Today, March 30, is National Doctors’ Day and I very much hope that what you read next honors this day and every day moving forward as we navigate the most challenging medical and psychiatric battle of my generation.
In times of darkness, grief, or simple life stuck spots, we all need to find our muse (or escape). Mine is music and it always has been. I’ve been a percussionist for over 30 years, I still have my Ludwig Rocker II cherry red drum set, stacked with Zildjian cymbals in my basement from my days in college where I played in some crap bands in the many bars of Athens, Georgia, a killer music town. I have the fondest memories of listening to the “oldies” on road trips with my family as we drove up the east coast from Georgia to New Jersey each summer to spend time with our cousins, aunts, uncles, and “northern” roots, right there on the boardwalk of Atlantic City (mind you the oldies back then were songs from the 60’s and 70’s, now my kids think the 90s music are the oldies). This was going to be the summer of concerts for me around the country, something I’ve always wanted to do but never set aside the time or budget. I finally did, but the world had another idea in mind for my summer, and I have an eerie feeling that my summer will be very similar to yours (yes, you), which I hope to never say again. Music has always been stirring inside me, playing in my head, I’m always tapping and drumming, no matter what I am doing.
I turn to music to for joy, for relaxation, sometimes just to match an intense emotional state I am experiencing. I use music to focus, its my motivation, my meaning, I even use it in my therapy sessions to help my patients find lyrics and songs that can guide them on their own journeys, or simply to create an emotional shift in the room. My cognitive-behavioral mentors (and heroes) would be horrified by this last reveal, but I’m cool with that at this stage of my career.
Right now, I feel we all need music, arts, and inspiration more than ever. I’m even listening to one of my playlists as I am writing this, and with a little extra time on my hands, I’ve been listening much more on walks and runs. One song specifically struck a chord with me recently, one of the most beautiful songs I’ve heard in the last few months, first released in 2019, serving as the muse for what I will be discussing in a moment, our broken healthcare system. I believe the lyrics offer some clarity on where we are and where we are headed: “Don’t give up hope/Keep dreaming,” “We share these moments/Till they melt away/To foggy memories/Of a distant day,” “I’m watching it all roll by/I can see/I can see/A life beyond the dream.”
This DREAM is more of a nightmare for many, but one day soon (I hope) we will all be beyond this tragedy unfolding each day caused by the COVID-19 pandemic. “A Life Beyond the Dream” may not be the lyrical masterpiece that Bob Dylan would have offered in his early years, or the musical perfectness of almost every Led Zeppelin album, but the beauty in the song (like a gentle cool breeze on a warm day at the beach) and the simplicity of the lyrics are exactly what is needed today. The song “A Life Beyond the Dream” was originally performed by the compilation group Ghosts of the Forest (and album with the exact name), it was written by Trey Anastasio, lead guitarist for the best touring band ever, Phish (you won’t convince me otherwise). For anyone in need of some heavenly music with the nastiest of blues guitar riffs, the most beautiful vocal harmonies, and a power lead vocals, I strongly recommend the version of “A Life Beyond the Dream” performed at the 2019 LockN featuring the Trey Anastasio, Susan Tedeschi, and Derek Trucks. Pure heaven from the first note Susan sings.
This musical intro is my way of walking into a more positive and hopeful analysis of our healthcare crisis, a crisis on full display as our country meanders COVID-19. I’m not suggesting that we avoid discussing grief, trauma, or fear surrounding this pandemic, nor that we avoid paying attention to the pain, suffering, illness, and death that this virus is causing. That can be for another day. Like many of you, it’s basically impossible for me to avoid the dark side of this when I have too many friends, family members, and colleagues on the front lines as doctors and nurses risking their lives, their livelihood, their families, and their career for anyone who shows up in their office or hospital, ANYONE. I have close friends that are unemployed and will likely be so for the foreseeable future, because of the financial fallout. My daughter’s Bat Mitzvah (which our family has been preparing for now for almost 2 years), is sadly being postponed by many months (have fun explaining that to a newly minted teenager. Though, to her credit, she handled it amazingly and with great maturity which, by the way, is the definition of becoming a Bat Mitzvah. We are very proud of her). Anyone pregnant is now having to face the reality of having her baby likely without her partner present. Many children who’s only full meals were at their school are now having to face the even harsher reality of rationing and/or not eating. Valedictorians just got screwed. Funerals can’t be attended by their loved ones. IVF candidates are now being told to wait longer. There will be no prom or senior spring break. Many small business owners won’t last three months without customers. Most of our kids have no real school going on and no extracurricular activities or in person socialization events. Its all disturbing and sad. The list goes on and on. Yet, I encourage us all to “Don’t give up hope/Keep dreaming,” “We share these moments/Till they melt away/To foggy memories/Of a distant day,” “I’m watching it all roll by/I can see/I can see/A life beyond the dream.”
