Chaos: Friend or Foe?

Jill Gilbert, MD

I recently had the pleasure of hearing a special lecture about the experience of being a medical professional during Hurricane Katrina. It is hard to believe that Hurricane Katrina and its devastation occurred almost 20 years ago. The talk was entitled “Humanistic Challenges in the Midst of Chaos.” This talk was timely given the changes we are experiencing in the country and within our profession of medicine.

There are approximately 26,241 oncologists in the US. Given this size, we often have diverse viewpoints on many things in both the medical and political arenas. Sometimes the political arena spills into the medical one. However, intellectual freedom is important. The ability to engage in respectful discourse, evaluate differing viewpoints, challenge our certainties, and find common ground is the bedrock of intellectual freedom. The ability to debate and think inde- pendently must continue. But similar to Hurricane Katrina or the awfulness of the COVID-19 pandemic, we find ourselves in a pressure point in the country and therefore in oncology.

I recognize that this pressure point may feel good to some but horrible to others. Your colleagues may be experiencing a range of emotions, perhaps changing by the day. There is no magic spell to weather each storm, but remember that individuals are feeling vulnerable and raw. Extending grace and listening, even if you personally want to scream, will become important in the days, weeks, and years to come.

From a personal perspective, I want to briefly touch on some professional strategy techniques that I have found useful through such incredibly challenging times. You may find these useful, or you may not. Take what you like and leave the rest.

Define Your North Star

My North Star at work is helping faculty find contentedness and abundance surrounding their professional life, whether during chaos or during times of stillness. At present, political divide threatens divisiveness among our physi- cian ranks and can lead to dissatisfaction. Our strength is our team, regardless of political stance. I plan to use professional development as a tool for unification. I can take actions and operationalize solutions that allow us to remain a team, a united force for patient care and for support of each other.

We may think of radical ways of doing this. Maybe, when life does not feel as raw, we can consider a “great debates” series in which we respectfully examine our differing views as they apply to medicine, helping us all find our commonalities to define a path forward, one that is action and engagement centered to fulfill common goals.

Action Is a Salve

This means that I translate my strong feelings into tangible and active steps toward an end product that aligns with my belief system, my moral compass, and my North Star, which is helping faculty find their sweet spot. Approximately 6 years ago, I was dismayed by what seemed to be draconian opioid restrictions and their potential effects on my patients. In order to address these, I teamed with lobbyists from 3 medical societies, testified in our statehouse, and helped enact a carve-out for our patients with cancer. Most actions are not in the political arena but can be just as impactful to the professional ecosystem in which you live.

Pressure Points Allow Innovation to Happen

This is not the same as toxic positivity, and I recognize that pressure points are not fun. From a more contemporaneous standpoint, the horror of COVID-19 resulted in innovations: a normalization of the ability to work effectively from home, the use of telehealth, and an emphasis on personal boundaries in ways that were not previously acceptable. Every thorn has a rose.

Recalibrating and resisting catastrophizing are important for mental health and for meaningful action that ensures the best future for our profession and our patients. But action is dependent on being willing to get involved. In times of pressure, we must evolve to excel.

Conclusion

I reiterate that this is my testimony of sorts. This is how I contextualize, process, and proceed in times of uncertainty. I invite you to join me on this journey, to help me create programs and opportunities to allow us all to rise, support our members, and serve as an example of how academic medicine can evolve and excel through unprecedented times of pressure and chaos.

This is not an academic vs private practice issue. This is an issue for all of us who practice oncology. But we can distinguish ourselves by doing this well. As oncolo- gists and physicians, our careers are about preventing and relieving suffering. Our individual willingness to become involved with issues that matter to help relieve suffering as well as our collaboration with our institutions and professional societies can make the difference between transcending the pressure points or succumbing to the pressure.

Jill Gilbert, MD, is a professor of medicine and vice chair of Professional Development for the Department of Medicine at Vanderbilt University Medical Center in Nashville, Tennessee.