Peter Brindley: Medical administration during covid-19—not all fun and games

When my children were younger—and believed they had “rocked my world”—they offered two showstoppers. The first was an imaginary microphone drop. This communicated that the issue was dealt with; nothing more need be said. The second was hands exploding from the side of their head. This illustrated that skulls would shatter if only the world accepted their inescapable genius. Both indicated “OK, so that’s dealt with, let’s move on.” This charade was fun, then benign, and—sorry kids—ultimately tiresome. All of this seems a good starting point to discuss my life in low-level medical leadership, especially as we enter covid month-six. This is because, in contrast to fun at the meal table, admin issues are seldom simple, and rarely fully addressed. Perhaps lesson one of adulthood is to simply persevere in the face of potentially soul-crushing truths. 

There are plenty of reasons why passionate clinicians resist the move from bedside to boardroom. Rather than guessing, let’s use me as an index case. Even before covid-19, I struggled mightily with the “administrative pause”, namely that excruciating delay between idea and action. This is especially tough after a clinical week of right-here-right-now thinking. Yet another meeting is torture if it feels like a time-delay or side-show. Excuse me for not offering a single analogy, but I suspect others can relate to clinical administration feeling like driving with the hand brake on, while shouting through a muzzle, and simultaneously watching paint dry. It feels inauthentic to remain implacable while a colleague communicates how much they dislike the policy that you didn’t even pen. It feels wrong to never send that first draft email. Oh, and don’t get me started on the biz-speak, even if it is “mission-critical to think outside-of-the-box while incentivizing a paradigm shift”. 

All of this explains why I (begrudgingly) admire the administrative class. It also explains why I find my admittedly low-level administrative job such a slog, and why this virus and I are no longer on speaking terms. The impetuous teenage me would have dropped the metaphorical mic and quit long ago. This is because he would rather lose for who he is, than win for who he’s not. Instead, “grown up me” keeps attending meetings, erasing email drafts, biting his lip and rehashing the message. Step one is to stop expecting admin to be joyful. Public healthcare is part of a monstrous bureaucratic system and I signed up. I probably owe at least one tour.

I am an intensive care doctor, university professor, and unit director, and I like my jobs in that order. Being a clinician and professor occupies most of my time and largely defines me. In quiet moments I ponder the chicken-versus-egg of how much my frustration is innate personality and how much is the job. Regardless, after 30 years of rushing it is tough just to slow down. A sense of urgency is needed around the patient’s bed, but is less welcome around the boardroom table. Impatience fuels my academic work, but is anathematic to hospital politics. 

On the left side of my desk is my “should do pile”; on the right is my “would like to do” pile. Usually life is all left pile, left-brain. However, covid has cancelled conference season and hence I had unexpected time to spare. This is why I decided to rope up and tackle the mountain on the right side of my desk. On this paper peak was another one of those books boasting the secret to happiness. I gave it three hours. After all, happiness should be easy to summit, right. Next was a hastily scribbled note to pursue an idea I heard on a podcast: “hypernormalization”. Both lessons would be equally informative: a bit of yin and a touch of yang. 

There is no shortage of “must read books”. Attend any lecture or dinner party, and some bore will likely foist one upon you. Let me be that bore and recommend “The Happiness Equation” by Neil Pasricha. He explains that, by mere possession of his book, we already have the ingredients in place. Normally I would scoff at such pabulum, or throw it away to illustrate my contempt. However, the author is right: you and I can read, we can afford books, and we have sufficient time away from toil and fear. We are lucky enough, and indulged enough, to believe that our happiness matters and our opinions should be heard. Many people—actually most people—do not have these luxuries. Therefore, I need to accept that leadership is a privilege even if it rarely feels like one. It is also a responsibility. This means not throwing away my appointment in a fit of pique. It also means never accepting a leadership job that I am not prepared to quit.

Peak two on “Mount Aspiration” was to understand “hypernormalization.” This idea is a more dystopian, less inspiring, but no less useful. It also nicely informs the covid debate and the covid debacle. Hypernormalization is outlined in a BBC documentary and the writings of Adam Curtis. It refers to a sense that you understand the system is not right, but you are so embedded that you cannot imagine an alternative. It originated in the Soviet era as people came to understand that the bosses did not have the answers, and even the bosses knew that they did not have the answers. However, everyone carried on with weary resignation. This was because nobody had a better plan or the resolve to follow through. I find this idea useful as I sit in endless covid-19 meetings, especially when another person throws out that exhausted word: “unprecedented.” 

In a few days I return to clinical work. I look forward to being distracted, even frazzled. I will have binary answers to complex questions. I will deliver opinions with exaggerated certainty and pivot quickly to the next concern. Existential angst will be replaced with the comparative simplicity of critical illness and covid-fuss. The days will contain comforting indignation and the pesky search for meaning will leave me alone. It’s not much of a mic drop but, then again, adult life rarely is. I wonder how long I can spare my kids that brain-exploding truth.

Peter Brindley, Professor of Critical Care Medicine, Medical Ethics, Anesthesiology at University of Alberta, Canada.

Twitter: @docpgb

Competing interests: None declared.