When it comes to our healthcare system, hope and dreaming is all many of us have left. COVID-19 at its core has proven how fragile and disjointed our healthcare system is. It appears that we have a President overruling the best scientists and researchers in our country, despite the evidence when it comes to how to slow the spread of the virus. Whether he is right or wrong, I don’t care, but I have my hunches. I only care that our doctors, our nurses, our medical providers, all of whom are the backbone of the healthcare institutions, are sacrificing themselves everyday without adequate communication, resources, personnel, or clear planning, rendering only limited confidence in the containment and management of this pandemic. It’s undermining the goal of offering best practices that most of us in healthcare strive for each day. Without even questioning it, our doctors and nurses are jumping in front of loaded guns and many will not survive, emotionally or worse.
It took our current U.S. President to go on national television during a health care crisis, at the pulpit of the White House press briefing, to announce that all of us health care workers (medical and mental health) are now permitted to use previously “unsanctioned” (non-HIPAA compliant) telehealth technologies to care for the ill and, in most cases, we are now allowed to practice across state lines. Why? Not because it’s the “best” thing to do but because we have no other options, because we were ill prepared for this, because we have a healthcare system that has been broken for my entire professional career, in my opinion. For those who do not work in healthcare, this decision to eliminate state boundaries may have not even registered with you but for all of us on the front lines of care, we have spent the last three weeks being inundated by emails, listserves, phone calls, and advertisements 24/7 all targeting new technologies, tools, and policies that increase our abilities to stretch as far as we can to care for as many people as humanly possible, and we are stretched as far as we can go. We are all doing our best to respond to the need.
Before this (and likely after), Managed Care Organizations (MCOs) had all the control over the pricing and reimbursement of healthcare, they controlled who actually gets seen, the timing behind it, by which care provider, in which location, ultimately limiting access to “best practices” (and in some cases, even mediocre practices) unless you were one of the lucky ones with a good healthcare policy, or you knew someone who knows someone, or you simply can afford it out of pocket. Because of the pandemic, new policies are making it possible for healthcare providers to simply treat those in need with much less attention to what the healthcare companies say or do, the red tape has fallen, for now and all of us are stomping on it as much as possible to help those in need. Its inspiring. Dare I say it’s almost liberating for those providers who exclusively see in-network patients. Why is it so important to be able to simply focus on helping others rather than the battle with MCOs, or state licensing boards, or expensive and cumbersome telehealth technologies? Because most of us in healthcare simply love helping and caring for others, because we believe in what we do, and because we take immense pride in our craft, but really, because we hate it more when we see people needlessly suffer. Like every professional athlete I read about who experiences more anguish in their losses than joy in their wins, those of us in healthcare are way more disturbed by those we can’t help than we are fulfilled and joyed by those we can help, and that is what makes us good at our jobs. Don’t get me wrong, I love my job, my team, my specialty, and my patients. I work as many hours as I do as the director of my clinic because I believe in our mission, our highest standards of care, and our outcomes. But I can’t take saying no to equally deserving people in need much longer, it’s too painful, and I’m not even the one making life and death decisions that medical providers are having to do literally right now as you read this in our current COVID-19 era.
