A senior family doctor supporting the health team in times of COVID- 19
How Can I Help Today?
This is the question that has woken me up every day for the past few weeks. The current COVID-19 pandemic makes life difficult in this unprecedented time. As a senior doctor and professor, my place is certainly not in the front line, in the trenches. But I feel compelled to help: first of all the team of doctors I coordinate; the health professionals around us; and, of course, patients and their families.
The efforts of all health professionals, each with their own competencies, are essential. While researchers and scientists work to find effective therapies and vaccinations, those on the front line devote their best efforts to the clinical care of affected patients. It is worth asking - what is the role of those involved in medical education in the midst of this global crisis?
With each passing day, the care of the health team itself is essential. Not only physical care (for which all possible measures are taken), but also mental health. Or put more simply, it is crucial to raise the morale of those who deal daily with this threat of unprecedented proportions. A discouraged, pessimistic doctor, with no perspective is also an element of the crisis. That attitude can cause insecurity in patients and does not help the health team.
Suddenly the idea arises - to provide a realistic view of the facts, to recover the sense of proportion that the team is experiencing in this crisis. This can be my help from the back stage. It is necessary - as a recent publication advised - to think globally, but act locally1.
The Decision Made - I will Act Locally
Our team operates in three small hospitals and takes care of several nursing homes with more than 600 residents. Thus, knowing how to tabulate daily the evolution of patients each of us has been entrusted to care for - the hospitalized, the deaths and, importantly, the discharge of the recovered - provides a sense of reality. Global information is important in shaping health policies, but is not necessarily relevant to what each professional has to face on a daily basis. Such information can even generate an anticipated concern and, worse, distract professionals from their immediate responsibilities. It is possible – to adapt an old saying - that too much focus on the forest can prevent you from seeing the trees that need help.
At our institution (SOBRAMFA - Medical Education and Humanism) we started to make short videos2 with recommendations that help professionals to maintain an objective view of the reality they are experiencing. An excessive and disproportionate concern for the global problems that the world is facing may not help and may even hinder each professional taking care of their own specific responsibilities.
The cinema, an educational resource used in medical education3, which is also included in these videos, helps to clarify the recommendations made.
The first message is - you are not alone! The film I am Legend4 has a straightforward message: if there's someone out there, I can help, you're not alone. After that, from the same movie, the fight against reigning pessimism - the people who are trying to make this world worse are not taking a day off. How could I?
The importance of leadership is revealed in the scene in Braveheart5 where the leader asks to wait for the right moment to face the enemy cavalry. Leadership also means knowing how to keep the team together and avoiding scapegoating people in the midst of a crisis. This is addressed in the film Ladder 496 after the fireman's death - I come to tell a mother that her son is dead, and this happens in my house. We deal with this by sticking together. We learn from it. And we get back on the goddam truck and that is how we honour him.
Then, to avoid useless worries, the scene showing the healthy unconcern of the Soviet spy in Bridge of Spies7 is helpful as it contrasts with the disproportionate concern of the lawyer's son. Then there is the importance of true teamwork revealed in Gladiator8 - I don't know what will come out of these gates, but if we are united we will survive - and Spartacus9 (I am Spartacus!). Spartacus is more than a person: it is an idea that takes care of the team and promotes solidarity in times of crisis!
We arrived at Easter time in the middle of the crisis. Someone sent me a Bible reading specific to these moments. I read it calmly, savoring it:
“Learn where prudence, strength and intelligence are found, so that you may know, at the same time, where long life and happiness are found, the brightness of the eyes and peace”.
I smiled pleased with the advice I realized I was incorporating.
And I remembered another scene from Bridge of Spies7 included in my teaching videos:
“When I was young. My father used to say: ‘watch this man’, so I did, every time he came. And never once he do anything remarkable. This one time, I was at the age of your son, our house was overrun by partisan border guards. Dozen of them. My father was beaten, my mother was beaten, and this man, my father’s friend, he was beaten. And I watched this man. Every time they hit him, he stood back up again. Soldier hit him harder, still he got back up to his feet. I think because of this they stopped the beating and let him live. “Stoikiy muzhik”. Which sort of means like a standing man.”
I realized that this is the help that as a senior doctor I can offer. My age does not allow me to be on the front lines, but from the rear of the battle I understand that I can and must help every day. No heroic actions, but showing prudence, objectivity, realism. Leading to serenity, daily effort, the team that I am responsible for. Being there, with open arms. Overcoming discouragement, without giving up. Like a standing man.
Dr. Pablo González Blasco is a Professor in Family Medicine, and since 1992 when he founded SOBRAMFA- (the former Brazilian Society of Family Medicine, nowadays SOBRAMFA- Medical Education and Humanism), has been involved in promoting the humanistic dimensions of doctoring. His research and teaching is focus on medical anthropology, medical ethics in the context of family medicine and medical education. His particular expertise is in teaching medical students through movies and cinema to promote positive attitudes and ethics.
Dr. Maria Auxiliadora Craice De Benedetto holds a medical degree from the Botucatu School of Medicine (Paulista State University - UNESP), São Paulo, Brazil (1980) and a PhD in Medicine (Health Sciences) from the Federal University of São Paulo (UNIFESP), São Paulo, Brazil (2017). Doctoral Thesis: “The Role of Narratives as a Didactic Resource in Medical and Nursing Education” cfr: http://repositorio.unifesp.br/handle/11600/41856. She is Publications Director of SOBRAMFA - Medical Education & Humanism, where she also acts in educational activities.
References
1. DOI: 10.1056/NEJMp2006740
3. Blasco PG, Moreto G, Roncoletta AFT, Levites MR, Janaudis MA. Using movie clips to foster learners´ reflection: Improving Education in the Affective Domain. Fam Med 2006; 38(2) 94-6
4. https://www.imdb.com/title/tt0480249/
5. https://www.imdb.com/title/tt0112573/
6. https://www.imdb.com/title/tt0349710/
7. https://www.imdb.com/title/tt3682448/
8. https://www.imdb.com/title/tt0172495/
9. https://www.imdb.com/title/tt0054331/
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