be able to come into work and interact with peers- giving some sort of reality to a world that occasionally felt fictional.
Interpersonally there has been a much larger focus on the wellbeing culture. Within my Trust, the clinical psychology team came down to ED regularly to allow staff to discuss how they were feeling and help staff come out with strategies to manage our changed existence better. Nationally we have had the “Thank you, NHS” campaign – I mean, who doesn’t appreciate a bit of gratitude?
Alongside that, businesses small and large have sought to demonstrate their gratitude by offering key worker discounts and donations. Many individuals have taken to social media to share their skills – to keep people moving and also very well entertained. With so many people affected financially; many charities and places of worship have stepped up to plug some of the gaps of the greater economic burden. Moreover, even if for a short period, the homeless in major cities had a place to sleep.
Clinically, simulations have been run with real-time feedback on how to ‘break bad news over the phone’ and manage a trauma case in level 3 PPE. Feedback from those situations are a reminder of how much of our communication, even in the age of social media, is non-verbal and how important non-verbal communication is. All this learning, we have been able to put into practice straight away. Some things that we can all apply to our communication include, the effective use of pauses, to give others the chance to speak. Also using closed-loop communication. This method of communication has been demonstrated to reduce misunderstanding, particularly in group settings.
Nationally, the sharing of information, updates on disease morbidity, understanding what works and what doesn’t have been more apparent. And this new information was available at all levels, thanks to good old information technology. Zoom (which has practically become a proper noun) meetings and E- seminars often free. Our academic response to this pandemic has shown how vital open access is when seeking to base our changing practice on the best available evidence.
This greater use of technology has also affected how we interact with patients. More patients, than ever before, have been exposed to the “AttendAnywhere” system for E-consultations and I believe that is a practice that is definitely here to stay.
It may be the greater stillness or our new focus for what is important in this time, that has reawakened our global acknowledgement of the ongoing inequalities that plague our daily existence. Some of these inequalities may have contributed to the disproportionate effect of COVID on BAME communities. As it was highlighted, the generation of the NHS risk assessment and stratification of at-risk staff to non-clinical areas, if required, is something I am proud to say my ED did well.
Could the pandemic have been handled better – most definitely; but hindsight is always 20 20. But perhaps our attitude and adaptation in working practices might have shifted us towards a new and better approach to working, to balancing our lives, to the NHS, to patient-centred and holistic care.
As we continue to exist in this place, we rediscover other fights for equality, equity and justice. Hopefully, we realise that all we can do is give daily support, listen to each other and work together using the best available evidence.
Mayowa Osinibi is a foundation year 2 doctor in Salisbury currently working in the Emergency Department and completed the Wessex public health fellowship during her foundation years.