Quite some time ago I took to writing things down in a paper rather than digital notebook. This morning, as people will do when they are bored, I picked up one of those notebooks and began thumbing through the pages. Not too far in, I came across some notes dated Sunday, April 5, 2020 that form the foundation of this blog post.
As we enter year two of â€œtwo weeks to flatten the curveâ€, the notes I jotted down in April 2020 remain relevant. What I thought would be a short kneejerk overreaction, turned out to be quite long. Fortunately, at least in California, the predicted impact of COVID-19 never manifested. To date, our healthcare system has never been in danger of being overrun. In contrast, many facilities ran with patient loads less than average throughout most of 2020. The same remains true for the early months of 2021.
The â€œlessonsâ€ outlined below represent individual opinions, nothing more. Theyâ€™re my thoughts from April 2020, with some updated experiences thrown in for good measure. Honestly, it is more about healthcare and people than it is â€œthe virusâ€.
- The pharmacy supply chain is broken. With hospital census numbers falling throughout most of 2020, the struggle to keep up with basic supplies became a real grind. Shortages are nothing new, but the problem was amplified during the pandemic. Personal Protective Equipment (PPE) became especially problematic, particularly for large facilities with cleanrooms. PPE was worth more than gold in the early months on the pandemic. Everyone scrambled to provide basic gear for IV room personnel.Â Reasons for the extreme shortage were many. A majority of PPE being made outside the country, fewer people available to work in production plants secondary to illness, and increased use were all factors. However, hoarding cannot be overlooked. Facilities were buying â€œas much as they could getâ€ and stockpiling. It was a real problem.
- Patient care became political. At no point in my career have I seen such a draconian dictation of what therapies could or could not be used. Historically, medication selection is based on physicianâ€™s professional judgement coupled with experience. That all changed in 2020. Legitimate, potentially beneficial treatments became political hotbeds. Physicians have always been the tip of the spear when caring for patients. They see things the rest of us donâ€™t, which often gives them insight into treatment approaches. Iâ€™ve seen things throughout my career that I thought should never have been used but were. It often boiled down to â€œwhat they doctor wantedâ€. Not in 2020. Providers were denied therapies that were not â€œmainstreamâ€. Normally, I’d get immense pleasure out of watching a physician turn into a 3-year-old that’s been told they canâ€™t have a popsicle for dinner, but not this time.
- 2020 exposed pretenders. I was shocked at the panic displayed by many healthcare providers. When things got tough, instead of rising up, they folded. The metal of which people are made becomes clear when the pressure is on. It’s often not pretty.
- The approach for treating any disease evolves over time. Some things work, some donâ€™t. Experience counts. COVID-19 has proven no different. Patients are doing better now because treatment has evolved. With that said, COVID-19 became the first disease in memory to have treatment dictated by reasons other than data. Thatâ€™s a precedent no one should be celebrating.
- Scientific literature died in 2020, and it will never be the same again. Instead of sharing information and ideas, it became political. In 2020, open discussion and thoughtful debate was traded for political correctness. Studies or opinions that dissented from mainstream political views were simply not tolerated. Articles were pulled. Commentary was written. Pop-up warnings were added to online journal articles that proposed alternate theories.
- Healthcare systems were not prepared. The pandemic exposed many weaknesses in hospital practice. So much for “mass casualty preparedness” lauded by hospitals everywhere. See what I said above about the metal from which people are made. It became obvious in the early days of the pandemic that many in healthcare leadership have no metal at all. I saw much panic, flailing, paralysis, and poor decision making throughout 2020.
- Healthcare forgot that other diseases existed. I simply stopped reading pharmacy forums and gave up on healthcare related websites. There was no reason to visit. Everything written was related to COVID-19. The same questions and commentary, day in and day out. It was monotonous and unnecessary. Itâ€™s a good thing all other illnesses and healthcare-related issues took a hiatus in 2020.
- Media in general, but more specifically social media, replaced idea sharing, science, and data with politics. What a mess. I gave up on social media in 2020 â€“ ironic that Iâ€™m sharing this online, right? There is no intellectual value left in social media, only hate-spewing, intolerant individuals.
- Healthcare systems are technologically inept. No surprise here, Iâ€™ve been saying this for years. The arrival of COVID-19 exposed healthcareâ€™s technology-last approach. Nowhere was this more evident than when â€œremote workâ€ became a thing. Excluding telehealth, â€œremote workâ€ for many healthcare systems was a joke. As someone that spent the better part of his career â€œworking remotelyâ€, I can tell you that it can be done, given the right equipment and infrastructure. Not in healthcare. â€œHereâ€™s a laptop, youâ€™ll be working remotelyâ€. Good luck with that. Not everyone is cut out for remote work. Many lack the focus, attention, and discipline to make it work.Â
- Over regulation. Does anyone doubt that healthcare is a regulatory nightmare? I cannot speak about other states, but the California Board of Pharmacy and Department of Public Health (CDPH) proved themselves inept and tone-deaf during the pandemic. I could go into details, but it would probably cost me my job, so Iâ€™ll just leave it at that.
- Waste. I will never again worry about â€œthe environmentâ€. Why bother? Given the millions of tons of unnecessarily wasted PPE that is surely piling up in landfills somewhere, I will never worry about what I toss in the trash. Day after day, I walked past trash receptacles full of used masks, booties, goggle, and gowns. Daily! The waste generated by any large facility in a week far exceeds my lifetime allotment of garbage. So please donâ€™t pander to me about â€œsaving the planetâ€.
Last year reminded me of all the reasons I left hospital pharmacy and spent a chuck of my career exploring other options. Healthcare is a mess and COVID-19 did nothing to improve it.