16. Physicians’ Reflections & Moving Forward After the Pandemic – Part 1 of 2

Dr. Kohler (00:00):
Good afternoon. Welcome to Beyond the Needle, A Year in Review. We’re going to be talking with Dr. Christina Wells, Dr. Marian Sassetti and Dr. Corinne Kohler about the year 2022 and what we have seen. I am Dr. Corinne Kohler. I am a semi-retired family medicine physician that has worked in an FQHC for a number of years. Dr. Christina Wells, would you introduce yourself please?
Dr. Wells (00:29):
I am Dr. Christina Wells. Of course, I’m a family medicine physician, and I work currently at a Federally Qualified Health Center. I’m also an Assistant Professor of Clinical Medicine at the University of Illinois.
Dr. Kohler (00:44):
Dr. Sassetti?
Dr. Sassetti (00:46):
I’m Marian Sassetti. I am now 30 plus years. I am part of an independent private practice just west of the West Side of Chicago, Lake Street Family Physicians. I am an Assistant Professor at Rush, and I’m delighted to be back with you.
Dr. Kohler (01:03):
Well, let’s start with you, Dr. Sassetti. What would you say crystallizes 2022 for you? What word or words would you choose, to just give us a short synopsis?
Dr. Sassetti (01:15):
Well, I remember at the last year’s podcast telling our listeners that the two words were trauma and terror. I’m thrilled to say that now the two words that are crystallized for me for the last year or 2022 is collaboration and community. I, with the deepest gratitude in my heart, get to say that I have seen enormous changes, people willing to come out and help each other. I could talk at length about it, but within my own practice, a community was built out of grief and crisis among my workers and staff. Collaboration among all levels from front staff all the way up to senior partners and then community.
(01:58):
I think we’ve talked in different parts and we’ll probably revisit again how COVID had really shown a light on how absolutely imperative our species is for community. How we lose people and we depend upon each other, and the lack of community was something that was really very salient in a lot of the suffering. I have seen community building. I’ve seen us nod to the need for community and also to acknowledge what happens in marginalized communities without community building. So, we’ve moved or at least I personally have moved quite far along.
Dr. Kohler (02:35):
Dr. Wells, do you have a word or words that you think characterize how you’ve seen this past year?
Dr. Wells (02:42):
Yeah. I think it’s moving through uncertainty, and we’ve shown that we’ve been able to, in some respects, learn how to move through uncertainty, although I think we’re still in the process of learning how we do that. I think we’ve also had, as Dr. Sassetti said, some great strides in community building, but I think that we are still living in vacuums and still need to learn how we can better build our community collaborations to make them long-lasting and exist outside of COVID and just in healthcare in general. I think those are the things that were characterizing it the most for me.
Dr. Kohler (03:33):
I would agree with both of you. I definitely see a lot of community building and a lot of collaboration and such. For me, I think I used the word perseverance. I think ’22, COVID we understood was here to stay. It was here for the long haul, but yet, for me, it feels like slugging through a mud pile almost. That perseverance and making sure that community building continued to hold together, that what we had built and what we had strived to accomplish with community assets and resources and such really held together. As we go through a pandemic or a crisis, we see lots of positives and negatives. We can see the demons and angels emerge, and we can see different community groups come in the forefront. So, what have you seen in your practices and communities in terms of positives and negatives over this past year?
Dr. Sassetti (04:39):
Yeah, I like this topic. In fact, I was asked to give a lecture in the community about what was going on, and I loved holding a mirror up to Oak Park and telling our community all the angels we had seen, in my experience, far, far, far more angels emerged during this crisis than demons. I think we’re pretty much aware of the demons, but the angels just emerged. I think we’re all aware of them, but I think it’s worth naming, and especially I really want to talk about us, you all who are listening to this. I mean, it’s amazing how many physicians put their lives on line, who helped out, went to the margins, or medical students who would not hear no for an answer and mobilized themselves and went to homeless shelters and made sure they were part of addressing this crisis, a part of history making.
