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Teaching and Learning Moments

Uncertainty Is the New Norm, Adaptability Is Essential

Mun, Monique MD

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doi: 10.1097/ACM.0000000000003652
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When I entered residency, I did not imagine that I would be training during a global pandemic. By March, though, I was inundated with news about COVID-19—the infection rate, the deaths, the uncertainty. I was barely able to process how my own education and training would be affected. I was pulled off my rotation in electroconvulsive therapy and placed on the frontline of mental health care at the inpatient psychiatric hospital in Detroit, an epicenter of COVID-19.

The pathology was the same—psychotic disorders, mood disorders, anxiety, suicidality—but all the patients shared a common element weaved into the narratives of their presenting illness: COVID-19. I was taking care of a patient, a young male admitted for suicide ideation after becoming homeless when his shelter closed due to COVID-19. To cope, he was consuming increasing amounts of alcohol. Under normal circumstances, I would have recommended inpatient substance use rehab for his alcohol use disorder. There, he would not only have shelter that would separate him from the drugs of abuse, but he could have access to social support and therapy groups. Some rehab programs even help patients find housing and jobs.

I remember sitting in the social worker’s office one afternoon, discussing his discharge plan. There were no available inpatient rehabs. There were barely even open shelters. We sat in a moment of silence and both looked down in despair as we realized the bleak reality of his likely outcome—he would go back onto the streets, drink again, become suicidal, and be readmitted.

As a psychiatrist, I treat my patients with a well-rounded approach. I recommend evidence-based treatments, including medications and referral for specific therapies. I put in place a treatment plan to help secure the best possible outcome for my patients, which includes outpatient follow-up care, recommendation for therapy, referral to a subspecialist, and even family meetings. I can do my job with a degree of certainty because of these resources and their accessibility. However, with everything shutting down because of COVID-19 and increased difficulty accessing these resources, I am left wondering what to do with my patients.

Uncertainty is the new norm, and adaptability is essential.

Navigating the COVID crisis has challenged me personally and professionally. It has taught me to be adaptable and to function in a degree of uncertainty. In a profession such as medicine, where we rely on facts and data, we shy away from the unknown. Anything that is unsubstantiated can be potentially dangerous for our patients. However, uncertainty can be a catalyst for growth. We are left to think outside the box, seek answers in places we didn’t look before; doing so challenges us to become better physicians.

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