Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

COVID-19 July 6, 2020 update

As part of AMA’s Resident Recognition Week, AMA Chief Experience Officer talks with residents, Meghan Srinivas, MD, Scott Pasichow, MD, and Bryanne Standifer, MD, about their experiences with COVID-19.

Learn more at the AMA COVID-19 resource center.

  • Scott Pasichow, MD, MPH, emergency medicine fellow, Brown University
  • Megan Srinivas, MD, MPH, infectious disease resident physician
  • Bryanne Standifer, MD, internal medicine resident physician, Henry Ford Health System

Unger: Hello. This is the American Medical Association's COVID-19 update. Today's the first episode in a week-long series, focused on residents and COVID-19, part of AMA's Resident Recognition Week to recognize residents for all they've done through the pandemic and continue to do for our country. We're kicking off the week by talking to three resident and fellow leaders, Dr. Meghan Srinivas, an AMA section delegate and infectious disease resident in Fort Dodge, Iowa. Dr. Scott Pasichow, an emergency medicine fellow at Brown University and the outgoing speaker of the AMA Residents and Fellow Section Governing Council in Providence, Rhode Island, and Dr. Bryanne Standifer, a member of the AMA Ambassador Steering Committee and an internal medicine resident at Henry Ford in Detroit.

Unger: I'm Todd Unger, AMA's chief experience officer in Chicago. Each of you chose to become a physician long before we had ever heard of COVID-19. I'd like to talk to you about how the last few months have either reinforced or changed your reasons for practicing medicine. Dr. Srinivas, why don't you start us off?

Dr. Srinivas: Oh, sure. The biggest reason that I entered medicine was because of the issue of health equities, and trying to fight for a system in which disparities could be overcome, rather than just trying to overcome one case at a time. In the setting of the pandemic, it's really just exacerbated the inequities that we see, whether it's racial disparities, whether it's rural versus urban disparities, the inequities have just become larger and larger and shows that this work is so much more vital than it was before.

Unger: Dr. Pasichow.

Dr. Pasichow: Yeah. I became a doctor because I wanted to be there for people in their time of need and I wanted to try to meet people where they are and help them to engage in good, healthy behaviors and take care of their sick loved ones and take care of themselves and try to have a better life in the future as well. Certainly, during the pandemic that has changed or the way that that happens has changed, but the desire to still be there for people and to help people has stayed the same. My hospital's been great at getting iPads into the hospitals so that we can have family discussions, even though we need to be physically separated, and that type of adaptation has been great and has really reinvigorated my desire to be there for people.

Unger: How about you, Dr. Standifer?

Dr. Standifer: I think similarly I became a physician because I wanted to help people. People come to the hospital in their most vulnerable times. This is something that we've seen pre-COVID and even more so during COVID, and it's been a pleasure to be there for people at their greatest time of need.

Unger: Okay. This is a little bit of a lightning round. I'd like to ask each of you, what is one thing, key thing, that you've learned through your residency and would like to share and one thing you'd like to change? Dr. Pasichow, why don't you start?

Dr. Pasichow: Yeah. One of the things that I think we learned as we went through this was messaging and how to communicate with the public in a way that gets behavior change and gets people to sort of act the way that we're looking for. In the beginning of the pandemic, we talked about we're here for you, stay home for us. That was important for people actually staying in their houses and not gathering in social settings like they were used to doing to keep people safe. In some ways that has felt like it almost became stay away from the hospital and that really wasn't the message we were looking to send. In Rhode Island specifically, we worked on changing that messaging and reminding people that heart attacks and strokes are still happening, so that's something I've taken away from this pandemic and from my time in training that will definitely be useful going forward.

Unger: I'd like to follow up a little bit about that. Before we started recording, Dr. Srinivas, you and Dr. Pasichow were talking about adjusting your communication style to get behavior change. Now that we're in the phase we are with the COVID pandemic, can you talk a little bit about how you're communicating to get that desired effect?

Dr. Srinivas: In the world of medicine, we get so locked into our jargon and thinking about numbers and the scientific method of physiology; the way that we view medicine, but when we're trying to communicate to the public, we have to relay it in a way that they can understand and that, not only is comprehensible, but that actually motivates them to want to make the right change. That has been such a key evolution during this pandemic: we've seen more and more people in the realm of medicine and science really crossing over into this public health advocate, something that unfortunately, has really been lacking in the past, but the pandemic has been really good at encouraging to bring this out.

Unger: Any other thoughts, Dr. Standifer or Dr. Pasichow?

Dr. Pasichow: Really meeting people where they are. That's the unique thing about myself. I'm from Detroit and working in my community. You have to learn how to meet people where they are. Find out about them, what struggles they have so that you can build that trust to begin with, and then leading on that trust, you're able to spread these messages of stay home. Don't come to the hospital. Wait, no, come to the hospital. It's kind of like a trust and meeting people where they are.