(05:27):
There were mask makers in my community who were sending me not dozens, hundreds, and I would estimate that the Oak Park, I wish I could name them, people who made masks were now over thousands. People who came out of retirement. There was an I believe 86-year-old psychiatrist in the Oak Park-River Forest community who came out of retirement to give vaccines. There were people like my brother, a psychologist, who volunteered to minister to traumatized nursing staff, not the patients, at one of the South Side hospitals that served the underserved. Things like that, putting his own health and wellbeing, as well as his family on the line to go minister to people.
(06:09):
We saw that over and over. I also want to talk about the people who developed the vaccine, who worked very late into night, 24/7, a collaborative effort among researchers. Just a shout-out, I think Dr. Fauci deserves a lot of credit. I think he withstood a lot of criticism, and he could have sailed off at the end of his career and then really stuck in there for us as a community of healers, so that’s just a few, but those are ones that I really want to hold up and admire.
Dr. Kohler (06:41):
I want to follow up with that. Do you see a change in that this past year as compared to 2021 with the first year of the pandemic or again, did you see any change in how people were stepping up or how they were responding or any of that?
Dr. Sassetti (06:59):
Absolutely. I think people recognized that none of us are disposable, that none of us aren’t needed, and I think people really got it. If they weren’t going to participate in this history making, if they were not going to participate in whatever they could do to offer some healing, probably weren’t going to get past that. So yes, I think people now for the most part, but certainly in my practice, my own staff, my own patients, my own family recognize they have something to offer, and I think they were quicker to give it. I think in the beginning, there was just so much fear and uncertainty. I think even politics have done it. I mean, people are saying to themselves, “What’s my role here and what do I have to offer?” I didn’t see that in 2021 as much as I’m seeing in 2022, for a lot of reasons probably.
Dr. Wells (07:50):
Yeah, I was going to jump in and say that. I mean, I definitely agree that we have realized the importance of healthcare and those who are the providers of healthcare. I also think we’ve seen how underappreciated healthcare providers can be, and I think that that is something that hasn’t quite been fixed, but I think that we can appreciate one another and understand that sometimes what we do is a thankless job, but we have definitely over the past couple of years demonstrated our resilience, our love for community, and our desire just to make healthcare accessible and to make it improve health outcomes for the communities that we work in.
(08:49):
I think that as we move forward, that will be something that we need to take with us is that that we’re not always going to get those pats on the back as we should deserve or maybe appreciated in the ways in which we feel like healthcare should be appreciated, but knowing the impact that healthcare providers are having on the communities around them and the impact they continue to make could be the driving force that continues to make us proud as a community and continue to help us to move forward in serving those around us.
Dr. Sassetti (09:25):
Indeed.
Dr. Kohler (09:27):
One of the things that I’ve really come to appreciate is the concept of team and the fact that clinics and public health districts and volunteers and other collaboratives have really discovered that the team approach and appreciation of everyone on a team. It’s not just the one person or the one that might be in the forefront, but it really takes a team effort for us to get through this, and all the team members are important, and I think all of them deserve to be recognized in that aspect with them.
Dr. Sassetti (10:03):
I agree.
Dr. Kohler (10:06):
Going forward, what do you see as concerns related to this? Do you see anything that has really popped up or that you think really we need to work on addressing over this next year?
Dr. Sassetti (10:20):
Well, I just want to augment what Dr. Wells had said, which is I think the greatest demon that arose among many pretty bad ones was what happened to us and whether it happened personally, which is that we began to feel burnt out and so underappreciated and really disillusioned. “Did this really happen to me? Did people really decide that they were going to lash out and be hostile to me?” What happened to so many of our colleagues who decided to leave, whether they were nursing or physicians, any level of healer, I think that is something we can’t just shrug and say, “That was too bad that happened.” I think it’s right in front of us, and we have to say, “How are we going to deal with this level of personal despondence?”
