Dear fellow class of 2020 medical graduates,
Nearly 30,000 of us have graduated medical school over the past month. Shortly, we will elevate our responsibility in taking care of patients, trading in short white coats for long ones.
Due to the COVID-19 pandemic, our roles as newly minted physicians are highly unusual. We join the ranks of medical graduates during World War II and the Spanish Flu Pandemic of 1918, many of whom graduated early to help serve. We too have demonstrated that we are eager to step up. Many of us, especially in New York and Massachusetts, have shown bravery by foregoing vacation time and helping patients on the front lines in ERs and the wards. Others have offered childcare to health care workers, collected PPE, or conducted COVID-19 related research.
As we enter the hospital as new doctors in a global pandemic, we will face unprecedented challenges. To carry us through this time, let us channel the basics we have learned in medical school. First and foremost, let us always practice empathy. Patients are especially vulnerable now alone in the hospital without their families or friends because of the risk of spreading the virus. When we talk to our patients, let us also compassionately listen. We must prioritize understanding our patients’ values and goals with their health to create the best plan for them. Perhaps most importantly, and the responsibility newest to us, we must execute those plans. This entails partnering with nurses, pharmacists, social workers, lab technicians, and many others. We must rally the entire team for our patients to receive the best care, especially in a pandemic.
Let us not forget that our future teammates have been working tirelessly for several months as the pandemic has roared across the country. The constant anxiety of contracting the virus and spreading it to loved ones must be overwhelming. To protect their families, many health care workers have elected to isolate themselves and temporarily move out of their homes. There is concern that the heightened stress combined with isolation may further increase the suicide risk in physicians, one that is already greater than the general population. Let us practice empathy with our teammates and remember that although we are junior, we can be a welcome source of strength for our colleagues and supervisors. As new doctors, our enthusiasm for practicing medicine will uplift the hospital staff likely fatigued by the pandemic.
The pandemic has also highlighted long standing racial and socioeconomic disparities in our health care system that we must understand. Alarming statistics have racked up from cities across the nation with the same grim message: communities of color, especially black Americans, are more likely to contract the virus, be hospitalized, intubated and die (1). This is —and always has been — unacceptable. The hospital needs to be a place where our minority populations feel safe and nurtured, especially by doctors. We should know that the simple objective of providing equitable care to all people will have its hurdles because of several system-level problems. Researchers have shown that even our hospital computer algorithms fed from electronic medical records that help us make health care decisions have shown racial bias (2). Other studies have shown racial bias in doctors tends to heighten when there is a larger patient load or overcrowding, characteristics likely to represent the new normal in our workplace in the pandemic era (3). As physicians, we must routinely check our implicit biases as we care for these minority patients so they can receive the same high-quality care as anyone else. Furthermore, we should encourage our colleagues and supervisors to check theirs.
Preparing for the new normal is a challenge, especially when we cannot fully celebrate our accomplishments like we may have dreamed. Missing the traditional pomp and circumstance of match day and graduation has a substantial emotional impact on us. Perhaps walking across the stage on a warm spring day, donning our caps and gowns in front of our loved ones would have facilitated a powerful transformation within us, reassuring us that we are indeed prepared for the major responsibilities of "doctor." I hope you have found creative ways in lieu of a traditional commencement ceremony to celebrate your accomplishments with people close to you. It is important for us to take care of ourselves now so we can show up as the doctors our patients and colleagues need us to be.
Our graduation ceremonies may be virtual, but our future responsibilities are not. If we work together and support each other I have faith we will emerge from this pandemic as better physicians.
Congratulations, doctors, on your remarkable achievements!
A fellow graduate rooting for you
1. Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and Mortality among Black Patients and White Patients with Covid-19. N Engl J Med. May 2020:NEJMsa2011686. doi:10.1056/NEJMsa2011686
2. Ledford H. Millions of black people affected by racial bias in health-care algorithms. Nature. 2019;574(7780):608-609. doi:10.1038/d41586-019-03228-6
3. Johnson TJ, Hickey RW, Switzer GE, et al. The Impact of Cognitive Stressors in the Emergency Department on Physician Implicit Racial Bias. Acad Emerg Med. 2016;23(3):297-305. doi:10.1111/acem.12901