The recent suicides of healthcare workers on the front lines highlight a potential second disaster in the making.

Psychiatrist Wendy Dean is an expert on Moral Injury in healthcare and talks about real solutions for healthcare professionals and their leaders. Here are her Medscape and Stat News pieces about the effects of COVID-19 on frontline caregivers.

Check out her non-profit dedicated to alleviating the moral injury of healthcare.

And for a quick refresher on moral injury, here’s a video I did based on Dr. Dean’s work (along with her collaborating Dr. Simon Talbot).

– Hey everybody welcome to The ZDoggMD Show. I’m Dr. Z a.k.a ZDoggMD if you’re nasty. Alright, today’s guest is a personal hero of mine because her work along with Simon Talbot on the moral injury of healthcare really modeled a lot of what our movement is about. Talking about moral injury in our population and how it is often confused with burnout and there’s victimization and all that. She’s a psychiatrist, she’s worked as an ER physician, she’s has surgical training, she’s worked with the military, she has a huge scope of experience to talk about issues that we’re gonna talk about today, which are the pending mental health crisis that’s gonna happen when frontline health care professionals start to process what they’ve been experiencing during the COVID-19 pandemic. And so guys, please welcome and by the way, she wrote a STAT News article that came out today that I shared or came out very recently that I shared on Facebook and got hundreds of comments and really hit a nerve. Wendy Dean, welcome to the show.

– Thanks so much. It’s great to be here. I mean, it took a pandemic to get us together.

– You know, sometimes it does. And you and I have spoken before on the phone, and we’re trying to figure out how do we get you on the show, because there was a geographic distance. And I’ve always said Wendy, I don’t do Zoom. Zoom is terrible. And now I’m like, forced, right?

– Right.

– And it works. It actually works. It’s not as same, but it’s so essential that we’re able to do it. So thanks for taking the time. Today it’s been a crazy day for you talking to press and doing all kinds of stuff, yeah?

– It has been a wild ride. Yeah. And it’s one of those things that’s, I’m so glad that it resonates with people and gives them language. And I’m heartbroken that it resonates with people and gives them language.

– That’s the thing. Everything you write about Wendy is like it’s a shame that we even have to write about it. Like it’s a tragedy and yet it’s so important because what you guys are able to do. And by the way, you’re the president and founder of Moral Injury of Healthcare, which is a not for profit or for profit?

– No, it’s a non-profit.

– Non-profit. And again, tell me the goal of that organization, by the way, just so people understand.

– So we’re out to reimagine better healthcare, and to reimagine better medicine for all of us. For patients, for clinicians, for healthcare organizations. And really, this is an opportunity for us to all come together and think about how medicine can be better for all of us.

– We’ll put links to all this after the show. So here’s something for the audience to recall. I did a rant. I don’t know a couple years back on how we shouldn’t be calling this burnout. We should be calling this moral injury and that rant was inspired by Dr. Dean’s article with Simon Talbot that put into words what many of us were feeling. And I had shared the article first, and I saw the response to it and I realized this hit the same nerve in y’all that it hit in me which is she was able to put words to our suffering and give it a sense of structure and meaning. And what I found with the piece you just did in STAT News about the suffering of trauma, emotional trauma, whether it’s death or moral injury, whatever it is, has a structure and a pattern that we’re not recognizing and therefore not addressing and it’s gonna lead to problems. I mean, can you start maybe talk, filling us in on some of that?

– Yeah, so what I’m worried about is that healthcare workers, there was a big uproar at the beginning, when we saw that this pandemic was coming. Everybody was worried about their safety. They were worried about being able to take care of patients and so there was a lot of clamor. Get us PPE, get us ventilators, get us whatever we need. And then once the virus hits, and people started putting their heads down and going to work, that clamor quieted, because we didn’t have time to do any more of that. All we could focus on was keeping our patients alive. Right? And so that’s quiet. And people in a crisis can look really good. And they can appear to themselves, like they’re doing really well. Because we’re able to compartmentalize and really push aside, so much of the things, so much of the feeling that might interfere with our ability to act. And then what happens is a little bit after, when the action slows down, we have time to start thinking and processing all of the events that we saw, all of the experiences we had, and it could come back in a flood. And we can’t predict when it’ll come back. We can’t predict how powerful it’s going be, and it can blindside us.

