An Apology Letter

I recently had the unfortunate opportunity to listen to a very condescending conversation between two healthcare professionals about COVID-19 vaccine reluctance. Their attitudes towards those that disagreed with them and their belief that this vaccine was the cure to all of life’s woes was astounding. At one point the argument was made that the reason that the south has low vaccine rates is because it is “filled with uneducated and unintelligent people”. They were so wrapped up in their affirmation of their own beliefs that they forgot about the southern hillbilly sitting in the corner that has as much education (albeit in other subjects) and knowledge as both of them.

After I got over my own hurt ego, I tried to see the issue from their point of view. They were frustrated because they felt that they had the golden answer and their patients were not receptive to their recommendation. Had I not ranted or raved about a similar thing after saving a drug-addicted patient for the second time in the same shift?

Healthcare professionals enter the field with the intention to help people but find it very difficult to actually do so. But why?

Because we have failed.

Dear Patient,

We have continuously failed you, as the patient, and you have understandably lost faith in our ability to do or say what is in your best interest. We have lost your trust, and honestly, we don’t deserve it. Please stick with me as I attempt to apologize for these failures.

We have turned our backs on you in the name of technology.

When the opportunity to move away from cumbersome paper charts and embrace electronic medical records arrived, we embraced it, even when we didn’t fully understand it. Unfortunately, the business-minded individuals (that are separated from the bedside) understood and set these programs to ensure maximum statistical and financial reporting data capabilities. They are not evil people. They simply were utilizing the tools available to them while we sat back and let them do it. This led to even more cumbersome computer programs that moved us from paper-pushers to mouse-clickers with even more information to record.

The result is the removal of the personal experience from healthcare. Instead of looking into sympathetic eyes or feeling a comforting touch from us, you are forced to listen to us slam the mouse and pound the keyboard while you look at our ponytail or balding crown. We eliminated the “care” from healthcare in the name of safety and convenience.

For this, I apologize.

We have bowed down to the pressures of patient-satisfaction scores and threatened legal assault.

Humans make mistakes. It is what we do. One great thing is that our bodies are created to be resilient to the continuous assaults that we place upon them. The problem arises when we ignore the warning signs or place more stress on the body than it can handle. Healthcare professionals should be telling patients the hard truth when it comes to the effects that some of their decisions are making on their overall health. Due to political correctness, fear of bad scores or even a lawsuit, we have cowered.

We do not tell you that being 5’3” and weighing 600 pounds will lead to health problems and decreased quality of life because we are afraid that you will think we are being judgmental. We do not tell you that your decision to choose drugs over relationships will lead to bad things in your future because we don’t think you will listen. We simply apply the metaphorical band-aid in the form of another pharmaceutical agent and send you on your way.

You deserve better than that. While these conversations can be difficult, we need to take the time and find a way to work WITH you on your issues. This is not because we know everything and that we don’t have issues of our very own, because we could definitely benefit from listening to our own advice. This is because you have come to us for help. We need to get over ourselves and find a way to have these difficult conversations while being respectful and nonjudgmental. We need to be honest with you about what we think and trust that you can be tough enough to listen, even if you disagree. We need to stop and listen to your concerns and not dismiss them. We need to take the time to have open, honest discussions. But we don’t.

For this, I apologize.

We have made healthcare more efficient.

Now that the insurance companies have more excuses to avoid payment for services and the administration has a multitude of data to scrutinize our activities, we are finding ourselves with less time with you. Under the guise of efficiency, processes have changed in offices and hospitals. You are treated more like cattle being herded into various rooms and exposed to random individuals for only moments at a time. We have come to think of you more as a room number or condition than a person. This wasn’t our intent when we chose the healthcare field but we have succumbed to the pressure of the numbers.

For this, I apologize.

We missed a golden opportunity to regain your trust.

The rapid spread of the SARS-CoV-2 virus put everyone into a state of panic. You overlooked your previous distrust of us hoping that we would have answers. Again, we failed.

Expecting anyone to know what to do with a novel virus is unrealistic. We didn’t have the answers but we didn’t dare tell you that. We pretended to know what was going on while making mistakes along the way. Then, we expected you to ignore any mistakes and trust us despite never making any effort to apologize for our mistakes. Here are just a few of them:

• We jumped to intubation.

