Tuesday, November 21, 2023

Q&A with Dhaval R. Desai




Dhaval R. Desai, M.D. is the author of the new book Burning Out on the Covid Front Lines: A Doctor's Memoir of Fatherhood, Race and Perseverance in the Pandemic. He is the Director of Hospital Medicine at Emory Saint Joseph's Hospital.


Q: Why did you decide to write this book about your experiences as a physician during the Covid pandemic?


A: For me, writing has become such a cathartic tool. I never would have thought I would write a memoir but given the chaos that I experienced in life during the pandemic the home, work, and personal fronts compounded with all the pressures in society, it was clear that I needed to share my story.  


I consider myself a frontline worker just like thousands of others in this country, and I want people to be able to relate to me and potentially recognize that their struggle may be common. 


A passion of mine is the human and patient experience in medicine. If our frontline healthcare teams cannot provide and feel the best about the human experience during their daily work, then they really won’t feel fulfilled.  


Doctors and healthcare workers are expected to give it their all, be seamless, not make mistakes, and just keep soldiering through some of the worst circumstances. Times have changed, and we need to recognize that healthcare workers are human beings with emotions, families, ambitions, and lives outside of the hospital. 


The pandemic became a tipping point not only for our healthcare system, but for so many of us in terms of our personal and psychological well-being.    


Nothing is closer to the truth than that for me, where I’m often viewed as the most composed and poised physician and leader who is unphased by anything. 


That changed during the pandemic, and it’s so important to share a story where I can be vulnerable and open up to help others realize that it’s okay to ask for help, acknowledge limitations, slow down, and recognize that healthcare and providing care to others is challenging with so many competing priorities. 


It’s also imperative to see that everything in society affects the healthcare system from current events, crises, wars, and events. It’s a system that needs more nurturing, structure, and resources than ever to ensure the workforce is strong and stable to ultimately deliver the best care for years to come.


Q: What impact did those years--including the pandemic and also the racial justice protests--have on you?


A: The twin pandemics surging in 2020 (COVID and racism) really made me newly aware of how complex our healthcare system is and how the system really does not always take care of the patients as well as its workers.  


Personally, I went through my own journey of burnout and mental health struggles and realized that I was not alone. I knew that the more I gave to the system, the less I was getting back personally.  It was a tipping point for me.


From a patient care standpoint, it was clear that there were so many inequities in the healthcare system and general health/well-being. In the summer of 2020, I would see a disproportionate number of minority patients admitted with COVID, those that were economically disadvantaged, limited English proficiency, and health literacy. 


It was clearer to me that patients need advocates, and without a good one, they are going to likely have less satisfactory care. The frontline healthcare workers are in a position to advocate for and navigate patients who need us more, and it’s more imperative now than ever that we need our frontline to be most present with patients.


Q: What do you see as the pandemic’s impact on this country, particularly when it comes to people’s trust in science and medicine?


A: It’s clear that there was a constant mixed and dynamic messaging during the pandemic. I think there was a general mistrust in science and medicine in many ways before, especially when messaged from the government. 


The first two years of the pandemic really demonstrated that. The country became more divided. I do feel that messaging was dynamic and was meant to be the most well-intended. As we continued to learn about COVID and its aftermath, messaging would continue to change.  It also become very politicized. 

At this point, I would argue that the CDC and governmental agencies need to continue to prioritize firm, simple, and accurate messaging about all things related to health. We need to separate any political pressures with messaging on healthcare, and have these agencies focus solely on health messaging.  


To follow, our frontline healthcare systems, staff, and leaders can message and advocate similarly. We are in a challenged position when it comes to trust in medicine and healthcare, and we must overcome this for everyone’s well-being.


Q: What do you think the country should do to prepare for a future pandemic?


A: First and foremost, we need a stable healthcare system. There is a continued underlying tone in healthcare (and likely other industries) to do more with less.


This is simply not sustainable. We need to attract and retain the best talent and skills for all healthcare workers. We have lost droves of healthcare workers and continue to try to rebuild teams and systems.  


We also need to focus on the wellness of our healthcare workers, and minimize the administrative burden that takes the frontline away from direct patient care and takes away from them working at the top of their licenses. 


Advocacy needs to be made to the Center for Medicare and Medicaid Services (CMS) as well as insurance companies that there has to be a partnership to adequately fund hospitals through fair reimbursements in the setting of rising costs as well as make regulatory requirements meaningful to patients.  


From a community health standpoint, if we can advocate for everyone to focus on preventive health from vaccinations, cancer screenings, and yearly physicals, we are more likely to preserve the healthcare system with diseases being prevented, caught early, and proactively treated. 


All of these things would lead to a more stable healthcare system that would be able to take on the next pandemic.


Q: What are you working on now?


A: I am continuing to work on writing projects including opinion pieces related to the patient and human experience in medicine.


It’s an area where I want to have a voice and platform for years to come, as I don’t think there will ever be a time where we are “over-focusing” on compassion, wellness, mental health, and the best experience for patients and healthcare workers in the system.


Q: Anything else we should know?


A: All of my author proceeds from this book will be donated to the Dr. Lorna Breen Heroes foundation.


Dr. Breen passed away from suicide in 2020 after serving valiantly on the frontline as an Emergency Medicine Physician and leader in New York City. Her family founded this organization to help de-stigmatize mental health for healthcare workers. 


I am very passionate about this cause, as Dr. Breen’s story could have been any one of us. Approximately 300-400 physicians commit suicide per year, and the cycle must stop. 


--Interview with Deborah Kalb

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