– I think what you said is so accurate even in the experience that I have as the role I’m playing in all this, which is listening to people’s stories. When the thing started, like you said, hundreds of messages from people around the country, we have no PPE, we’re absolutely not ready, this is a complete crap show. We’re all gonna die. Then it hits New York in a way that really nobody really understood what was gonna happen. New York was silent. I did not hear a peep from people in New York because they were heads down on the ground in that zone that we trained for. Now, what you’re saying is when that starts to let up, which it’s going to, it’s already plateauing. That’s when the coping mechanisms that we had, which were maybe a bit of detachment, and you kind of really go through a good job of doing that in the article saying these are the kind of ways we can either internalize, externalize, we can compartmentalize, there’s different things we can do. But then when we have downtime and space for the first time, those feelings start to rise and they want your attention and how you deal with it then. And I think you started the article with the story about two healthcare professionals that lost their lives, an EMS provider and an emergency physician, Lorna Breen. And the story with her that I remember reading, is that she was super on the frontlines. Ended up getting sick with COVID, wanted to go back. They wouldn’t let her go back. She went to stay with her family or something. And then the report was that she died by suicide. And does that sort of fit this idea that you have a reprieve and all these feelings come up?

– So I can’t pretend to know what she was thinking or feeling. But what I can say is that in my own experience of having been through what was a traumatic experience at the time, where I thought I was doing just fine head down into it, plowing through, I did not realize until about a month later, when I had been out of the fray for about three weeks that I was not okay. All of that, in the downtime, those things sneak up on you. And it can be a trigger of anything or nothing.

– And for you, that was a triple whammy that I’ve never heard. Your husband got sick was in the ICU, your elderly mother fell and broke both hips, and your brother had a massive stroke, all in the same day, roughly?

– Yep.

– So okay, first of all, that just shows there’s no justice in the universe because nobody deserves that. But second, that was the trauma that you’re talking about. And you went into clinician mode and you did your thing, but then the space opened up and you wrote about it very poignantly about how you allowed, your friends helped you take little sips of the emotions. Can you describe that, what you mean by that?

– So what was happening in the time was up, and I had the same experience when I was in the trauma bay, I had taken care of patients. The same experience in the OR when things got challenging. And what it is you only process the bare minimum that you need to, to get you through to the next day, to the next hour. So, I would call my friends and I would rant or I would just say, “Man, I don’t know. “This is getting to me.” And they would kind of hear me, validate it, put it put me back together, send me back in. If I didn’t have them, it would have been much more challenging, because I could at least offload a little bit to them. There was nobody who can do what I was doing and who could carry all of it for me, but they could at least, shore me up. And that’s what I meant by you take sips of that emotion. I could let myself be a little bit afraid. And then I had to box it right back up, and my friends helped me to do that. Because they knew what I needed, and they knew, one of my friends knew that I needed just a year. Like she rarely said anything. My other friend would start swearing. Because that’s what he’s good at.

– I’m that friend.

– Right, exactly. And so, I had people who knew what I needed. And knew what would put me back together and keep me back in the fight.

– So that’s still a short term coping strategy, right? So then what happens after that?

– Well, so here’s the challenge, is a lot of people think, well, why didn’t you process it in the moment? Why didn’t you just deal with it and feel those feelings, be mad and sad and scared and all that? Because if you take away that coping, if you take away the denial and you take away the compartmentalizing, and you take away all of that, you might not function. Because when all those things come crashing through, it actually takes, it takes brain power to process them, it takes energy to process them, it is distracting, it’s distressing. And you can’t be in your rational mind taking care of somebody else, especially in a crisis situation, if you’re distracted by that processing.

