Tag: Health

The Cruelty of COVID-19

We’ve been living with restrictions caused by the COVID-19 pandemic for over two months now. I recently lost a patient due to COVID-19, and this loss caused me to reflect on the effects of the disease, and it’s impact on society. There really is only one word to describe it.

Cruel.

This disease is unrelentingly, unwaveringly and inexorably cruel.

This has nothing to do with the actual pathology (the conditions and processes) of the disease. That in itself, is in line with a bad viral illness. You (mostly likely) get a fever,cough muscle aches, etc. In people who are predisposed (elderly, those with immune compromise) COVID-19 is more likely to get into the lungs and cause inflammation. There is, of course a much higher rate of death for those who have multiple other medical conditions.

Doctors have seen viral illnesses throughout the years, and this pattern of the weakest among us been more adversely affected is one that we are all aware of. Indeed, my patient was elderly and had a number of medical problems. Truth be told, it would not have been unexpected for my patient to have died anyway from any of the other conditions they had. While tragic and sad, the fact that COVID-19 took them when infected, is no real surprise.

Instead, however, the cruelty of this disease is manifested in how my patient, and the grieving family spent the last days. My patient was in hospital, isolated, and alone. No family could visit. No comfort in their last days and no ability for the family to say goodbye, which I know will haunt them for a long time to come.

But it is not just the patients with COVID-19 who are dealt this cruel fate at the end of their lives. Another patient recently died in hospital due heart disease and was COVID-19 negative. Didn’t matter, the new restrictions in place to increase physical distancing and reduce spread (all of which make sense on a population level), meant that they too, died alone, with no contact from family, and the grief of not saying goodbye will haunt their loved ones as well.

This doesn’t apply just to hospitals either. The local hospice (my community is fortunate to have one of these) has new, stringent guidelines in place for their palliative patients. Only one visitor per patient at a time. A maximum of two people allowed to visit at all (what happens if you have more than two children who want to say goodbye). Common area not to be used, so no sharing your grief with other families (which is often therapeutic).

Yes, I know, communication via online tools and phone is encouraged. But we humans are social creatures. We need to see each other in person. We need to hold hands. We need to hug each other. We need physical contact. Yet we can’t have it. Of course, this is necessary and appropriate. But that doesn’t make them any less cruel.

The further medical victims of COVID-19 are of course, the patients whose care has been delayed while waiting for the acute stage of the pandemic to pass. My patient who has a growth on her ovary, and has not been able to get a repeat scan (and worries daily about what it could be). My patient with chronic hip pain who was already waiting for 12 months for their hip replacement surgery before it got cancelled since it was “elective”. Numerous patients with cancer who have had their treatments delayed. The 35 (minimum) whom the Health Minister herself said may have died due to the care that was delayed by this pandemic.

Then of course, there are economic victims. The 44% (!!) of Canadians who lost work due to the pandemic. They now struggle with finding ways to pay the bills and provide shelter and food for themselves and their families. The toll as they struggle is heartbreaking.

We are also seeing an increase in domestic abuse, more people with alcohol and drug problems relapsing, and warnings of Post Traumatic Stress Disorder in physicians and allied health care workers who treat patients with COVID-19.

All of the above are victims of the cruelty perpetuated by COVID-19.

But in all that, there is, to my mind, hope.

There has also been this year an explosion of gentleness, kindness and decency amongst Canadians. Whether it is a grass roots group like ConquerCovid19 (which has, to my mind saved an untold number of lives and reduced morbidity), or simple acts of gratitude like shining a light for doctors, these acts make a difference. Whether you provide PPEs, or grocery runs, or other support to health workers, you are making a difference. Whether you call your friend to check on them after they have lost their loved one, or check on isolated seniors, you will make a difference. Whether you sing songs like these students or these doctors, you will make a difference (seriously, click the links, those songs are great).

Or if you are the unknown (to me) person who left this on the front lawn of my office building…

… you made a difference.

“Gentleness is the antidote for cruelty.” – Phaedrus

Indeed, while it seems that COVID19 is inexorably cruel, the gentleness and kindness that has been exhibited by so many people proves that we will get through it, and we will succeed. It will not be easy. And we will need more kindness and gentleness than we thought possible, but we can do it.

