Edward J. Gutmann is an associate professor in the Department of Pathology and Laboratory Medicine at the Geisel School of Medicine and directs the cytopathology fellowship program at Dartmouth-Hitchcock Medical Center. This column was adapted from a commentary published in the December 2020 issue of Cancer Cytopathology, a journal of the American Cancer Society.
Vox Populi is the Dartmouth News opinion page for commentary written by members of the Dartmouth community that is intended to inform and enrich public conversation. The opinions expressed in these essays are the writers’ own.
Establishing and maintaining collegial relationships among physicians and other health professionals can be challenging in the best of times. During a pandemic, this important framework, while more difficult to accomplish, is also more vital than ever.
These relationships are important for the well-being of the health care workers and for patient care. Responsible for preserving or restoring the health of our patients while preventing medical error, physicians practice a demanding and stressful profession. Fortunately, our burdens are lightened, and the likelihood of burnout is reduced, by the support and friendship of our colleagues. But opportunities for physicians to build this critical social capital have diminished in recent years, and the social distancing mandated by the COVID-19 crisis threatens to isolate us further.
However, I have found that connections with colleagues continue to be fostered, in a seemingly unlikely setting.
In my work as a cytopathologist at Dartmouth-Hitchcock, I often go to areas of the hospital where other physicians, including gastroenterologists, radiologists, and pulmonary doctors, are performing needle biopsies of lesions deep within the body. Using a microscope mounted on a cart, I quickly examine aspirated cells and provide immediate, in-person feedback to the physicians as to whether their needle has hit a targeted mass in an organ. I believe that my presence at these so-called “rapid onsite evaluations” (“ROSE” procedures) effectively builds social capital. The pathologists, radiologists, and clinicians who work together and get to know one another at these cases are more apt to pick up the phone and call or text one another for help with problematic cases of other kinds for which they share responsibility.
But social capital accrues in other, less formal, settings, too.
For example, our chats with colleagues from other departments at the physician group’s annual December holiday party and at the occasional “state of the group” dinner meeting create bonds that both sustain us and facilitate teamwork in caring for patients. I mention these events because over the years they have been phased out. Although I don’t fault my institution for eliminating them to achieve cost savings, they do represent lost opportunities for building relationships.
In years past, physicians routinely would dine together in the cafeteria. Indeed, for decades, four of my departmental colleagues ate lunch together and had vibrant discussions about politics, science, and movies; physicians from other specialties often would take a seat at their table. One by one, those pathologists retired; the last of the four who still works now eats alone in his office. “Grab and go” back to one’s desk to eat and do paperwork is the new norm for physicians—efficient, but lonely.
Electronic consultations are another means to increase the efficiency of physicians. Faced with a clinical question, a clinician can electronically query a specialist, whether or not he or she has previously met the consultant. A billable answer is received, but the question, “How are your kids doing?”—which might have been asked at the conclusion of a face-to-face clinical discussion—remains unasked.
Amid the ongoing, gradual attenuation of our social bonds, a worldwide health crisis has taken hold. As I write this in late 2020, nearly 300,000 deaths have been attributed to COVID-19 in the United States. Our mantra continues to be hand washing, masks, and social distancing. Holding a dinner meeting of 250 closely seated physicians is not possible.
How then do we build meaningful relationships with each other, especially when social distancing is mandated? Guidelines from the Centers for Disease Control and Prevention suggest a possibility: “Indoor spaces with less ventilation where it might be harder to keep people apart are more risky. Activities are safer if they are held in outdoor spaces.”
Our clinics, endoscopy suites, and operating rooms all are indoors, of course. But our parking lots are not. Indeed, despite months of frigid Northern New England winter weather for which a parking garage would appear mandatory, all the physicians at my medical center park in a large outdoor lot. This turned out to be fortuitous.
Even before the pandemic, I recognized the value of the parking lot for establishing relationships. In the lot one Saturday a few years ago, I encountered someone I had not seen before, but from the “ID” badge dangling from his neck, I recognized the name of a new pulmonologist for whom I had recently rendered several cytologic diagnoses. We introduced ourselves and had a 20-minute chat that included exchanging information on where we had trained and worked, our partners, our hobbies, and the like. This new friendship eased communication in subsequent months when we shared diagnostically challenging cases.
The lot has assumed greater importance during the pandemic. It is a large space in which it is easy to maintain a safe social distance. The warm sun there this past summer, most welcome after a bitter cold winter, was pleasant for us and less hospitable to the COVID-19 virus. I listened to a tale of unpleasant divorce proceedings, asked a colleague about his progress on an academic article, discussed a difficult case with an oncologist, and was advised about good bicycling trails. My list goes on, and my own conversations are a small fraction of the many daily impromptu meetings in the parking area.
To be sure, the lot is a large, lifeless expanse of concrete. But it is also a unique liminal space where we transition from our private lives at home to and from our clinical lives caring for patients in the hospital. Reaching out, sharing news, discussing a case, or simply wishing a colleague “good day” or “good evening” all challenge workplace trends that keep us apart.
Summer yielded to autumn, and, in a matter of days, winter begins. Our conversations in the lot will likely be briefer in the cold. But as we chip away at the ice on our windshields, we will chat. The bonds we form nourish us in all seasons.
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