– And that’s particularly unique to our profession, because may be pilots and others that are in these very mission critical military. You have to do that in order to function. And actually I have an interesting angle on that myself because having gone from a full time clinical practice in hospital medicine at Stanford to I round a few days, a month as a voluntary faculty in Las Vegas. When I round now, I have an openness to emotion and experience that I could not have allowed myself when I was full time practicing because I wouldn’t be functional. So I have a great support team and so I feel every patient in a way that I wouldn’t allow myself to feel because I couldn’t function. Now I have the luxury of doing that. And the emotions are overwhelming at times. And so it’s a real thing that we have these separate abilities to compartmentalize and it’s essential to our job. But then the question is then what next? How do we when those emotions come out, how do we process them?

– We need to honor them. And i think that the answer is gonna be very different for each individual person. So there are some people who are going to say you know what? If I start deconstructing this, I’m worried that all of the glue is gonna come undone, and things are just gonna cave in. So I’m gonna keep all this together. There are other people who will really need to spend a lot of time processing it, particularly if it brings up past traumas, or past grief. I mean, because I think that’s the other piece of this, that we’re not that talking about as much as we need to is, we’re grieving. Right? Like this is collective, this is trauma, for sure. It is also grief. It’s grief for what we thought we could do for patients. It’s grief for those patients that we’re losing, its grief for the fact that some of them will die alone. So it’s both things. And I think getting to the other side of it, we’re gonna have to really spend to honor those feelings and that experience and take the time we need to walk through it.

– You know, I’m appreciating this more now. I interviewed a APRN in critical care early on in this, who was working at Gradient in Atlanta seeing the first wave of COVID. And this is real expert on ICU management of this stuff and great teacher and she taught us about this stuff. Throughout the interview, she was emotional, and would tell stories and would talk about the patient who’s they had to put their cell phone in a biohazard bag so that his family could say goodbye. And I realized I’m like, this is really hard, but I was like, I’ve not seen clinicians behave this way about their patients in the moment because you see them all tightened up, but she’d had a minute now to let this kind of out and her way of processing it was, it doesn’t matter how many hundreds of thousands of people see it that ultimately did, she’s gonna do it right there. And it was again, you honor those emotions.

– And sometimes you don’t have a choice. And that’s okay.

– What is unique about this? I mean, there’s things that aren’t unique, but there’s things that are very unique about COVID-19. There’s a collective grieving, like you said, a collective trauma, but there’s also a specific trauma to healthcare professionals, like you said. You mentioned in the article, the moral injury of fearing for your own life, because you don’t have enough protection while wanting to help a patient there that has COVID or you worry has COVID. How is that affecting us? And are we being supported in those feelings?

– So yeah, that’s a challenge. I think when you watch someone die alone, or when folks are witnessing so much death, it’s traumatic. When you watch someone die alone, because you don’t have sufficient PPE, to go in and hold their hand, that’s moral injury. Right? Because you are screaming, we have to shut down the elective surgery two weeks earlier than we did. We have to shut it down. And because we need the PPE. And somebody said, “No, we’re good.” And in the end, it turned out, maybe not so good. We don’t have enough to be able to go in and comfort patients in their last days, in their last minutes. And that’s the moral injury part of it. Because something outside of my control, prevented me from giving my patients what I knew they needed in the moment.

– I think that’s spot on. That’s spot on. And what this led to I think, a lot of antagonism between frontline healthcare professionals and management, whether they’re clinical or not, and I’ve talked about this before. And actually had a thing where I ranted about how management is really– They had one job, which is to keep us safe there. And I was feeling that same, hearing all these stories from the frontlines, and then you talk to the management. I had Rich DeCarlo on the show from PeaceHealth, and I talked to him on the phone a lot more than I talked to him on camera. And man, they are trying to keep the lights on, they’re worried about their staff, they’re worried about their patients. There’s so much that they’re having to deal with, that’s out of their control, and they’re suffering their own moral injury. And now with operational revenue plummeting, and everybody shut down, they’re wondering, they’re starting to furlough physicians, and they don’t wanna do this, and yet here they are. Now another conflict, right? So this is, and people aren’t really talking about the emotional valence of that or the traumatic valence of that. It’s us versus them still.