The early death count was high and the ventilators were short. This is not because every one of those patients required intubation to save their lives. It was because we were scared. We were afraid of the virus particles floating in the air so we jumped to contain them. 

Placing someone on a ventilator is not a benign procedure. If it was, we would be tempted to do this for every alarm-hugging, pain in the butt patient that walked in the door. The act of shoving a tube down a patient’s throat and into their lungs and hooking it up to a machine to force air into the body is in some ways barbaric. Normally, we would only do this as a last resort to save your life.

 But not with COVID-19. We were encouraged to, and gladly accepted the advice to intubate anyone with a breathing issue that we suspected of having the virus in an attempt to contain it.

Some could argue that this was the responsible thing to do in order to spare those with the knowledge and skill to save others. And if the virus had turned out to be more deadly to healthcare workers, they could have been right. All I know is that I still have pangs of regret for my participation in those early intubations.

When we learned that this practice was causing more harm than intended, we quickly changed our approach. We learned from our mistake but we never admitted it to you nor apologized for it. We didn’t want you to know that we were scared, too. We didn’t want you to know that we were not perfect.

For this, I apologize.

• We relished in your worship of us.

With the world’s attention placed on us for our efforts to save lives, we allowed our egos to get in the way.

 Healthcare is hard. Standing alongside another human being at their worst moments in life is a heavy burden to bear. This did not change in 2020. Healthcare was hard in 2012 and in 2018 and in 1955 and in 1972 and in ………

 Instead of returning to our work with a nod of acceptance for your appreciation and newfound (although unearned) trust, we relished in the attention. There were signs, buttons and T-shirts being made labeling us as heroes. There were politicians and news media discussing our efforts and deeming us “essential” employees. You showered us with gifts of food and positive comments on social media sites.

 We let this go to our heads. We felt that we were finally being appreciated for the hard work that we have done for years and didn’t want to ruin the accolades by admitting that some hospitals were empty. We didn’t want to dissuade you from acknowledging our efforts by admitting that we didn’t have all of the answers. We enjoyed playing the role of God.

 For this, I apologize.

• We failed to encourage good behaviors.
  • It didn’t take us long to learn a few things about the SARS-Cov-2 virus.
    • We learned that the ones most susceptible to the SARS-CoV-2 virus were the elderly, obese and those with multiple comorbidities (many related to or exacerbated by obesity).
    • We suspected that certain vitamins may have beneficial effects and knew that if taken responsibly have very few side effects.
    • We knew that this virus was highly contagious.

• Instead of encouraging you to consume proper nutrition to boost your body’s reserves in case you contracted the virus, we told you to order fast-food delivered to your doorstep. And yet, we simply shake our heads at the “Covid-15” term as many patients gained a significant amount of weight during 2020. We ignore the fact that this weight-gain can actually INCREASE your risk for complications should you contract the virus.

• Instead of encouraging you to exercise to prevent weight gain and improve your overall health, we told you to sit on your couch and hide away from the world. We even participated with the politicians to close gyms and parks.

• Instead of encouraging outdoor walks to expose you to fresh air and improve lung function, we told you to put on a mask every time that you stepped outside. We didn’t provide good data to support the use of masks but we encouraged it and, in some cases, found ways to require it.

• Instead of providing suggestions on how to reduce stress and educating you on the negative impact that stress can have on your immune system, we encouraged you to tune in to daily reports from your politicians or news stations spouting doomsday predictions. We offered no resources or suggestions on how to cope with this new stress in your life.

• Instead of encouraging you to seek comfort from close friends and family, we turned you against each other. We even went so far as to tell you to hide a family member (even a child) in a separate room if they may have been exposed to the virus. We told you that human connection was dangerous and that traditionally normal behaviors had the power to kill others. We told you that you were selfish for wanting to maintain in-person human connection. We pretended that communication through a screen was just as good as in-person. We ignored one of humanity’s basic needs.

• Instead of suggesting that you search for hope and answers from your religious beliefs and institutions, we told you that singing and praising the Lord could “kill grandma” who was sitting next to you. We weren’t providing answers (we didn’t have them) and yet we participated in ways to prevent you from discovering them for yourself.

 For all of this, I apologize.