This is not the best time to be bending the rules and making up policies, but we are now bending. In most situations, healthcare providers are forbidden to practice across state lines unless you are dually licensed in both states (or get some kind of provisional temporary approval from the 2nd state’s licensing Board, good luck waiting around for that), but right now this regulation is waived. For me and my team, and many of my colleagues around the country who have trained for years to become specialists, not generic therapists, but actual specialists (I’m an anxiety and OCD specialist), we have gone through exhaustive training by those who have literally developed and field tested the gold standard of anxiety and OCD treatment, known as Exposure Therapy or Exposure and Response Prevention. Yet, there are nowhere near enough anxiety specialists even in big cities like Atlanta, Georgia, where I work, to serve the thousands of anxiety sufferers. Like many of my colleagues around the country, we get calls from people out of state, from out of state college students whose parents live in Georgia, from families in rural parts of the country who found us simply through a google search, wanting and needing to be seen right away, not weeks or months away. Too many times, the answer is a no. Not by choice, but because of the laws of the land, the laws of the state, the laws of my Licensing Board, or because their insurer has a therapist who they believe can offer an equal level of care in-network (which is sadly very rare).
So, though I know the current flexible provisions set forth by the President are temporary, and I know we are clearly under resourced as a country for this current battle, I am very hopeful that the problems COVID-19 has highlighted within our healthcare system will turn into many positives, that new policies will be enacted, and that better planning will be in place so that we see a significant increase in the accessibility and availability or best practices, for all specialties around the country so everyone has more equal access to great healthcare. Not just during a pandemic, but always. It should not take a pandemic for healthcare providers to be allowed to treat those in need, regardless of locale, or those in underserved areas, or those in need of immediate care. “Don’t give up hope/Don’t give up hope/Keep dreaming/Keep on dreaming.” I won’t give up hope and I will keep dreaming to be part of a healthcare system that aims to prevent more illness than just treating it, that it makes available “best practices” not just to the select few but to the many, and that we have the resources, personnel, and effective decision makers at the top to stay ahead of the next healthcare crisis, whether it be of virus from a living organism or a computer virus that holds us all hostage.
Americans have been through other health crises before (and there will be more down the road), we are not even 20 years beyond the worst terrorist attacks my generation ever witnessed, attacks that shutdown our travel industry, altered our financial markets, and left an indelible mark on our foreign policy. We have had notable down economies over the last 20 years. We seem to be living in the most polarizing partisan environment that I can recall, essentially rendering it impossible to talk about or even joke about politics with anyone unless you absolutely know whether they bleed blue or red. Despite each of these moments in time, some that lasted months, some that lasted years, and some that are still present, we as Americans seem to have a knack for bouncing back, for re-establishing a sense of “new” normalcy, and for healing together. But for anyone hoping that things get back to normal or to get back to the way things were, I urge you to re-evaluate how good things really were in our healthcare system. When this is all over, I hope each one of us takes a moment to thank every medical and mental health provider who put their own medical or mental health well-being on the line to care for your family members. For those of us who fall victim to the perils of being on the front lines, I hope the rest of our brothers and sisters in healthcare, along with all citizens, fight for healthcare reform, for better access to care, for more access to care, and so that no one else has to needlessly suffer or die because we were not ready, or because of policies limited access to resources or best practices.
For me, I will continue to connect with my professional peers so I maintain the healthiest of attitudes and stabilize my own emotional needs. I will continue to spend each day managing my clinical practice, supporting my staff each, and providing what I believe to be the best services possible to every child, parent, adult, and family I serve as a psychologist. But I do not believe my service ends there. So, my charge to each of us as mental health providers is to reach out to our medical friends, maybe it’s a doctor at your community clinic, or the nurse that sends you those special referrals, or that pediatrician who knows to call you specifically for a consult because she respects you as a specialist in your field, and let them know we are available to listen, to support, and to validate all of their frustration, concerns, and sadness. Offer them hope and appreciation for what they are doing. This starts for me today. I already have my first pro bono call tomorrow with a near and dear friend and colleague, an amazing pediatrician. It’s the least I can do for her given what I know she has to endure every day this pandemic continues.
I truly hope that in the coming months, I can say that “I’m watching it all roll by/I can see/I can see/A life beyond the dream,” and that this dream is no longer a nightmare but rather a more comforting dream, one that we all look forward to each time we put our kids to bed, each time we kiss our loved ones goodnight, each time we call it a day, put our heads to rest, and recharge, so we can fight another day.
Face your fears. Live with uncertainty. Take control of your life.
Dr. Josh Spitalnick
Licensed Psychologist, Board Certified in Behavioral and Cognitive Therapy
Clinical Director, Anxiety Specialists of Atlanta
Dr. Spitalnick specializes in the assessment and treatment of anxiety disorders and OCD in children, adolescents, and adults
