By Samyukta Mullangi, Johnetta Blakeley, and Stephen Schleicher
The COVID-19 pandemic has brought many challenges to oncology care; an area of medicine that typically involves frequent, in-person patient visits to complete a course of treatment.
In many ways, COVID-19 has served as a stress test for the specialty, and has catalyzed adaptive changes that we hope will make the oncology care, and the health care system in general, more resilient going forward.
By Elizabeth Clayborne
I was a little less than six months pregnant when the COVID-19 pandemic hit in 2020. As an Emergency Physician, I am well aware of additional risks that my job often exposes me to on a daily basis. We frequently face physical and emotional strife from unstable psychiatric patients, critically ill nursing home residents, sexual assault victims, and newly diagnosed cancer patients.
People who work in an emergency department tend to understand what comes with the territory: a lot of hard work, unexpected outcomes, and daily traverses of the human experience, from the best emotions you can imagine, to lowest depths of human despair. This is what accompanies caring for every ailment for people from all walks of life. I actually love this part about my job! I never know what I’m going to see when I walk through the doors.
That said, being a frontline physician during COVID-19 has provided me with a profoundly different lens on the pressures surrounding health care workers. And experiencing this while pregnant was pretty terrifying.
By Benjamin Podsiadlo
The COVID-19 pandemic has posed persistent, wide-ranging existential threats to effective 911 emergency response.
The EMS (Emergency Medical Services) system, which sits at the intersection of emergency medicine and public safety, is the out-of-hospital component of the acute care health care system. The EMS mission is targeted at identifying, responding, assessing, treating, and entering suddenly ill and injured patients in the community into the health care system.
The EMS system’s viability is entirely dependent upon the capacity of its workforce of EMTs, paramedics, and 911 EMS telecommunicators to respond 24/7/365.
The devastating impacts of the COVID-19 pandemic on EMS include: severe damage to workforce sustainability; grossly insufficient logistical resourcing; and further erosion of cohesive system identity.
By Cynthia Orofo
There are two experiences I will never forget as a nurse: the first time I had to withdraw care from a patient and the first day working on a COVID ICU.
Both were unforgiving reminders that the ICU is a demanding place of work that will stress you in every way. But the latter experience was unique for a few particular reasons. Before the end of that first shift, I had overheard several staff members on the floor speak about their fears, thoughts of the unknown, and their version of the “new normal.” As I realized that life would almost certainly not be the same, I developed my own vision of the “new normal” of health care.
By Lauren Oshry
In 1982, when AIDS was first described, I was a first-year medical student in New York City, the epicenter of the epidemic in the U.S. To the usual fears of a medical student — fears of failing to understand, to learn, to perform — was the added fear of contracting a debilitating and universally fatal infection, for which there was no treatment. But our work felt urgent and valued, and the camaraderie among medical students and our mentors is now what I remember most.
Nearly forty years later, my experience as an attending oncologist during COVID-19 has been different. Yes, I am older and less naïve, but also this pandemic has been managed in fundamentally different ways. Aside from the obvious federal mismanagement, my own institution has deeply disappointed me. The institutional shortcomings we had long tolerated and adapted to were laid bare by the COVID-19 pandemic, and massively failed our patients and morally devastated those of us on the frontlines.
As a provider in a large safety net hospital, I care for a predominantly minority population in the lowest economic bracket. These would be the individuals disproportionately affected by COVID-19, with highest rates of infection and worse outcomes. My patients have the additional burden of cancer.
By Molly Levene
“Heroes Work Here.”
Sometimes those three short words make me angry; other times they make me cry.
I was one among thousands of EMTs and paramedics who were deployed to New York through FEMA last year. Having studied public health in school and worked in EMS for over a year, I thought I had seen the extent to which we fail patients; I believed myself disillusioned enough to be prepared for any injustice or chaos I might encounter.
But last April, I quickly learned I was wrong. And when you feel complicit in such deep structural dysfunction, it is incredibly difficult to feel heroic.
By Jenna Becker
Race-based clinical algorithms are widely used. Yet many race-based adjustments lack evidence and worsen racism in health care.
Prominent politicians have called for research into the use of race-based algorithms in clinical care as part of a larger effort to understand the public health impacts of structural racism. Physicians and researchers have called for an urgent reconsideration of the use of race in these algorithms.
Efforts to remove race-based algorithms from practice have thus far been piecemeal. Medical associations, health systems, and policymakers must work in tandem to rapidly identify and remove racist algorithms from clinical practice.
The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School is hiring a full-time post-doctoral fellow to support its newly launched Diagnostic Digital Home Health initiative. This position will likely be a three year commitment.
This sponsored research project examines the ethical, social, and legal challenges of digital home health products, with a focus on home diagnosis of infectious and chronic conditions. This project will develop scholarship, guidelines, and proposed regulations for the ethical implementation of these products, using focus groups, virtual workshops, and interdisciplinary scholarship, with a focus on considerations of access and equity, social interconnectedness, and patient privacy.
Previous Petrie-Flom Center post-doctoral fellows have used their positions as successful launching pads for tenure-track legal, health policy, and bioethics academic careers. Our most recent post-doctoral fellow has published in leading journals such as JAMA, Science, and the Journal of Law and the Biosciences. She has been interviewed as an expert in biomedical regulation by media outlets such as Forbes and Lancet Digital Health and presented to regulators at the U.S. Department of Health and Human Services.
Read More
By John Tingle
The Healthcare Safety Inspection Branch (HSIB) in England, which conducts independent investigations of patient safety concerns relating to the country’s National Health Service (NHS), has just published a learning report that examines the findings of investigations they have carried out on incidents classified as “Never Events.”
England’s NHS defines Never Events as “patient safety incidents that are wholly preventable,” in accordance with the implementation of “guidance or safety recommendations that provide strong systemic protective barriers.”
In the National Health Service’s policy and framework, Never Events are listed under the following headings: surgical, medication, mental health, and general. These headings include incidents such as overdose of certain medications, failure to remove a foreign object used during a procedure, and transfusion of incompatible blood.
The investigations for the HSIB report cover seven of the 15 types of Never Events listed in the National Health Service (NHS) Never Events policy and framework published in 2018. These seven categories account for over 96% of the total Never Events recorded in 2018 – 2019.
Controversially, the HSIB report recommends that NHS England and NHS Improvement revise the Never Events list to remove several which don’t have “strong and systemic safety barriers.” “These events,” the report states, “are therefore not wholly preventable and do not fit the current definition of Never Events.”
This suggestion is, arguably, not in the spirit of advancing the patient safety agenda in the NHS in England.
Diagnosing in the Home will seek to examine the ethical, social, and legal challenges of digital home health products, with a focus on home diagnosis of infectious and chronic conditions.
January 27, 2021 – The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School today announced a new research initiative, Diagnosing in the Home: The Ethical, Legal, and Regulatory Challenges and Opportunities of Digital Home Health. This three-year project will seek to promote the translation of diagnostic medical services into home health care through regulatory and ethical frameworks. This initiative is generously supported by a grant from the Gordon and Betty Moore Foundation.