(11:05):
Again, if I have a chance to do it, I just want to tell people thank you, and I said it last time. This cannot define your career. As awful as it may seem, if you’ve been the butt of this or this has been directed at you, you’ve had a long career, and whatever is going to come is going to come. I think it’s going to give all of us some healing, but this can’t mark our careers, the negativity that happened. I think it’s a blip in time and it has to be honored. I do think we have to address it collectively. Not just personally, but collectively, how did this happen? Dr. Wells had mentioned, we have to be aware of it going forward because this is not the last time social media bots are going to teach our patients and our populations something negative. I think what happened is they got taught to fear us, to view us negatively and to be hostile to us. We really have to grapple with that.
Dr. Kohler (12:00):
I think a lot of the misinformation, vaccine hesitancy, naysayers, people who still think COVID isn’t real, really contributed to that negative influence. I mean, trying to deal with that on a daily basis. It’s hard enough to deal with the illness and the disease aspect and caring for patients when you are all on the same track, but when you’ve got somebody intersecting that’s really trying to derail where you’re going, it takes much, much more energy over that, so I definitely would see that as that. I don’t see that going away. I really don’t see that we improved upon that really this last year. Unfortunately, I still think there’s a lot of miscommunication and misinformation. Do you see that in your population, Dr. Wells, too?
Dr. Wells (12:51):
Yeah, I do, and I agree. I don’t think that it’s going to go away. I think that our efforts have to be centered maybe in a different place. One is to be able to … People have a right to believe what they want to believe, and we’re never going to stop all negative information, but what can we do I think can be important. Some lessons that I’ve learned is that we can build stronger ties to our communities, and when our patients and communities trust us, then they will trust what we have to say and they will put less trust in the misinformation that they may receive in other outlets. So, we have to make sure that we’re building those strong ties, that we present ourselves as trustworthy, and that we’re careful how we interact and how we disseminate information, so that we’re viewed as credible.
(13:54):
I think that that’s really important. Also working with patients in a collaborative manner versus like, “I’m the physician, you’re the patient,” or “I’m the provider, you’re the patient.” As we work in collaboration with our patients, with our communities, then we will see that our relationships with them will be stronger, and they will be more likely to be able to understand where we’re coming from, more likely to follow the education that we’re giving them and less likely to give into misinformation that they are hearing at other places, so I think that’s a real key that we should be thinking about, building those bridges even more so as we move forward.
Dr. Kohler (14:39):
Do you think as healthcare providers we have hopefully improved in our communication with patients, staff, community in how we communicate those issues and how we maybe work on a daily level?
Dr. Wells (14:55):
In answering your question, Dr. Kohler, I think that at least we’re having more conversations about it. Over this past year, I’ve heard more about things like motivational interviewing and that patient-provider relationship and how we interact with our patients. So I think we’re at the place where we’re having these conversations more and talking about this more than maybe we have done in the past, so I think it’s a step in the right direction. We’re still going to have bridges across, but I think we’re at least moving forward in that area, so I think that that’s progressive.
Dr. Sassetti (15:32):
What I was going to say is two issues. I absolutely think that as a community of healers, we are addressing all topics differently because of COVID. I think because of first the very surprising backlash that we all experienced. We all had to teach each other how to deal with that, how to deal with hostility, and then just frankly had to deal with misinformation and patients saying no to us when they hadn’t before and what that looked like to turn that around. Professionals, podcasts like these and just us talking among ourselves about, okay, now we need a different paradigm. We have another approach. We have to be collaborative.
(16:10):
That’s been in the literature for a long time, but now we’re really starting to see each other do that, so absolutely, I think we’re doing it. I think it’s spilling over into many other things. It’s been known for a really long time that the best educators for diabetes outcomes, not an endocrinologist, not a family doc, but a community peer member would bring that hemoglobin A1C down lower, so the idea of being in solidarity with each other, being a team versus what Dr. Wells was alluding to, a top-down hierarchical approach, just doesn’t work anymore, probably never did, but if that was a model we were using, it just isn’t going to work.
