As resident physicians, now is not the time to be quiet

By | April 21, 2020

As resident physicians, now is not the time to be quiet. We must stand up for ourselves in the face of this life-threatening virus. Our health is vital to preserving the standards set before us in providing exceptional medical care to future generations. In the wake of the tragic deaths of a few of our colleagues – now it is more important than ever to speak your voice and demand change. Who are these young physician heroes that died on the front line? Why haven’t we heard about them, yet we continue to hear from the media the incidence of this disease, to stay indoors, and we will be okay. As medical professionals, we do not have this option to stay indoors. We have sworn an oath always to serve the sick. However, how do we respond when we are becoming sick?

As trainees in graduate medical education (GME), we are subject to the rules and regulations of our residency programs, hospitals, organizations, and government committees. Many of the policies behind GME have been in place since its birth and do not allow much room for adjusting. The interesting point here is that this pandemic is demanding changes to these historic rules and regulations. Residents deserve more – including, but not limited to, additional stipends, paid parental leave, life insurance, Advanced practice registered nurses, and physician assistants are being granted autonomous practice in various states for this pandemic and receiving a hefty increase in compensation.

We are working without adequate protection; we are living away from our families; we are even working outside of our scope of practice. Overall, we are risking our lives daily to fulfill our education and program requirements to graduate. If we do not do this, we will lose our coveted spot in graduate medical education and, thus, our medical careers. Long story short – we either work in these dire conditions, or we risk losing everything we have worked for. We did not go through at least four years of undergraduate school, four years of medical school, and thousands of dollars in debt to be put into this position.

Now, an ethical question that presents itself is this: Should we continue to work in these conditions without adequate protective equipment and risk becoming a vector for this deadly virus? Do we continue to work 80 hour weeks at adjusted wages near minimum wage because this is what we signed up for? At what point do we say enough is enough?

Of course, many readers will say, “If you did not want to be in this situation, then why did you sign up to be a doctor, why are you in this situation?” Well, my answer is as follows:

I signed up to be a physician first and foremost to save lives, serve the general population, and support people in their darkest hours. I see patients every day that are dying. I have conversations daily with family members to provide an unbiased, professional opinion to encourage a decision to follow their loved one’s wishes first and foremost. This is whether it is all out pressor support or hospice. Am I ready for others to have this conversation about me? I view myself as an ambitious, goal-oriented young physician that believes that I can change the world in one or another. Did I sign up to sacrifice my life to a virus that I cannot see?

The same question applies more generally — Would you walk into a fire, not knowing whether or not it would take your life? Are you okay with playing Russian roulette?

We have preached the Hippocratic Oath to “do no harm.” But there is more to this passage that is applicable to the current pandemic:

 I will not be ashamed to say, “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

We do not know how to treat this life-threatening illness yet. We do not have the powerful and resourceful treatment like we possess against most bacterial infections. We are following international input that changes daily on how to treat this deadly illness. We do not know what the future will hold. Nevertheless, we will do everything we are mentally and physically able to do, as physicians, to save lives during this pandemic.

As the future of medicine, as young physicians, we will not back down from this fight. We have been trained and will do our best to tackle this catastrophe. However, please help us from dying. It is unethical to put us out on the front lines without adequate protection. We will die, and we will not let the fallen perish without their voice. Without protecting us now, you must be okay with leaving millions of lives in the hands of underqualified, non-Medicare-funded practitioners. Not only will this lead to media stories leading to hospital lawsuits, but it will lose the government a ton of money.

Please stop referring to us as heroes. This applies to all health care professionals. We are not superhuman, and we have emotions – fear, panic, depression, and anxiety. We see the media, we read articles, and appreciate the severity of this pandemic.

We furthermore realize this:

This is our occupation, our profession, our obligation, and our life. Provide us with adequate protection, and we will do our job. An added benefit is our education to provide life-saving measures to support as many threatened lives as we can. Otherwise, we will utilize those life insurance emails we receive on a daily basis and write our living will.

Alexander Lake is an internal medicine resident.

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