September 2, 2026: Salus Forum

Bill B

I refer to the old Western movies from the 1940s. These are the movies with which I grew up. I would be watching a Western movie. The cattle are there. They’re all just a little bit restless. They’re kind of stirring around a bit, and then something happens, and they stampede. Fortunately, we are not cattle. But we can stampede. What our Salus discussion up to this point suggests is that there needs to be considerable dialogue if we are to avoid the human stampede when things are a bit restless. The issue is, how do you increase the dialogue with your colleagues when there are high levels of anxiety? How do you begin to connect with one another, so as Jack was talking about, you’re not just an individual cow? How does this collaboration work? It’s not just working and conversing upward in the organization. It’s about conversing with colleagues. How do you make sure that you’re not isolated? Because the isolation, from what Jack’s talking about, leads to stampede. So, I suggest that the dialogue enable us to continue not being alone in the midst of troubling times. Spending time with colleagues becomes really important, so there is no stampede despite the difficult times. There’s the restlessness that’s not going away, and there are problems that are hard to be solved. The stampede would mean that everyone is going all over the place. People are resigning. They are doing really bad work. There is lower morale. It’s the old issue, how can a healthcare system treat people when itself is ill? Can an ill system bring about health? And the ill system is in the middle of a stampede. Does this make any sense?

Jenny

Oh, it makes so much sense. You’re hitting it on the nail. I’ve had many conversations with Jeremy, who knows all of what I’m saying, and I finally come to the conclusion that, yes, you start with your peers and are able to debrief and talk about the challenging conditions. But then what about in a system where you don’t have that community to debrief? How do you help create that community? So when I started, I will be honest, it was very fragmented with physicians versus nurses and social workers.

I think it is just the nature of medicine that there’s hierarchy, but in palliative care, I very much believe we need a flat hierarchy. I believe in working together, especially learning from my nurses and social workers during my consults. I try to create a community by hosting more happy hours, hosting more wellness events, like bringing charcuterie boards during lunch. And I will say I succeeded. I am super close with the team. The team has not been closer than ever. However, I think the issue, unfortunately, is that there’s always an “us versus them” mentality. The “us” are in the ones on the ground doing the work and the “them” are leaders who are not doing the work, who are telling us what to do.

And I’m used to being around physician colleagues. I’m not as used to always being surrounded by non-physician colleagues. And I’ve realized there’s a big difference. You can debrief (with the nurse as much as you want, but at the end of the day, a nurse cannot understand your responsibility as a physician because you’re prescribing, you’re doing all of this.

And what I’ve learned that I’m lacking comes from the conversations I have with Jeremy. The conversations concern the peer support that I lack. How do I create that peer support? Well, it would be figured out if there was funding for another palliative care doctor, but there’s none. So then how do you work in a system when it’s not setting you up for success?  I didn’t tell the whole story, but I think it depicts the situation.