Calamity, or opportunity?

The sky is falling. Who hasn’t heard this saying, or believed it to be so, based on what we’ve seen in these calamitous days?

COVID-19 has upended the world. It’s killed many of our vulnerable elderly, and even a few of the young and healthy. It’s damaged our economy. And it’s hurt the development of children, many of whom are struggling to learn via Zoom. School is just as much about socialization as it is about learning facts and figures, math and science. The former has suffered, without question.

In CDI, I hear from members worried about job outsourcing, due to a combination of hospital financial hardships and a need for cost-cutting measures. Some fear the growth of ever more sophisticated artificial intelligence platforms that seem to circumvent the need for traditional CDI queries and tasks. Others believe that with their staff offsite, CDI will no longer be taken seriously or have a seat at the table.

Sometimes the sky is falling. But almost always it is not, or at least not as precipitously as we might believe, in our own overactive imaginations.

Now, I’m not making light of any of the challenges that we face as a nation, or those that I and our ACDIS members face in our profession. Far from it. I worry about my daughters’ future, and what their job prospects will look like. I worry about the mental health and sanity of students who stare at computer screens instead of interacting with classmates, and the futures of anyone who owns restaurants, gyms, bars, or any business that depends on face-to-face service. And I worry that ACDIS will not be able to rise to the new and more urgent needs of our members.

Changes are indeed occurring that have impacted our lives, our routines, and our expectations. In life, and in the CDI profession which ACDIS serves, they’re happening all around us.

But I also believe we have a choice in how we perceive these events, and we get to decide what to do next.

Times of turmoil are often the catalyst for necessary change, and transformation. I’m incredibly proud of the work my team at ACDIS has done to adapt to changes. In 2020 we moved our live events—a national conference, specialty symposium, and leadership and physician exchanges—to virtual platforms. We doubled down with more webinars, podcasts, Facebook Lives, Leadership Council calls, and informal meet-and-greets, to keep our members connected, and sharing new ideas and strategies.

I know that we will return to face-to-face education and conferences. We might not look the same, our crowds might be a little smaller in 2021, but we will have had experiences that made us stronger. I believe that we grow by being placed in adverse situations and experiencing discomfort. Only by being stretched, sometimes right up to the breaking point, do we realize that we can handle situations we otherwise might have thought impossible.

Is transformation easy? No, it’s not. Am I immune to anxiety and doubt and fear? No, I’m not. Life is hard. In the last 12 months we have lost revenue from cancelled events, downsized education budgets, and members who left the profession outright. But I think we can take comfort from history, and the lessons of those who have lived through such times (and worse) as those that plague us today. Marcus Aurelius, Roman emperor from 161 to 180 AD, lived one of the most challenging lives imaginable, and did so with a grace and a forebearance and dignity and a strength that is almost beyond belief—except that the historical record is quite good, and we know he not only talked the talk, but walked it, in a daily hard road. His name has since become synonymous with a philosophy of Stoicism that continues to be practiced today. Some his sayings that I hold dear include:

You have power over your mind—not outside events. Realize this, and you will find strength.

Very little is needed to make a happy life; it is all within yourself, in your way of thinking.

Change, even calamity, can improve us as individuals, and as a species, by teaching us to be more grateful for what we have. By reminding us that safety and community and generosity are our highest values. By not judging others. You cannot know all the circumstances that lead to the tough choices people must make in their lives. Be tolerant, be kind.

Calamities also reinforce the simple virtue of toughness. Tough times require we take an honest evaluation of ourselves and our practices, and make hard choices to abandon familiar ways that no longer work, and embrace the next challenge. Then stick with these choices, and course correct as needed.

Humans are a tough, adaptive, resourceful, and resilient species, capable of far more than we give ourselves credit for. I see it, every day, in the stories of CDI leaders who are doing more, fighting harder, learning, and growing.  I’ve seen CDI departments moving to all payer review, placing COVID discharges on pre-bill holds, and taking the extra hard steps of reviewing for the presence in the record of a positive COVID lab test, and working across departments to get it done. Performing deeper dives into records, looking at OB, newborn and psych cases to determine if there is any opportunity for future reviews. And branching out reviews to include risk-based contracts and the capture of chronic diseases in the clinic setting, in the inexorable shift from fee-to-service to pay-for-performance.

But I also acknowledge that these times have taken a mental toll. We need to take time to mourn, to practice self-care, and to care for each other. I’ve seen incredible acts of kindness in the ACDIS community. CDI directors allowing their staff to work flex hours as stay at home moms help their children, or middle-aged members care for sick parents. Staff donating PTO hours to colleagues in need. And in some cases, CDI professionals voluntarily returning to the front lines, either to administer vaccines or to care for the sick and dying at the bedside.

Kindness and toughness may sound like they are at odds, but they are not. Both need to be applied in equal measure.

No one said this was going to be easy. But as Marcus Aurelius said, the power is in us, in our ability to clear our minds, refocus, take responsibility, and live each day with fresh intention and possibility. I’m going to keep fighting, for my family, for the CDI profession, and I hope that by doing so I may make a small difference in the wider world.

Calamity or opportunity? It’s all in how you choose to view the day’s events.