“Human kindness has never weakened the stamina nor softened the fibre of a free people. A nation does not have to be cruel to be tough.” Franklin D. Roosevelt.

Canadians have shown COVID19 what we are made of this year. We have shown it that its cruelty is no match for our kindness. We have shown it that we will beat it and all it’s complications, though it will take time and continued effort.

So continue to be good to one another. And together, we will win.

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Nothing Wrong With Advocating For Physicians

Authour’s note:  This opinion piece of mine was published in the Medical Post.  However, many physicians are unable to access that as you need a dedicated account.  I’ve reproduced it here.

The Canadian Medical Association (CMA) has been embroiled in controversy this past year.  It first started with the announcement of “Vision 2020”, the new strategic plan for the CMA. What’s the first priority of the plan? “Consistently bring a patient perspective to the work of the CMA.”  The second priority?  “Engage in courageous, influential and collaborative dialogue and advocacy.”

This all sounds nice, and politically correct and oh so socially conscious.  Except for one thing.  The CMA is supposed to represent physicians and their needs.  That’s the whole reason for its existence.  Instead, physician representation is third on the priority list, and even there, it’s couched in phrasing like “based on empowering and caring for patients, promoting healthy populations and supporting a vibrant medical profession.”

From the perspective of the CMA’s leaders, I suppose the needs of the general membership don’t really matter.  The recent sale of MD management to ScotiaBank has provided the CMA with a significant amount of revenue.  So much so that they likely don’t even need members anymore.  It’s worthwhile noting that the first $15 million from the sale has been earmarked for a building for health care innovation, as opposed to, you know, a program to look at the alarmingly high burnout rates of physicians.  Certainly the changes made at CMA Governing Council (no more motions to direct the organization) prevent the CMA Board paying attention to silly little things, like the duly elected representatives of physicians across the country.  (NB – it would be unfair of me not to acknowledge that at least the General Membership will be able vote on all the Board members for the CMA.  However, I’m curious to see what the criteria are for becoming a candidate for CMA Board).

There is similar pressure to advocate for patients and health care policy, being placed on the Ontario Medical Association (OMA), particularly on social media.  Recently the OMA has been asked by various physicians to:

– sign letters opposing the separation of children from parents of migrants

– condemn the changes to sexual education curriculum made by Premier Doug Ford’s government

– speak out against the pause to Vaping rules, also made by Doug Ford’s government

– express concerns about the health care for trans gender patients

– and a bunch more.

There are merits to all of those causes (the separation of children from parents is the one I feel strongest about – it’s just child abuse). There is also the argument that physician’s organizations should use their authority to advocate for social issues, as it increases our standing in the eyes of the public and makes us “leaders”. This enhanced standing will supposedly help us when we advocate for ourselves.  The cynics, especially those of us burnt by the previous Ontario government will strongly disagree with this.

But here’s the thing, there are so many good causes out there to advocate for.  And they will keep coming.  How should the OMA, which unlike the CMA, continues to need broad member support, choose?

There is already disagreement about vaping rules/sex ed curriculums and so on.  What happens when the OMA is presented with information about the poor health care Rohingyan women receive?  Or the damage the contaminated water in Flint Michigan has caused?  Or if you want controversy, how about the malnutrition and mental health issues suffered by Palestinian children?  The OMA is supposed to represent 40,000 members with a diverse range of views, not just those who are motivated by one particular issue.

Many Provincial and Territorial Medical Associations (PTMAs) offer media training and advocacy courses.  The OMA for example, has long been asking physicians to become advocates.  Perhaps rather than criticizing on social media, those who feel passionately about various issues can receive the training to allow them to become leaders in their areas of interest.  They can then directly get their message across to the public and work for whatever their cause is.  They are still doctors, and they will still be seen in the public’s eye as doctors taking a lead on health care issues.

As for the PTMAs is it really too much to ask that they focus on membership advocacy first and foremost?  There is absolutely nothing wrong with advocating for meaningful action on high burnout rates, fair contracts and improved working conditions with less interference from bureaucracy.  It’s what these organizations are supposed to do.  The simply reality is that you cannot have a high functioning health care system without happy, healthy and engaged physicians.  Surely advocating for the same is not unreasonable.