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Looking Back on Omicron, Looking Ahead to Hardship

Michael A. Sharma, PA-C

Disclosures

March 30, 2022

A quarter-century ago, I stepped onto campus at Texas A&M University as a college freshman into the spit-shined shoes of the student cadet corps.

Recently, a college buddy asked me to speak to current cadets in our old unit about thriving through hardship. "I want to get some highly successful folks in front of them," he told me. (To which I replied, "Well, until one of them says 'yes,' I'm happy to give a talk.")

When the talk came, I showed them a screenshot of a recent social media post by a large healthcare organization. It was a quote attributed to college football coach Lou Holtz: "It's not the load that breaks you down; it's the way you carry it."

It's a quote that someone might frame and hang in a locker room or a hotel lobby, and you would walk by it in real life without paying it a second thought. However, this suggestion brought about so many angry replies from healthcare workers that the organization deleted the post. People couldn't even stand to think about this quote and its implications about hardship.

After feeling like COVID-19 was getting better in the summer of 2021, the Delta variant hit Texas like a bomb. I didn't even feel like I had fully recovered from preceding waves of COVID-19, and then came record-high patient volumes for weeks.

Delta brought new questions about vaccine escape, post-infection immunity, and COVID-19 severity in young adults and pediatrics patients. I also had my top 10 worst shifts, back-to-back.

When Delta finally tapered off, I looked back and didn't know if I could ever do something like that again. Enter the Omicron variant, with an almost unreal degree of infectivity.

As Omicron now wanes in many places, the BA.2 variant, with all of its uncertainty, now looms on the horizon. Hardship feels like it's here to stay in a job that wasn't the easiest to begin with.

America is slowly recognizing the problems that healthcare workers face in pursuing behavioral health care. Pamela Wible, MD, has been highlighting the hidden epidemic of physicians dying by suicide for years.

The Dr. Lorna Breen Heroes' Foundation, named after the chief of the emergency department of NewYork-Presbyterian Allen Hospital who died by suicide in the early days of COVID-19, is an organization decreasing the stigma of healthcare workers seeking behavioral health care.

Barriers to discussion of depression, anxiety, PTSD, and other disorders and their treatment are falling, but the reaction to the Lou Holtz quote illustrated what I already knew: that resistance against resilience training is growing.

There has been a growing backlash against concepts like resilience and stoicism, or even the mere use of the term "burnout." Often critics say that emphasizing these concepts gives cover to leaders and systems for mistreating their rank-and-file workers and puts the blame on workers for not being resilient enough.

Leaders undoubtedly have grave responsibility in times of hardship to ensure that those in their charge are not unduly burdened and are appropriately compensated. However, the stress in our lives as healthcare workers is a complicated problem.

Like most complicated problems, this stress is not solvable by just addressing one variable. It's clear that people handle stress differently. I'll prove it: "moist." Just by writing that word, I made a bunch of people dry-heave; others are unaffected.

Some healthcare workers are shifting the conversation from resilience training, which sounds like training on how to suck it up more when things already suck, to "performance training." It's not just yoga or meditation (not to knock those things).

To use healthcare-speak, performance training is primary prevention, addressing issues before the disease happens. Treatment for a behavioral health condition is secondary prevention, preventing further damage after a disease has taken hold.

As we know from other situations in healthcare, primary prevention is healthier for the individual and less resource-intensive on the system than secondary prevention.

Rob Orman, MD, of the Stimulus blog and podcast and Dan Dworkis, MD, of The Emergency Mind book and podcast,  are two emergency physicians doing excellent work in presenting actionable tactics from healthcare and beyond that clinicians can apply on their very next shift.

When what's coming in the door is different, doing the same thing that we've always done is not going to result in the same output. New perspectives about how we think and act in hardship are going to be required if we want things to be better. Like Orman says on his tagline on Stimulus: "Don't just suck it up. Think differently."

A change in thinking about hardship is needed for many. It starts with merely acknowledging that performance training is valuable for healthcare workers.

Some patients have a certain line of thinking when it comes to health: "Can't you just give me a pill?" We as healthcare workers can't succumb to this same thinking: "Can't the system do something for me?"

The bad news is that, for some of us, the system is not going to do anything, and we have no power to compel it to do anything. We and our patients can't wait for the system to save us.

The good news is that we as healthcare workers can take small steps today to start the process of saving ourselves, to thrive through hardship instead of sucking it up more. Becoming healthcare workers required a great deal of personal growth for most of us. We have to believe that we can still continue to grow.

If some healthcare workers doomscrolling their social media get angry when someone tells them they have the capacity to grow and thrive better in hardship, they're the ones that would benefit from changing the most.

The views expressed by the author are those of the author alone and do not represent the views of any company or entity.

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About Michael Sharma
Michael A. Sharma, PA-C, is a practicing emergency medicine and urgent care PA in the Dallas, Texas, area. He is the co-host of The 2 View: Emergency Medicine PAs & NPs podcast with NP Martha Roberts. Mike is a US Army veteran, including a deployment to Afghanistan as a trauma team leader at a NATO Role 1 aid station. He has lectured and taught hands-on workshops internationally and nationally on emergency medicine topics to a variety of clinicians. Follow Mike on Twitter, Facebook, and Instagram.

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