Gillian Hawker is the Sir John and Lady Eaton Professor and Chair of Medicine at the University of Toronto
As Chair of the Department of Medicine at the University of Toronto, I have a bird’s-eye view of the tremendous impact that the COVID-19 pandemic has taken on our faculty members and staff.
We have more than 800 full-time faculty working clinically across six hospitals and another 600+ across our affiliated community sites. We are responsible for 20 residency training programs and train roughly a third of Canada’s specialist physicians, many of whom also teach, research and work on quality-improvement initiatives both nationally and internationally. It’s a big and truly awesome group of people.
Along with colleagues in other disciplines, our department is an integral part the “front line” of the COVID crisis. Our faculty and learners are providing infection control guidance and patient care in emergency departments, ICUs and in-patient wards.
My job is primarily to oversee the department’s teaching, research and other academic activities.
One of the major advantages of my role is that I have a broad overview of what’s happening across the hospitals and the healthcare system.
Without doubt, the lack of assurance that there will be the necessary personal protective equipment (PPE) to provide clinical care has been the biggest stressor for everyone. Hospitals have to conserve PPE to plan for the absolute worst-case scenario but this has exacerbated anxiety around workplace safety. Rationing of PPE is terrifying if you’re providing care on the front line.
I surprisingly don’t hear much from our department members about fear of becoming ill but there is major fear that they will bring that illness home to their loves ones. Many have had to move out, away from their families, only exacerbating the isolation, stress, and loneliness they are experiencing.
As teachers, there is additional fear that we will fail to provide a safe learning environment for our residents and fellows. It’s an extra burden of responsibility that our faculty members bear, which takes its toll on them physically and emotionally.
And while the public may be hearing that the numbers of patients in the emergency departments and wards is lower than usual – which is true – it is taking that much more time to take care of the patients that are there. The hypervigilance is unprecedented – are we wearing the correct PPE, has it been “donned” appropriately (and is it available)? Updating families who are unable to visit also takes time and care.
I see that members of my department are experiencing a form of emotional exhaustion that is both striking and unfamiliar. And while I am not directly on the front lines, I feel it too. It is the fear and anxiety of the unknown. And as this situation persists week by week, it can be overwhelming. We are working hard to provide resources to support the wellbeing of the faculty but these are folks who aren’t great at asking for help – and I worry they won’t. The aftermath of this pandemic may haunt us as a result.
If the clinical demands of the pandemic aren’t enough to worry about, some of our faculty members have expressed concerns that the quality of their teaching and other academic productivity won’t be up to expectations given COVID-19. How do I get the message out there that academic activities must, of necessity, take a backseat to clinical care right now? We get it and will rejig timelines, deadlines and expectations accordingly.
But it has not been all bad. As in any crisis, good can come from it, such as our ambulatory clinic care. It has largely continued during the pandemic but virtually. This is something I am personally delighted to see advance, and the pandemic has ensured that infrastructure needs to support virtual care have materialized in record time. I have also been heartened by the ingenuity of our doctors to figure out how best to do this in real time, including how to incorporate teaching into this new form of care. These activities will have enduring effects on care and learning that are needed.
Being away from the clinical hubbub is challenging for physician leaders like myself, both personally and professionally. I have always believed that a leader should step up to do what she expects others to do. But how can I be a “visible” leader and role model when physical distancing is required and PPE access is reduced? As I am sure many medical students are feeling right now, I too am desperate to be at the front line alongside my faculty members and residents. But I have been told (and understand) that my duty in this pandemic is not this – at least not now.
I miss the banter before and after departmental meetings. I miss seeing our staff. And I miss the flow of trainees through the department. I am very proud of my department and want them to know that we are working hard to ensure they are safe and well. Even if I am not there with them, I want them to know how much we care about them and how hard our department’s leadership team – faculty and staff – are working in the background to advocate for their wellbeing during this profoundly difficult time. Thank you to all the front line workers. I wish I were there but, from the sidelines, please know that leaders like myself care.
Heartfelt note from Dr. G Hawker. Having a physical leadership presence is important in these times but as she pointed out that is hard to achieve, making Department “unity” hard to experience. Adds to the anxiety.
Thank you for expressing lack of life saving protective gear and supplies to our health care workers so clearly and publicly. Around the world most of the health care settings have faced the challenge of providing care for patients with COVID-19. Because of often ill-equipped with personal protection equipments (PPE) and poorly prepared (despite credible research have forecasted about this pandemic well in advance). Despite, our health care heroes are working hard with compassion to save others lives while risking their own lives. They honor us all with their commitment, dedication, empathy selflessness, and professionalism. We all need to show our sincere gratitude and think about everyone of them every day.
The void we cannot fill (selected news story to highlight a real hero):
A consultant who warned UK PM Boris Johnson about the need for more personal protective equipment (PPE) to support NHS staff during the coronavirus crisis has died from the disease (1).
Dr. Abdul Mabud Chowdhury, 53, made a direct plea to the prime minister in a Facebook post last month, when he asked Mr Johnson to “ensure urgently personal protective equipment (PPE) for each and every NHS worker”(1).
Dr. Chowdhury, who worked as a consultant urologist at Homerton Hospital in east London, said in his post: “People appreciate us and salute us for our rewarding job which is very inspirational but I would like to say we have to protect ourselves by using appropriate PPE and remedies.”(1).
PPE shortage globally is one consequence of years of underinvestment in pandemic preparedness, despite many warnings. However, using traditional news outlets and social media platforms, physicians are sharing off-the-books tips for creative solutions amidst the lack of protective gear and supplies (2) . JAMA editors have shown their real leadership in timely important manner and made a huge plea to medical health community around the world to share ideas on how to be creative to address the shortages of this life saving medical supplies (3). The WHO, is also made a plea to increase PPE manufacturing by 40% to meet rising global health care demands. “Without secure supply chains, the risk to healthcare workers around the world is real,” said WHO director-general. “We can’t stop COVID-19 without protecting health workers first.”(4) During the COVID-19 pandemic, physicians and other healthcare teams make difficult decisions by the second (4). We need to show our sincere gratitude to organizations like the Canadian Medical Association (CMA) for working tirelessly to mitigate the core issue and finding the ways increase medical supply production and delivery (5). Many doctors are also often expressed their fears and frustrations on the unclear, conflicting and misleading guidance of PPE use. It is therefore, equally important to address this issue by drafting clear guidelines on PPE use.
(3). Bauchner H, Fontanarosa PB, Livingston EH. Conserving Supply of Personal Protective Equipment—A Call for Ideas. JAMA. Published online March 20, 2020. doi:10.1001/jama.2020.4770