(16:49):
Then I would say that going forward, I personally have a real interest in neurobiology. What is it that the naysayers tapped into that was so profoundly effective? We better learn what that is. What happened to our patients’ decision-making skills or what happened to their brains that this kind of misinformation became so much more important and was put ahead of our recommendations? How do we tap into that and how do we help our patients’ brains rewire, to possibly be a little melodramatic, but it is with love.
(17:22):
The love that we’ve had for them, the love we’ve demonstrated for them, the commitment to our communities by going out and doing other things. Not just staying in our offices, but be present in their lives and their children’s schools, in temples and churches, all the rest of it. I think we’re tapping into that and beginning to understand the power of that. I have to say also big picture, I think the whole planet is. I think there’s a pull to be collaborative and in community. There’s certainly women’s circles that have known that for a long time that are teaching us that. I think it’s great. I think it’s good.
Dr. Wells (17:57):
I think that our patients are connected to entities where they get misinformation from, and I think that is what’s drawing them is their connectedness to these things. As you were saying, Dr. Sassetti, I think our biggest job is to stay connected. As we stay connected, then we can disconnect our patients hopefully from some of the outlets that are providing that misinformation.
Dr. Sassetti (18:25):
Absolutely. Yeah. I had said it on another podcast, but when I bump up against that, in a very gentle way I’ll say, “Up till now, we’ve been a really great team. What do you think is happening now? What do you think we’re disagreeing about? I’m reading the same literature, I’m reading the same resources and the same people who have guided me for 30 years that you’ve trusted. What’s different now?”
Dr. Kohler (18:48):
Going forward, as we’re talking about our social media influences, misinformation, public perception, community, team building, how do you think COVID fatigue has affected us going forward as we’re now in our basically third year of this pandemic?
Dr. Sassetti (19:05):
This is Marian, Dr. Sassetti, and I definitely see it. I see it on all levels. I see personal and then all the way up to community levels. I think nationally for sure, but the way it’s affecting my practice is I think we’re just tired of literally talking about it and literally saying the same sentences we’ve said forever. I think we’re watching our patients just not be interested in wearing masks. Certainly it’s beginning to show up as parents just not insisting that their children wear masks, and I think it’s going to trickle up. People aren’t interested in the booster. Many of the people who were clamoring for the original vaccine are just shrugging and looking at me and saying they’re not so sure they want the booster, and they’re vaccined out on it all. Then just trying to talk to patients and communities about, “Look, this is something that we continue to lose our loved ones. How can we help?”
(20:02):
I think people feel like they’ve helped a lot, and they’re just wondering if they can move on to the next topic, and there’s this sense that there isn’t the next topic yet. There certainly will be. We aren’t done with pandemics. We are still right in this, and we’re delighted that most people aren’t dying from it anymore, but we’re really in it. We’re still seeing a lot of sickness. Then my grave concern is children’s neurodevelopmental delays and long COVID, and how do we re-harness that energy we had before around people who didn’t want to die, who didn’t want to see their loved ones get sick, are now getting fatigued and not really interested in any more chaos or possible bad outcomes. Even healthcare providers, my own office, my staff not as aggressively bringing up these topics. I think we’re all fatigued, and I think we have to re-energize.
Dr. Kohler (20:54):
Dr. Wells, what have you seen?
Dr. Wells (20:57):
Yeah, I agree that everyone, everyone is tired of COVID. If you’re living on this planet, you have COVID fatigue probably. I think that we have to maybe think about how we focus on COVID. We know that COVID is going to be here to stay. We know that this virus is here to stay, and we also know that this isn’t going to be the last pandemic we go through. We’re going to see other viral illnesses, other chronic illnesses that have impacts on healthcare. I think for me, my thought is that if we focus more on what we as family physicians are really trained and really our big passion is prevention and how do we put everything, instead of siloing diseases, how do we now think about how we have this umbrella of how we prevent disease and manage disease better and keep people healthier so that people understand that we’re interested in their holistic health with COVID being a part of that and their other health conditions being a part of that.