– So the other role that I had, that you didn’t cover in your introduction, come on man.

– I make those introductions up man. I do them based on no science. I’m just like, this person seems like a psychiatrist. I don’t know.

– So the other role that I had, most recently before I went to doing the moral injury thing full time was, as an executive in a very large non-profit, and $0.5 billion non-profit and I was making those decisions. Those decisions are incredibly wrenching. Nobody makes them lightly. Nobody puts their people at risk without feeling distress about it. I think the challenge is that it’s also very easy when you’re in that remove, to say, well, so here’s how we need to think about this. The rationalization may be easy or we need to present a reasoned approach rather than being able to go to people and say, “This is incredibly hard for me. “My back is against the wall, “help me figure out how not to be there. “Let’s work together to try to not be there.”

– So, okay, what you’re saying put a finger on what I’ve been trying to convey with varying degrees of success, which is communication, openness, a degree of vulnerability would be so freaking awesome, right Wendy? From both management and frontline staff to say, you know what? We are all in this together, we are suffering, we feel like we screwed up a little too because we didn’t prepare for this and we didn’t see it coming, but a lot of people didn’t. So we have to forgive ourselves and say, what can we do now? But instead, what I think has happened is people go into a defensive mode which you understand quite well, where it’s like, Well, okay, now you guys, I’m getting these horrible emails that are personally hurting me. These kind of emails that would trigger any human being to put up walls. And that’s what’s happening. And then management says, “You can’t talk anymore. “You can’t speak to press, “you need to stop this.” And then it becomes just a crap show. Right? I’m trying not to curse because I respect you.

– Oh, you’re welcome to.

– All the other interviewers were I was like, f this f that. So you didn’t respect me? What’s going on?

– You know what? I ride horses, I spent time in a barn. I’m good with that.

– Enough said. Exactly. So tell me how you see this because we’re gonna get very shortly into your solutions. In other words, what are your action items? And I think one of them is communication.

– Absolutely. I mean, so one of my challenges was with approaching problems that way to say, well, we don’t have a choice but to continue elective surgery and so we’re gonna frame it in this way. That’s a bit patronizing.

– Yeah.

– And so what I would rather see is people is the administrators or the executives coming to the physicians and saying, okay, confession here. I am worried. I wrote this in a Medscape article that the administrators were worried their organization’s weren’t gonna survive the COVID virus. They were worried and rightly so, They’re proving to be patient here that the revenue streams when you stop elective procedures, the revenue streams dry up extremely quickly. And COVID treatment does not pay like elective surgery procedures pay. They are very staff intensive. They are resource intensive. And so in some ways they were absolutely right that they couldn’t, they were worried. They had no assurance that they were gonna get to the point where they would get rescued, right? That they would have any revenue flowing in. But at the same time, knowing that going in, it would have been so much better to come clean with your staff and say our backs are against the wall. We are offering to take 25% pay cut, we’re all in this together, what are you willing to pitch in.

– That is exactly it. Because I’m hearing so many people now. We have the executives not taking pay cuts, they’re furloughing doctors, they wanna restart elective procedures, it doesn’t feel safe to us, we still don’t have enough PPE this and that. Well there’s no communication. What’s really crazy is again, like the PeaceHealth guys. I got a lot of crap for letting the COO on the show. He’s a lovely human being. When I talked to him, his back is against the wall, he cares deeply about his stuff. Now, again, there may be other problems there that I don’t see and I hear about it from the frontlines all the time. So I get that. But these are human beings doing their best. Now, if we had an open communication that wasn’t so afraid of, whether it’s an HR violation, or whether it’s legal stuff, or whether it’s– Whatever it is. You gotta realize, we’re all in this and we have to fight together, which means that that’s one thing is to understand our shared mission, and then communication and I think you put that in one of your action items in the piece. The other piece you put up. So again, here we are, we’re in a situation where we’re gonna lead to a lot of trauma, a lot of grief, a lot of unprocessed emotion. And when that comes to roost if we don’t have processes, we’re gonna see a difficulty in addition to the 1% rise in suicides we see with every 1% rise in unemployment, and now we’re at what 30%. So, and again that’s a whole nother discussion is how far to go with this. But back to this, what should administrations and the public and others be doing to help frontline health care professionals process this stuff?