Unger: Dr. Standifer, while you've got the mic there, can you talk about one thing, key thing, that you've learned, and one thing you might change coming out of your residency?

Dr. Standifer: I think one thing I've learned in medicine and in residency, everything is about rules, guidelines. What are the new guidelines? What are the new guidelines saying? COVID has taught us, and it's been amazing actually, because there are no guidelines and we are relating to our physiology in med school as to kind of guide us to what we're doing now. I think that having that thought process and not always being strict to guidelines is what we need right now because things continue to change, especially coming post-COVID, how you screen a patient to go to a COVID side versus a non-COVID side. You have to change constantly and it's not a strict guideline as we are thought to be as physicians. We're so strict and rigid with our thinking in it and we have to be able to become fluid and evolve quickly. As far as what I‘d change is kind of encouraging fluidity. You don't have to be so strict. It's okay to move and change from day to day.

Unger: We have a whole new group of folks entering the residency's, Dr. Standifer. What's one key piece of advice that you would give those folks?

Dr. Standifer: Just come in every day, give it your all, leave it at the hospital and then come back the next day a new person. Don't ever let what you came in and what affected you that first day go into the next day because every day literally looks different.

Unger: Dr. Pasichow and Dr. Srinivas, what's your piece of advice?

Dr. Pasichow: I think getting to know the people that you're working with is really important, and it's not just the residents, supervising residents, or the attendings that are training you. It's the nurses, it's the techs. It's everyone in the hospital that is part of training you to become a good physician. Get to know them a little bit, become friends with them because when you need them, they're going to be there for you and that's going to be really key to great patient care and learning how to practice medicine.

Unger:  Dr. Srinivas?

Dr. Srinivas:  Agree completely with that. The biggest thing I learned in residency and fellowship was really that medicine is a team sport. It's about knowing that even at 2:00 AM in the morning, you have a whole team supporting you to hit a tough obstacle or a patient that you just don't know what to do and you can come together and really discuss it and make sure that you're going the right direction. You're never alone. Showing that you're willing to reach out to others, regardless of level. Like Scott said, sometimes the nurses in the NICU know so much more than a trained doctor of many years, because they've seen this and vice versa. It's really about working together with everybody on their team and trying to collaborate and you're never going to have an obstacle alone.

Unger: Well, you've all been leaders at the AMA, and I'd like to ask you about how you've used your leadership roles to elevate the concerns and issues that are important to residents. Dr. Pasichow?

Dr. Pasichow: Some of that's really just been listening; listening to what people are telling me about and seeing the struggles that I've had and that I've experienced and relaying that and talking about that to either my resident leadership or the hospital administration, or bringing some of that stuff to my national specialty society or the AMA or the State Medical Society, but it's really just listening and seeing what's going on and thinking about how can we make that better? Whether it's telehealth access for individuals or making sure that there's good mental health access for health care providers while they're struggling to deal with our changing environment.

Unger: Dr. Standifer?

Dr. Standifer: We did a couple of things. The first thing was we noticed that everybody in a hospital was getting surge pay, except for the little residents. We had a conversation with our chair and we were actually able to make some headway and actually get some sort of surge package, so that was really nice because people didn't want to say anything. I was like, "Well, why not? Let's just ask." We got it. That was really nice. I think the second thing was from a mental health standpoint of everything; seeing patients die, eight patients in 42 hours is very traumatizing for anybody. I noticed that you needed something to boost our morale. I went to our program director with the idea to have a tee-shirt contest to design for internal medicine residents. It allowed our creative co-residents to showcase what they can do and we were able to get these nice tee-shirts funded by the program. We wear them very proudly.

Unger: Dr. Srinivas?

Dr. Srinivas: One thing about being a trainee is you go into a wall that you haven't really been exposed to before entering medical school, but you're suddenly 24/7 taking care of patients and living their stories. You see the holes in the system, you see what's impacting the way people can take care of themselves, and even their ability to do the right thing even if they want to. That's when we really get motivated. We want to help change those things. We want to help those people that we now care about have to better life, and seeing those goals and feeling that motivation that residents, my co-residents have had, we really want to get involved in changing the system. The AMA has been instrumental in framing that message to we can get involved in advocacy in a way that we wouldn't have been able to before, and that's truly been one of the most empowering things.

Unger: Well, Dr. Standifer, we've talked a little bit about residents using their voices to make change. Why is it so important right now for them to use their voices in medicine and how do they go about doing this?

Dr. Standifer: I think not being afraid to say and speak their feelings. Of course, talk to your co-residents first. Hey, is this too much? Am I being a little aggressive? No? Yes? Okay, cool. I think using your peers to help you make a blueprint of what you want to say and never being afraid to just ask the question and put your voice out there, because a lot of these hospitals, as you spoke earlier, Dr. Megan, we work as a team and residents are one of the core parts of the team. I think being okay with asking the question and voicing your opinion and letting them know you feel is very important. Especially from day one.

