The HCW (Health Care Worker) Disconnect

# 253


Over the weekend I received a long email from a nurse who is very concerned that her colleagues and their workplaces show little or no signs of preparing for, or even accepting the a possibility of a pandemic.


Why, she asks, is there such an institutional blind spot when it comes to avian flu? And how can we change that?


As I’m not a psychologist, and am no longer directly connected to the health care field, the best I can do is tender a guess. And if I had to guess, I’d say the twin reasons are fear and stasis.


Depictions of bold and maverick medical types on TV aside, in reality most medical professionals are fairly conservative. They’ve learned, due to mounting litigation concerns, to do things by the book, and not to stray far from the accepted norm. Pioneers are easy to spot in the medical world.


They’re the one’s with arrows in their backs.


So the medical establishment tends to be monolithic, and moves only slowly towards new ideas. And in some ways, this is a good thing. It means there is uniformity in medical care, and that patients are more likely to receive generally accepted and approved treatments wherever they may go. But it also promotes stasis in the industry, and a reluctance to embrace new ideas.


For now, the avian flu pandemic threat is simply that, a threat. It is not guaranteed that it will ever become a pandemic strain. It is a possibility, and opinions vary as to how likely it is to happen. Many doctors are understandably reluctant to jump onboard the pandemic bandwagon, for fear of appearing to have fallen for the `hype’.


Any doctor who does openly accept the pandemic threat opens the door to criticism from their colleagues. Public health doctors can get away with it, because they’re supposed to be alarmist. Their job is to anticipate and stop health threats. But clinicians are supposed to remain focused on their patient’s immediate problems, not worry about something that might happen someday.


Once a doctor embraces the idea that a pandemic may be coming, they immediately are faced with a variety of ethical considerations.


What do they tell their patients? How do they handle requests for Tamiflu and antibiotics? What do they tell their staff? How much time, effort, and money do they expend on PPE’s (Personal Protective Equipment) for their people?


If the imminent arrival of a pandemic is uncertain, then worrying patients and their staff about one could be seen as a violation of the first tenant of medicine: Primum non nocere : First, do no harm.


I spoke to one doctor, a closet pandemic worrier, who admits he is frightened over the avian flu threat, and asked if he was talking to his patients about it. He said `No’.


I asked him why and he shrugged his shoulders, and said, “If it comes, there is nothing we can do to help them. The hospitals will be overrun. There aren’t enough drugs, and the ones we have may not work. What can I tell them, other than they might die?”


While I may not agree with their conclusions, or their actions, I do understand why many doctors are very reluctant to even discuss a pandemic. They have patients dying today of heart disease, cancer, and AIDS. They can see no upside to dealing with a problem that doesn’t, as yet, pose a direct threat.


And any doctor who does stray from the reservation, who openly discusses the need for pandemic preparation, runs the risk of drawing flack from their peers. `Rocking the boat’ isn’t often viewed with favor in any industry, but this is particularly true in the medical world.


Preparing for a pandemic is frightfully expensive, and takes badly needed resources away from today’s needs. How does a hospital justify buying and storing hundreds of thousands of N95 masks to protect their personnel against a pandemic that may not come? Add in gowns, gloves, face shields or goggles, prophylactic Tamiflu, and everything else a facility would need to handle a pandemic, and even a small hospital could expend millions of dollars.


Doctors who see the need to take these steps are often viewed as alarmist or radical. Luckily, they do exist, and are growing in number, but for now they are a minority.


The level of concern in the health care industry therefore is muted by a large contingent of doctors who are unwilling, as yet, to deal with a pandemic being an imminent threat. One can either view this as being reasonable, or shortsighted, depending on your personal view of the likelihood of a pandemic.


Lost in all of this debate, or lack of debate in too many cases, it the sobering reality that once a pandemic begins, it will be too late to prepare. The scramble for PPE’s and medicines will quickly outstrip the supply chain.


And this will put hundreds of thousands of Health Care Worker’s lives at risk. Mostly nurses, techs, nurse’s aids and orderlies: for these are the ones that will have the closest, and most prolonged contact with infectious patients.


The medical establishment is taking a terrible gamble in hoping a pandemic doesn’t come, and if they are wrong, there can only be two results.


Either HCW’s will be forced to work without adequate protection, and will undoubtedly succumb to the virus in droves, or HCW’s will simply refuse to work and risk exposure.


Either way, it is a tragedy in the making.


My view, for what it’s worth, is that we have to accept the possibility of a pandemic coming, and do what we can to prepare, even if it means spending money today for a threat that may not materialize in the immediate future.


But for that to happen, nurses, techs, and other HCW’s need to become vocal about the preparations of their facilities, and demand that their safety come first. Many nurses and HCW’s belong to unions or professional associations, and they need to push their representatives to make pandemic preparations, and particularly the stockpiling of PPE’s a priority in their negotiations.


The stakes are simply too high not to do this. And we need to do it now.


The battle against the next pandemic will be won or lost based on what we do to prepare before it arrives. Waiting for proof positive that a pandemic is coming before we begin will almost certainly guarantee failure.


And this is a battle, quite frankly, we can’t afford to lose.