– So I think the first thing that they need to do is give them a break. Ease up. When they’re done, there’s gonna be a powerful urge to just say, “Okay, let’s go. “Back to business as usual. “Let’s just wind those gears up and go.” And there will be some in medicine who are chomping at the bit to do that. The folks who have been on the sidelines, they are ready. Those folks who do mostly elective procedures, they’ve been like, kept up, let’s go, game on. And I understand their perspective too. But again, I think there needs to be a negotiation between those who are exhausted and they’re seeing some light at the end of the tunnel and they’re thinking, okay, maybe I can rest a little bit. Maybe I can get caught up a little bit. But I think there needs to be some negotiation about continuing to up staff a little bit. Continuing to over staff slightly or have people on backup, so that when know when those unexpected days happen and the doors blow open and all the emotions come out, you can call in and say, “I need to tap out today.” And somebody says, “Yep, I’m on it. “No worries.”

– The proverbial mental health day but actually applied correctly. Yeah.

– Right. And, it doesn’t– You can’t just be, okay, we’ve got some, there is staff available to take your shift. It has to be one phone call. Where you call your scheduler and you say, “Can’t go in today”

– Can’t do this, can’t do this. And so easing up is a key thing and I think that’s right. Now of course, they’re gonna be resource constraints and the administration is gonna say we’re out of money, like how do we staff up that way? But I think, again, would you rather replace someone who quit, suffered the end stage of moral injury, which is burnout or worse? Or would you rather invest in your people because they’re the main thing that makes health care work, right?

– So for every person who leaves it costs about almost $1 million to replace them. So I don’t know.

– I don’t know. Seems like the math works out, give them a day or to process. And then another thing you said was checking in with your staff. And this is one thing, so checking in, you know how that is right? You get the email. “Hey, hope everyone’s okay. “Everyone hanging in there.”

– This is not a performative check in. This is a check the box check in. This is a genuine, heartfelt I am a servant leader, I am responsible for you, I care about you. What do you need to be successful today? And then making sure that it’s available and easy to access.

– So this is, again, as someone who’s worked in large organizations too, and has led a smaller organization, the act of feeling valued and recognized and even having your suffering witnessed is so powerful. If leaders did that, and nothing else, even if they paid people crappy and treated them like crap, although that’s not true. There’s a lot of things people will tolerate, if they feel like they are serving a role that is felt and appreciated and that the struggle they have is actually witnessed and appreciated.

– And if your leadership acknowledges that suffering and says, “Here’s what I’m doing to change that.” And is transparent and honest about that.

– And the limitations of that. Because sometimes it’s like, well, we can’t get you 20 more nurses to staff the floor immediately. So what can we do to make life easier? Maybe there’s a few less check boxes that you have to do. Maybe we won’t hassle you about your whiteboard today, whatever it is. And, so you say check in and mean it. And the way you mean it is with your actions and your words, right? So you have to do something. Now the other thing you say, and again, I’m referring to your article, because it’s so well done. Really, you have a gift at being able to put this stuff in a way that people can process it, right? Like my gift is being able to talk, that’s all I can do. Yours is real. I mean, this is this is a beautiful gift you have. So provides support is the other thing you say. Now, what do you mean by that and how is that different than checking in? So I feel like support comes in a lot of different ways. And what that means is I’m gonna, support like processing is a little bit different for each person. So, I am going to provide additional staffing for you, I am going to provide mental health support for you, I am going to make sure that we have MOUs with local organizations that are going to provide either crisis counseling or group therapy, or something. I’m gonna have MOUs with spin classes so that people are getting what they need and they feel like their organization is hearing them and doing something about it. And this is beyond like an EAP or one of these employee employee assistance programs, something like that HR always has.

