In Disruption, Defiance

If you have children—and even if you don’t—most of us are familiar with LEGO™ models. Hundreds (sometimes thousands) of similar bricks come with an instruction book that shows how to turn the individual pieces into a model: a house, a car, the Statue of Liberty, things like that.

Some children, having made the investment of time and effort to put the model together, want to preserve it that way forever. They are content to let it gather dust on a shelf. There’s nothing wrong with that.

But, creativity doesn’t come into play unless that model is deconstructed back into the individual bricks, freeing the builder to imagine and create thousands of different models from the same set of pieces.

Right now, our society is a little like a model that fell off the shelf and broke into pieces. We can view this as a disaster that we must fix by reassembling the original model, or we can view it as creative destruction and an opportunity to reimagine it as something new.

Innovation takes time and energy, so I am imagining how this sounds to you. To people who are juggling all their roles at once, without the familiar boundaries of home, office, and clinic. To people who have made a phenomenal effort over five months. You may be asking, “How do we sustain this?”

The answer is we don’t. We can’t. You need some time off. Take a break, take a vacation, keep your evenings and weekends work-free. Give yourself permission to read that book, knit that scarf, build that deck, go for a walk or take a nap. I’m not just saying this, I’m taking a break next week. We all need to. Our first obligation to our work is to keep ourselves physically and mentally healthy. I’m sure you don’t hear that enough. Please hear it now because we have many challenges still ahead of us.

Even though the pandemic is not over, we can see the level of disruption that has occurred. We can see things where we gave our best effort under pressure, but that still need improvement. I recently had an example of this pointed out. As we began to bring patients back in for surgery, we needed to ensure they were tested for COVID-19, right? So a checkbox was added to Epic to indicate that testing had been ordered. Like so many things in this pandemic, however, answering one question was not enough. In fact, answering one raised two more questions: Who is responsible for the testing? Was the test negative or positive? There are so many things we don’t know, and it requires us to continue to learn, adapt, and improve.

This is also true when we try to reimagine a better post-COVID world.

  • Our jobs in clinical care, research, and education will not be the same—telemedicine, hybrid of in-person and virtual care, and data-driven clinical diagnosis and decision. How can we position ourselves for a new or different work life? What do we need for personal development and growth?
  • In the past few months, our ideas about what services are “essential” have changed. How will that be reflected in our values? Our lifestyles? Our economy?
  • The financial models of healthcare we have been using are no longer applicable or sustainable. What can we do to move toward patient-centric and just healthcare, and more human conditions for caregivers? How can we leverage these changes to improve health equity and access.

These are questions to be answered personally, as a medical school, and as a society. Now that we know that we can’t always even imagine what the future will hold, our old standbys—planning and assessment—will need to be augmented by improvisation and adaptation.

Unexpected events in the future are a given. So, too, is our ability to find vitality in disruption, defiance in crisis, and confidence in academic medicine and in each other.