(22:13):
I think as we umbrella it instead of siloing it, and people with all the misinformation that’s already out there and people thinking it’s this and conspiracy theories and all these things, I think as we package health in a holistic approach, then that will help our communities, our patients to have more trust in our interest in their healthcare as a whole instead of these special diseases and viral illnesses that come and go from time to time.
Dr. Kohler (22:46):
Do you think that the public perception of how individuals see healthcare has changed also this past year during the pandemic?
Dr. Wells (22:57):
Yeah, I’ll add to that, but I think that there has been this perception of mistrust, and we’ve seen it in ways that we haven’t seen it before, but I think that goes back to what I said earlier, which is why we as healthcare providers have to be more connected to our patients so that we can be a source of true information and helping to dispel that misinformation that may be coming from other outlets that we may not always be able to control.
(23:30):
And then as people understand again that I’m interested in your whole health and that I’m focusing on COVID, but it’s within the spectrum of your health as a person as a whole and not just siloing it. I think then patients will not feel as if there is this overriding focus on COVID that has displaced everything else in my life. Then now I feel like you’re approaching everything about me, and then I understand that COVID has an impact on the other things going on in my life. COVID has an impact on increasing my risk for long COVID or increasing my risk for chronic disease or making the chronic diseases that I have worse or impacting the health of my children as they grow, so I think if we package it in that way instead of siloing it, then I think that when moving forward we will have better impact and be able to better address the misinformation that goes on in our communities.
Dr. Kohler (24:35):
Dr. Sassetti, do you want to add to that?
Dr. Sassetti (24:38):
Oh, I agree 100%, really well articulated, and I think it’s pulling out the best in us. I think that’s what we do best, like Dr. Wells said. I think there’s even a metaphor in my practice. We originally had these siloed COVID clinics where standalone certain times, and now the vaccine is embedded in everyday life. I’ve talked on a previous podcast about the joy of seeing my MA give a DPT right along with the COVID. I think that what’s happening out in society is the spillover effect of the COVID deniers, I have now heard more patients saying, “Well, what about the MMR?” I heard the vaccines that they would’ve ordinarily not reacted to, I have read a statistic that fully 37% of Americans believe that vaccinating their children is not important. That’s astonishing, and that’s a side effect of the vaccine deniers getting a foothold in social media, so we definitely have to be aware of it.
(25:40):
Again, I think what’s in our toolbox is our commitment to our patients, our teamwork, our collaboration, relying on a history of that. If you’re young and you don’t have a history of it, my guess is you’re probably better at starting this de novo and understanding how important collaboration is among your staff, among your patients. Community building from day one, which is we’re all in this together, and how do we embed the COVID conversation right along with … During the wintertime, I have a different conversation with health and wellbeing for my patients. “It’s cold out. How are you exercising? How are you eating right?” There’s a seasonality to diseases. “How are you keeping yourself from respiratory viruses?”
(26:24):
That’s what I talk about now. Just like Dr. Wells said, I don’t isolate COVID. People are surprised to hear that RSV is a major threat to our elderly population. Masking up to prevent RSV in grandma is important. Now that she’s vaccinated against COVID, it may be more important. I don’t know, but that whole topic of let’s talk about keeping our whole bodies, our whole families, our whole community safe during the winter months, and then what does it look like in the summer months? I think that seasonality and prevention is right where we belong, and it’s our skillset.
Dr. Kohler (26:59):
I think both of you put that exceedingly well, as we’re seeing so many improvements in the way we function either as a team or as a community. So in order to summarize a little bit, in just a few short sentences, even though we did words at the beginning, I’m going to start with you, Dr. Wells. If you had to take just a short couple of sentences to say how you see things have changed in 2022, both in improvements and maybe not so positive effects. Go ahead.
