When COVID-19 is not a shared experience: Suggestions from NewYork-Presbyterian's CXO on how to deal with fatigue and denial

As I write during this holiday season, we are seeing COVID-19 cases rise in the city and much more significantly in other parts of the country. We are facing down this fierce surge — by far the worst nationally in the pandemic — even as we look forward to the arrival of the first vaccine.

It's frustrating to see this virus continue to spread and know that the weeks ahead could be very grim when we also know that vaccines are coming.

This is a common thread in many of our conversations — both locally and nationally. How is it that we can see cases rising to levels not seen before, hospitals filling, deaths increasing, and still have so many people behaving in a way that flies in the face of this reality — traveling, not wearing masks, and having or attending large gatherings? How can this be? And, how do you address it?

As a patient experience leader, it makes me think of some of the parallels that we deal with when we face denial or non-compliance with our patients and their loved ones. Are there strategies here that can be applied to our current situation with COVID-19?

It is probably best to start with the less "in your face" causes for risky behavior — fatigue and information overload. In our current situation, this is totally understandable. It's been said many times already — we are all exhausted. We are more than ready for this to be over. And, we are bombarded with COVID-19 information day in and day out. It all starts to blur together and we slip — either from fatigue or simply because we crave a moment of normalcy. We all know that this isn't the moment to slip. In fact, this is the moment to bear down and build on the hard won work we have done for the last nine months. 

The parallel in the patient experience world is when we are dealing with chronically ill patients over the long haul. These are often patients who have been working hard to manage their condition or disease. They know what the right things to do are, but they can become tired and overwhelmed. What do we do in these situations? 

First, we provide encouragement. We remind them of the progress they have made. We acknowledge and normalize the feelings that come with long haul work: fatigue and frustration. We also reinforce positive behaviors and reiterate the essential actions that are needed for success. These might be lifestyle changes or new habits that need to be achieved. 

COVID-protective behaviors are no different — they need constant reinforcement, especially when the situation starts to improve and people think they can let up a little. Constant refocusing of the absolutely core and critical elements helps us all sort through the blizzard of information that we all face. And encouragement is critical, too! I've said in earlier columns that we've all been through a lot and that we need to have compassion for one another as we enter this last leg of the marathon.

Fatigue and information overload are challenging enough. But, what about the more "in your face" behaviors that are behind the harrowing surge we face now? These are the COVID-19 deniers. And the anti-maskers. And the "personal rights" protesters. These are much harder to address — but there are parallels in the patient experience world here as well. 

The parallel here is when we are dealing with patients who are in denial about their condition or even in an anger phase. They are the "non-compliant" patients or those who are actively resisting treatment or care team interventions. At their worst, these are the patients who become belligerent or violent while we are caring for them. How do we address them in ways that we might adapt for COVID-19 deniers?

The instruments at our disposal are less subtle. The primary tactic is simply setting clear boundaries in environments we can control. We have standards of behavior for our staff and for our patients and families. We communicate them in multiple settings, and when they are not observed, we have a quick and clear escalation process. 

It's the same with COVID-19-protective behaviors within our walls. We are clear about those behaviors and we do not compromise. For example, within our walls at NewYork-Presbyterian, wearing a mask is not optional for anyone. We are clear and unapologetic. And, we enforce it. If you cannot observe this, you are removed from an environment where you can put others at risk. The stakes are too high to do otherwise. 

We've learned that if patients, families or even colleagues are unable or unwilling to maintain the boundary, then we must — for their safety and also for everyone around them. This is where the notion of respect and the common good come into play. Our individual rights are not unlimited. They must be balanced with the rights and well-being of others in the world around us. COVID-19 deniers seem to have lost sight of this concept. The politicization of the pandemic has not helped either. In these situations, the best we can do if we cannot persuade with facts and science is act to protect everyone else. That means a form of "tough love" — setting boundaries and maintaining them.

I have to admit, COVID-19 deniers grate especially on those of us in New York who have seen the worst that the coronavirus can dish out. Other parts of the country are learning this lesson the hard way. It's even more heartbreaking to see this happening when a potential vaccine finish line is especially within sight. But, perhaps some of the parallels we have learned in the patient experience realm can help right now. We must encourage and buck up the tired, and isolate the resistant. 


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