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Burned Out by the Pandemic? War Zone Medicine Tips From an Army Physician-Turned-Geriatrician

By Ross Colt, MD

Constantly changing guidelines and hospitals overwhelmed by the surge in cases driven by Omicron have driven many doctors, nurses, and other clinicians to burn out. Physicians, especially geriatricians like me and my team members at Gary & Mary West PACE, are under continuous fire nearly two years into a pandemic that particularly threatens older patients, strains resources, and affects staff support levels.

If we are not careful, the things we do when under this kind of stress can have serious negative consequences for the health of those older adults we are striving so hard to protect. Pandemic burnout can drive us to make mental shortcuts that exacerbate the rampant ageism in the US health care system, ultimately leading to worse outcomes. Thankfully, I’ve been able to draw from my background as a US Army surgeon in Iraq to help my team continually provide our older patients with the holistic care they deserve.

Thinking Like a Soldier
I spent 24 years in the US Army as a physician and served two tours of duty in Iraq. During my first tour, I slept many nights in a tent or in an ambulance stretcher and provided trauma care to soldiers who had experienced everything from grave injuries after explosions to acute appendicitis. I did much of this with very little in the way of equipment or facilities. Sometimes I had no more than a large backpack full of supplies at my disposal, and I often performed medical care in the field out of the back of an Army vehicle.

This experience taught me to think quickly on my feet and pivot more easily, and gave me some mental tools to use in the most complex, stressful civilian medical situations—the type that often arise when you are coordinating the care for older adults with multiple medical issues and few family and financial resources.

These are the individuals most likely to come in through the doors of Gary & Mary West PACE. West PACE is part of the nationwide network of Program of All-inclusive Care for the Elderly, or PACE, organizations that focus on the mission of enabling older adults to successfully age in place with access to high-quality, affordable health and support services such as dental care, mental health, and social services that preserve and protect their dignity, quality of life, and independence.

Older patients with more complex health care concerns can present a frustrating challenge to overtaxed doctors, but they need and deserve a centered, holistic approach, no matter the circumstances. If you’re a health care worker burned out by the pandemic, the following are some war-zone medicine tips to help you keep going, and especially do what’s best for your older patients and their families:

• Take an overwhelming situation and break it down—then break it down even further. This type of team-based approach is not unique to the military. Civilian hospitals know how to do it; it’s just more inherent to military thinking. For example, I would tell a 19-year-old medic during a trauma code, “Your job is left arm, IV. Focus on that.” This type of extremely granular, team-based way of doing medicine can be a real benefit if you’re dealing with patients with multiple medical issues, who may also have some cognitive decline or communication problems.

• Pay attention to your patient’s daily reality. Geriatric patients can be overwhelming, with a lengthy medical history and a long list of ailments and medications. However, treating any individual medical conditions they have may not be the greatest service you can provide. Instead, sometimes the best thing you can do is pay attention to their everyday lives—the social determinants of their health. For example, it’s no use prescribing them another medication if they don’t have any transportation to the pharmacy or can’t afford their co-pay (just as it’s no use prescribing a treatment that a military patient will not be able to access when they’re deployed somewhere remote). It’s less helpful to prescribe a new blood pressure medication than to address the real stress caused by loneliness and social isolation (another issue often encountered with deployed service members).

• Travel light. There’s a famous—and very true—adage among doctors that the best geriatricians “de-prescribe,” taking older adults off medications they’ve been on for a long time. Older patients have often been prescribed something during a short hospital stay for an acute problem, but because it’s on their medication lists, it stays with them for the rest of their lives because future doctors are afraid to remove them. Have the courage to decrease your patients’ medications where you can. It increases the quality of their care, reduces the chances of drug interactions, and makes their daily medication regimens less complex, which is what you need when life is throwing you multiple curveballs per day. For the ones you do keep, make it simple for patients. PACE utilizes a bubble packing process through CareKinesis that has medications already sorted and organized for participants, who simply “punch out” a bubble on the weekly medication prescription card that is marked for day or evening use, eliminating multiple pill bottles and confusion.

• Think of yourself as their only advocate. Often, the people we have the privilege of treating have nobody else who knows the medical system well enough to advocate for them. Many are isolated and don’t have any family or friends nearby. When I was in Iraq, I was the only senior American medical resource within a 50-mile radius. Try to remember that for many of your patients, it’s you or nothing—that’s a dramatic lens that can help focus you on providing the best care for them possible, no matter how burned out you are.

These approaches have helped my team make a real impact for many of our participants in one of the most trying times for the medical community in recent memory. We have been able to more closely manage medication and monitor behavior consistently for participants with mental illness, stabilizing their housing situation and keeping them off the street. We have provided transportation to doctor and therapy visits at our center for participants who haven’t had a way to get to doctors’ appointments for many years—and we have decreased hospital visits for patients who have typically only gone to the doctor to manage routine health conditions when they are very sick and are forced to go to the emergency department.

While not every medical facility can operate like a PACE center, there are ways for the American medical system to reorganize processes and train new doctors in techniques that help them overcome these hurdles—and it involves thinking more like a soldier.

Ross Colt, MD, is the medical director for the Gary and Mary West PACE, an innovative, nationwide model of care for vulnerable older adults with chronic care needs offering high-quality, comprehensive, and coordinated health care, social services, and support to enable them to successfully age in place.