Dr. Wells (27:36):
I think I would say that we are definitely moving in an area of focusing more on community outreach and community building and looking at better ways of how we could have decreases in health disparities and improvements in health equity. And so I think that those are some positive things. I think that we have to continue to move forward in how we work together as a community to build upon those areas and also working together to be able to help dispel by our personalized interactions with patients, the misinformation that they receive, and then understanding what drives our patients and their viewpoints and how they care for themselves and being more connected to those ideas, but I definitely see us as looking at areas of health that we haven’t explored as well in the past like social determinants of health and really trying to move forward in connecting with our communities better.
Dr. Kohler (28:48):
Definitely a very strong community connection component. Dr. Sassetti?
Dr. Sassetti (28:54):
Well, I think Dr. Wells touched on it, and I know we’ll talk about it in another podcast. I feel strongly that we can’t un-see the astonishing death rate in our marginalized communities and our people of color. We can’t un-see that, and we have to offer up whatever little cup of resources are good we can to that effort. I think going forward, again, there’s going to be other pandemics, other illnesses, other medical maladies that affect wide swaths of our population. I think now is the time to mobilize goodwill, thoughtfulness, research, collaboration to really begin to address this. I think it can feel so overwhelming to the average primary care provider that we might just be encouraged to just shrug and hope that somebody else deals with it.
(29:47):
I really want to encourage us, invite us all to hold up whatever cup we can offer and just say, “Now we can’t un-see that. We have to acknowledge that a huge percent of our patients.” These are our patients, even though we don’t minister to them directly, they’re in our communities and what we can offer, and hopefully not to be daunted by it, but to see how well we’ve done and to harness that, everything that we’ve harnessed in our practices and interpersonally, intra-personally. The resilience in my old age, I’ve had to demonstrate, just like you were saying in the beginning. I think that’s still here, and I think it would be a tragedy if we did not use this opportunity to say, “What are we all going to do about this? How does this not happen again on our watch,” and not to be overwhelmed by it.
Dr. Kohler (30:37):
I think that’s very well said. As we go forward, being again, in our third year, we’ve seen the concept of COVID being hopefully a more mainstream respiratory virus as we go forward, looking at how we’re going to implement these changes into our community, into our clinics and such like that. I think that resilience, that perseverance, that sense of community is really important. Any final words from either of you for wrapping up?
Dr. Sassetti (31:09):
I’ll just remind all of us how well we did the unimaginable, tele-visits, right? I mean, now that technology’s part of us, but boy, when I was in medical school, I could have never dreamed of it and now it’s become. I have taught our patients, if you can afford an O2 SAT monitor, have that in the house. Take your temperature. Take your blood pressure, and we could do very comprehensive tele-visits. Going forward, I think we’re going to have to add little bits of technology there. We already know our cardiology colleagues have all kinds of technology to monitor their patient’s heart rates and their rhythms and everything else.
(31:46):
I think it’s encouraging for us to participate in history and see that we could do this, and what is the next chapter? Be open to it. If any of you are old like me, and you’ve got younger children who are always teaching you, I remember calling my daughter in college because I couldn’t figure out a Google document and her walking me through it. That’s going to spill over into our practices, my friends, and I think that we should be proud of ourselves and we should say, “Look what we’ve done,” and keep going. This is a time to feel good about technology, feel good about what we’ve accomplished, and recognize that we can harness that same kind of ingenuity and desire to use these new tools and skillsets going forward.
Dr. Kohler (32:31):
Well, thank you, Dr. Sassetti. I think that was very well said, and I think that encourages us to stay tuned for the next episode of Beyond the Needle, where we are going to look at how our practices have changed for the better and talk about some of the issues such as mainstreaming the vaccines into our practice. Telehealth, and how some of those changes have kept us going. I’d like to thank everyone for tuning in today, and thank you from Beyond the Needle Podcast.