– Right because not everybody is gonna process by talking. Right? Some people are gonna are gonna process by breaking stuff. I mean, glass recycling bins are great place sometimes. Some people are gonna need to skip stones for hours, some people are gonna need to just sweat it out. So the processing if you prescribe what processing looks like by having processing groups and reflection rounds, those are great, and they help some people, but other people just don’t find that useful. And so I think there needs to be some flexibility in how we support.

– I think you’re right and I think this one size fits all mandate of like, hey, we’ll do some mindfulness bro. Like that is not a one size fits all. I happen to like meditation, but if I tell somebody who’s preferences is to break things, that you should sit and be alone with your thoughts, watch them. No, that’s not how it works.

– So funny story. I was one of the first medical students in Jon Kabat-Zinn.

– No way. JKZ?

– So I went to Umass–

– Dude, he’s the OG of mindfulness. I love it.

– And spent lots of lunch times on conference room floors. It did not take.

– I love it that you were with like the guru of medical application of mindfulness and you’re like screw this. And it is, and I think it’s again, a lot of this stuff you have to commit to in a way that we don’t have the time. Like I could tell you Wendy man, if I could do cognitive behavioral therapy and journal and recognize all my cognitive distortions, I’d be so much happier man just listening to the audio book feeling good by that psychiatrists made me feel better but when I try to apply it and I recognize I’m catastrophizing or I’ve got a black or white thinking or I’m over generalizing all the distortions, which by the way, we now see on mass regarding COVID-19. Catastrophizing, overgeneralizing, black and white thinking. Boy I’d be happy but it’s just not in my blood to be able to pull that off routinely. For some people it is. You find what works for that person. The other thing you said is listening. So administration and leadership should listen. What do you mean by that?

– So I think there’s often a lot of talking, the, “I’m gonna tell you what we’re doing. “I’m gonna tell you what the problems are “and what we’re doing about it.” And there’s very little receiving. Saying, again, this idea of what do you need to be successful today? Where are the gaps that you see at the coalface of care? You’re the one who’s in the thick of the fight. What do you need? Listening to your people, getting that feedback, incorporating it, and then acting on it.

– Listening again is part of the communication piece. Again, we’re taught that, I can think of a great example, New York Presbyterian, their CFO, COO, you saw that clip with the– Yeah. Man, that’s a tough one, because she has a reputation for being an excellent leader manager, right? But then how she communicated when staff were sending her nasty emails about, hey, we don’t wanna come here. We don’t feel safe and they were back office staff. She said, “Hey, we give you a job. “You’re lucky to have this job. “You come in and support the staff.” And again, it was taken out of context, but again, the listening and the communication there boy, and then she did a conference with CBS where she just doubled down on that and it’s like, there’s a way to do that, that shows that you’re listening, shows that you care. And it’s really it’s that. It’s the appearance of that.

– Yeah, and I think part of it is being willing to be vulnerable and having the emotional fluency to be able to recognize these people are scared. Their anger is fear. And if I respond back, if I bite back, then we’re just gonna get into a really nasty fight. And everybody’s gonna come up bloody. So how about if I just check where I am, and get curious about their anger. Where’s that coming from?

– Yeah, it’s interesting because watching what she did, she said, “Listen, it is very upsetting “to the leadership to receive these emails.” So she’s actually pointing at her own anger there. And it would have been interesting. I’ve often weighed, how I would have handled that. But I’m curious.

– And her fear.

– And her fear, yeah.

– I’m guessing that she was fearful as well. Right? She didn’t know what she was asking them to come into. She knew that she was gonna put them at risk. And she didn’t have another choice. But still, it would have been better to be vulnerable and say, “I don’t know what’s coming either. “I feel your fear. “I have it too. “So let’s walk together into it.”