• We made you scared to seek our help.
  • We twiddled our thumbs waiting for patients that we knew were out there and wondered why you refused to seek our help. We ignored the fact that our continued efforts to make you afraid to leave your home were causing unintended, harmful consequences. You experienced longer hospital stays and painful procedures because you were afraid to seek our help.

For this, I apologize.

• We closed down “non-essential” medical services
  • Whether it was by government mandates or due to our own fear of contracting the virus from you, we stopped providing services to you. We didn’t bring you the home health care that you expected. We cancelled therapy and chiropractic appointments that left you with decreased mobility and increased pain. We didn’t provide a place for you to receive cancer screenings, mental health services or preventative care and pretended that this was done in order to protect you.

For this, I apologize.

• We separated you from your loved ones.
  • We participated in conversations that encouraged the closing of churches.
  • We created restrictive policies that isolated the elderly in nursing homes, reducing those institutions to what were essentially jail-cells.
  • We suggested that the emotional and mental benefits of funeral rituals were not important, resulting in many people burying loved ones without the support that they needed.
  • And in my opinion, our worst act was separating loved ones at the end-of-life. When situations became desperate enough that you came to us for help, we took your loved one and told you to sit in the parking lot for updates. We prevented you from saying goodbye. We pretended that talking through a screen was an acceptable alternative. We ignored the comforting effect of holding the hand of a loved one as they passed on and pretended that we were doing this for your safety. We prevented you from having true closure and the dying individual from having a respectful and comforting death.

 For this, my apologies are not enough.

• We vilified our own that dared to have a different opinion.

We were taught in school that cooperation and group participation will sometimes allow us to find answers to problems that elude us. We are encouraged to be open to ideas from all different backgrounds as we may be exposed to a solution that we never considered.

 And yet, we destroyed those within the healthcare community that had the courage to offer suggestions that seemed outside-the-box. Instead of admitting that we didn’t have all of the answers and being open to ideas, we pretended that we knew it all and silenced anyone that suggested otherwise.

 We didn’t stop there. As we worked to prevent the sharing of their opinions and supporting information, we also destroyed their reputation by every means possible.  

 I’m not saying that every idea or suggestion provided by healthcare professionals at the beginning of the Covid spread were valid. I am simply saying that we should have at least listened to them and not tried to prevent you, the patient, from being exposed to alternative points of view. We should have trusted that you could have handled the knowledge that we were also learning and didn’t have all of the answers. If we could treat “one of our own” in such horrible ways simply because they expressed a different point of view, how can we expect you to feel free to share your concerns or thoughts openly with us?

 For this, I apologize.

And now, we expect you to listen to us simply because we have a few letters after our name or because we wear a white coat!! How dare we be so egotistical? What right do we have to expect anything from you after the way that we alienated and isolated you? We have not proven ourselves to you. We expect your trust and respect but have failed to earn it.

A comparable analogy would be if we hired a contractor to build a deck for us. After only a week, that deck fell to the ground. Despite his failure, the contractor wanted us to praise him for the detailed woodwork lying in a heap on the ground. If that isn’t bad enough, he now wants us to trust him to redo our bathroom AND encourage our friends and family to do the same thing. We would never hire a contractor that incompetent and arrogant, so why do we expect that behavior from you?

It is because we are arrogant, egotistical and prideful. More importantly, it is because we are so ashamed of our failure and fearful that you will never trust us again. Most of us didn’t enter this field for the accolades or publicity. We entered healthcare to help people…… and we are failing.

For all of this, I am sorry.

Please bear with us as we try to fix it.

Please continue to hold us accountable for our mistakes.

Please don’t give up on us. You deserve better and we know it.

Most importantly, please take responsibility for your own healthcare. Let us advise, but don’t let us make the decisions for you. We don’t deserve that amount of trust or power. We have good intentions but we are fallible humans. You will be the one to suffer the consequences of bad healthcare, so do your best to make good decisions as we work to improve the way that we provide services to you. Find a way, despite our failures, to live the best and healthiest life that you possibly can. You can do it. We want to help but we need to fix some of our own problems in order to find a better way to work with you in this endeavor. It will take time and hard work but we hope that one day we have found a way earn back your trust.  

Sincerely,

One of many healthcare professionals trying to do better.