Dr. Pasichow: Just to piggyback off of that, I've always said, "If you're not at the table, you're on the menu." Right now people are really paying attention to what we're doing in health care and the sacrifices that we make to take care of our patients, so it's a really great opportunity for us to talk about some of the things that can really make our lives easier and make it easier for us to provide great patient care for our patients. Now is definitely the time to speak up and to make sure that you have a seat at the table and that the decisions that get made, get made with your input so that we're not stuck with policies that we don't like.

Unger: Dr. Srinivas, I follow you on Facebook. I'm seeing you use your voice. Can you talk a little bit about why it's so important and what's happening with you in Iowa right now?

Dr. Srinivas: Yeah. Despite being still an infectious disease fellow, I am board certified, but still in the research track. Despite being a fellow, I have enough knowledge, I’m realizing that I can really be a voice to create change, and positive change. One of the big issues that we're seeing in my state is the lack of appropriate messaging as to what should be done, and constant contradictions from our leaders at the state, the local and the national levels, which is leading many people in local communities and actually throughout Iowa being confused. It's causing them to be very confused as to what they can do for themselves, the community, and what really is the right thing to do. Being a physician, we have a designation already in society where people want to trust us a little bit more than the average person.

Using our knowledge to spread what we know based on evidence, based on experience, is one of the biggest things that we can really do to help the community, and that's what I'm trying to do; trying to get the right message out there and answer questions for people, so we can hopefully get people wearing masks more frequently, and hopefully that stops the transmission before it gets even more astronomical than it has been.

Unger: Well, last question, Dr. Pasichow, why don't you start? What's the one thing you'd like to see better support residents and fellows as they develop their clinical and leadership skills?

Dr. Pasichow: I think we're starting to work on it, but I'd like to see better access for mental health care for us. I think there's a stigma that comes along with seeking help when you need it. When you're not feeling like yourself and you're not feeling like you can take the best care of your patients as you need to. Licensing questions that may look at the fact that you had worked with a counselor in the past and may try to limit your ability to practice in the future because of that. Those are the things that the Federation of Medical Boards is recommending that we don't ask. If it doesn't affect your ability to practice medicine, then it's not something that we need information about when you're going for a licensure. Making sure that the rules are in place so that residents don't feel like asking for help in their time of need is going to prevent them from ever practicing medicine again.

Unger: Dr. Standifer, how about you?

Dr. Standifer: I will totally piggyback on that as well. I think, particularly with us, a second year internal medicine resident, well, almost third year, in a couple of days, applying for fellowship, what does this look like for you? How is my application effected because you have people who wanted to do oncology, for example, who were pulled from their clinic responsibilities in the oncology department to come help with the GPU or general floor in ICU. They lost that one on one time, and so you have residents who are fearful of their careers as COVID has happened. I think normalizing it being okay to be stressed and having a plan and being vocal about those things, I think, to make us all feel like one and not just robots.

I felt like a robot. Nobody ever asks, "How are you doing today?" It's no, there's a new patient. Go see it. There wasn't a lot of, "Are you okay?" We didn't get a lot of that. We just didn't have the time to do it because the volume; it was what it was. I think the mental health piece is so important.

Unger: Dr. Srinivas?

Dr. Srinivas: I have to agree completely. There are so many things that we can talk about, but I just have to reiterate what Bryanne and Scott said. It really comes down to feeling supported and that mental health aspect of it. We go through so much in residency and fellowship and not just because of the emotional roller coaster after what you're seeing, but even just the hours alone and what's expected of you and this perfect image of what it truly means to be successful in medicine, which is the image that we've upheld for decades. We need to show that that's not true; that we are human and that understanding our humanity actually makes us better at our profession.

There was one professor I had my intern year who made such a difference. Honestly, I will remember this moment for the rest of my life because it truly impacted my humanity and medicine. As an intern, you're expected to take anything. Whatever the patient says, it's your fault. I had one patient that was massively mistreating me and my entire team and I was taking it because I thought that's what I had to do. That's what's drilled into you. The patient's always right. Kind of like customer service. This professor one day just walked into the room. She was my attending at the time and she just stopped the conversation and said, "You are mistreating my team. They don't deserve to be treated this way. You can choose to get care here by treating us respectfully, or you can choose to leave. I will not allow anybody to treat my team this way." That meant so much to me. I don't think she even knows how much that meant to me and I will forever carry that with me.

Unger: Wow. What an important lesson. Dr. Srinivas, Dr. Pasichow and Dr. Standifer, thanks so much for being here today, sharing your perspectives and kicking off our resident recognition week. That's it for today's COVID-19 update. We'll be back tomorrow with another segment. For updated resources on COVID-19, go to ama-assn.org/COVID-19. Thanks for joining us and take care.


Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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