– Beautiful. Man, if that could all happen. If we could just show a little more vulnerability, maybe a lot more. It’s a very hard thing to do because we’re so conditioned in healthcare too to be the rock and the wall.

– Let me tell you. So a friend of mine, one of my best friends read the article, and she’s like, “Wow, your vulnerability.” I was like, “Wait, what?”

– Immediately you’re like, “I wasn’t vulnerable, bro. “I was just telling you facts.”

– So because I said to her, “Oh, I didn’t have time to be vulnerable. “That was the fastest thing I’ve ever written.” And I think it was partly just, let’s just get through this. I do not wanna be vulnerable.

– Wow. No, the vulnerability came through actually. But you could tell actually, I was thinking this when I read it. I was like, “Oh man, this is like vulnerability “through the filter of professionalism.” Because it’s so hard to do, and you don’t wanna do it in a way that you’re just falling apart. You wanna do it in a way that it actually shows the truth. And it’s a balance, which I think he pulled off in this article unintentionally, because clearly you weren’t intending to be vulnerable. But again, that just shines through in what you’re doing and I think good leaders are able to do that naturally. I actually saw, quick side story. I have a friend who’s a venture capitalist who’s also a physician, we went to med school together. And he was talking to me about this, about how he’s had to make decisions around COVID-19 for the companies that he invests in that he’s on the board of, that have been just rending. And the way he does it is with open vulnerability. He’s like, this is the hardest thing I’ve had to, I hate this. I’m scared, you’re scared. This is the best of the worst decisions. I think I could still have it wrong but I need to do this and I’m sorry. And people respect that. They respond to that, because they don’t see the obfuscation that so many administrations seem to put on.

– And what I think people don’t realize, or they convinced themselves is not the case that people see right through it.

– Yeah, they see right through it.

– Doctors, they know what the story is about PPE. They know. They know.

– Yeah, yeah, exactly.

– So coming up with that framework of how you’re gonna present it. Everybody knows what that process is.

– Exactly. This is the corporate spin. This is administrator speak. This is the email that has it parsed out that someone thought over thought and overlooked.

– Legal has reviewed.

– Yeah, legal has reviewed. That’s the key thing. That’s why I no longer do a lot of sponsored episodes because when legal has to review, I’m like, “Well, now the deal’s off, “because that’s not a show that my audience cares about.” And, I think it’s interesting. Now one thing I wanna make sure that we don’t forget is the stigma in health care about admitting that you have you have feelings or difficulties, and some of that stigma is because on our licensing apps we have to right. Oh, were you treated for this? Or have you had a problem with that? It’s really terrible. And it dissuades people. And then the cultural stigma around, “Hey, you just suck it up.” What are your thoughts around that?

– So I love the fact that frontline workers are being called heroes right now. And it worries me very much.

– Yeah, I feel the same way.

– Because heroes don’t cry. And heroes are not vulnerable. And they’re the ones who save the world and kinda, okay, I’m good. So that part of it worries me. I don’t wanna change that, because I think we need it right now desperately, but I also want the frontline health care workers to realize you can be a hero in that room and you don’t have to be one after, right? That you can, when you doff, you’re taking off your cape. it’s okay. Like it’s okay to be human at that point. So, I think there’s a whole other piece of medical licensing boards and PHPs. That is just a quagmire that might be one of the other silver linings in this whole challenge is finally getting those off of licensing board applications and renewal, licensing renewals.

– That would be a wonderful thing and it would change a lot. And then also, having good insurance coverage for mental health care. One thing you mentioned that kind of struck me the idea that heroes don’t show vulnerability and they’re the rock, right? So this act of calling healthcare workers heroes is almost, it’s perceived by some health care workers as a way of saying you will work until you die. And we’re very grateful for that. But we’re not gonna support you at all. And so that’s an important point.

– And I don’t think that’s, the general public is not thinking that way.

– Not the public, yeah.

– They are desperate to support frontline workers.

– That’s right. Not the general public.

– Yeah, I am so grateful for that. To think that all of New York City lights up every night at seven o’clock with this brand, this huge racket, I mean, that’s awesome.

– It’s pretty awesome. And it’s a way of reaffirming why we went into this so that it’s a calling. So one thing that it reminded me of was in “Superman II,” which is, it’s hard to remember. It was one of my favorite superhero films because it happened when was growing up like 1980 or something. In “Superman II” these bad guys come from wherever but Superman gives up his powers in order to be with Lois Lane. And he suffers indignity after indignity after indignity. Like somebody crushes, the guy crushes his hand and he’s beaten up in a bar in Alaska. And that’s when you start to love Superman. Because you see that he’s a hero, but he’s also this vulnerable human being with frailties that when you see them, you go, “I can relate to that.” And that’s what makes him real. Then when he gets his powers back, you’re rooting for him. You’re like, “Man, I like you bro.” And I think we could take a lesson from “Superman II” right? “Kneel before Zod,” for people who know. Nobody knows that movie. But anyway, so–

– You deserve to date yourself I gotta tell you.

– I date myself every single day, just like I used to in high school because I had no real dates. But there’s another side there. But so Wendy, what sort of important parting thoughts do you want to impart here because I wanna have you back on the show to talk about this and follow up but there’s also on the moral injury standpoint. Because this is a big movement now that you’ve started that understanding moral injury is important to understanding the solutions to it. So please.

– So I think that the moral injury was a big problem before we got, before the pandemic arrived, right? Like we layered the pandemic on top of an already challenging healthcare system. And I really think that the moral injury has morphed and it’s magnified in the context of COVID. And we need to pay attention to it. And we need to start working, we need to somehow get administrators and executives to recognize that it’s in their best interest. Their clinicians are their most valuable resource. And it is in their best interest to work together with them to get to better medicine.

– I think that’s a great way to end the show because that ties everything together. That we need to support our frontline, and we also need to stop being so, the frontline needs to stop villainizing management and start to work with them and demand better communication, listening, vulnerability. I think we need to really start to demand that by showing it a little bit ourselves too.

– And we also need to be curious about what their challenges are.

– People don’t understand how hard it is. I remember Wendy, I used to take a crap on healthcare administrators directly until I became one, then I was like, this job sucks.

– This is hard.

– Like I’ve never hated a job as much as having like managing physicians, managing physicians. You’re supposed to lead them. Trying to manage them is like herding cats. Leading them is inspiring them and showing them that you’re part of their tribe and also helping to keep the lights on and supporting them as best you can but being realistic when you can’t. It’s a had balance.

– And that’s the whole point. Right? If we can get to true servant leadership, where we’re saying, What do you need to facilitate your engagements with your patients? How does this entire organization help to support you in providing better care for your patient?

– Yeah, yeah. You know, if it’s one magic wand I could get rid of, it’s all the corporate speak, it’s all the BS legal crap, it’s all the obstructions to open and honest communication. If we could get rid of that and with our patients too. Think how much less malpractice insurance would be if we could just be honest with our patients. “Dude, we made a mistake. “It’s an error that should not have happened “and it did for these reasons. “We will never let it happen again. “We’re gonna change our process, “we’re gonna do all the root cause analysis, “we’re gonna apply just culture.” There are very few patients and families that would not hear that and appreciate at least the sentiment of it. And so I think that’s important is this openness. But Wendy, thank you for, we finally got to do this.

– Yeah, this is great. It’s really great. Thank you so much.

– Thank you for helping people. You really help a lot of people with this. You help me understand it better and communicate it better. And guys, I will put links to Dr. Dean’s stuff in the description and on my website. If you like this kind of stuff, please share it with people. Share it with your administrators as an olive branch. Let’s start talking and understanding each other better and stop pointing the finger and fighting and let’s get through this together. Let’s support each other and that would really mean a lot. It’ll go a long way. All right guys? Let’s find the silver lining in this crisis and do better in the future. Alright guys, I love you. We out. Peace.

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