Small Changes Big Impact

Longterm care and leadership during COVID-19 with Dr. Allan Grill

June 03, 2020 University of Toronto - Department of Family & Community Medicine Season 1 Episode 28
Small Changes Big Impact
Longterm care and leadership during COVID-19 with Dr. Allan Grill
Chapters
Small Changes Big Impact
Longterm care and leadership during COVID-19 with Dr. Allan Grill
Jun 03, 2020 Season 1 Episode 28
University of Toronto - Department of Family & Community Medicine

This week, we have Dr. Allan Grill's second appearance on our podcast, who spoke about longterm care and leadership during COVID-19. Dr. Grill is the lead physician at the Markham Family Health Team and Chief of Family Medicine at Markham Stouffville Hospital. 

Show Notes Transcript

This week, we have Dr. Allan Grill's second appearance on our podcast, who spoke about longterm care and leadership during COVID-19. Dr. Grill is the lead physician at the Markham Family Health Team and Chief of Family Medicine at Markham Stouffville Hospital. 

Dr. Rezmovitz:

Small Changes, Big Impact: a DFCM podcast. I'm your host, Dr. Jeremy Rezmovitz. This is awesome. We have Allan Grill in studio today. today's episode is another candidate covid conversation. If you remember, Allan is the lead physician at the Markham Family Health Team and Chief of Family Medicine at Markham Stouffville Hospital. Welcome Allan.

Dr. Grill:

Thanks so much for having me back, Jeremy. It's a pleasure to be here.

Dr. Rezmovitz:

It's no problem. I love having you on here. You're one of the few guests that has had a second coming here. It's fantastic. Obviously we enjoy your company

Dr. Grill:

And I enjoy yours as well.

Dr. Rezmovitz:

That's amazing. Let's talk. How's COVID treating you?

Dr. Grill:

Well , life has been pretty busy, I'd say for the last around six weeks. I think everybody that you speak to has a different start date for when lives sort of got turned upside down by the COVID-19 pandemic. For me, it was around mid-March. And I remember that because that was the first day where at my family practice, there were some serious discussions of the group on the importance of switching to virtual care. And I went from that to no longer being in my office very much to most meetings being remote, and then obviously inundated with the various aspects of COVID-19 on my family practice, as well as some of the leadership roles that I play in primary care.

Dr. Rezmovitz:

So can you remind listeners what some of the leadership roles are that you play?

Dr. Grill:

Yeah, for sure. So I'm lead physician at the Markham Family Health Team. And so I am responsible for clinical oversight, strategic direction, and when it comes to outbreaks - as I spoke before in my previous podcast with you - when H1N1 hit before I was even lead physician, there was still a pandemic planning committee that was put in place by the lead physician. So I just sort of assumed the same role this time around, and I put together a pandemic planning committee. So that had to be started right away when this thing hit. And then I'm Chief of Family Medicine at Markham Stouffville Hospital. And there has been meeting after meeting - in fact, one of my colleagues made a good joke. She told me that the meetings are having babies. They're just multiplying all the time. And it's very true. So lots of meetings at the hospital and how this affects the Department of Family Medicine. And then I'm also a physician advisor part time for the College of Family Physicians of Canada.

Dr. Rezmovitz:

Okay. And so where do you want to start?

Dr. Grill:

So I think I'd like to start with my hospital - Markham Stouffville Hospital - and because we're trying to focus on small changes, big impact, I put some thought into this as I mentioned to you before, and I wanted to try to tell some stories about COVID-19 how has impacted me in terms of some of my leadership roles. Since the listeners have already heard enough about my leadership roles, I thought it would be a nice connection. And so I'll start with the hospital. And the reason why I'm starting there is that I was sort of drawn into an initiative to focus on a population of patients that I care very deeply about. And that's the frail elderly. So, for the listeners , I've been working in longterm care for about 15 years. I actually had a part time practice within longterm care at the Sunnybrook Veterans Center for the first 13 years of my career. And then , I gave that up when I moved on to the CFPC and I still do call for that group. So I have a lot of clinical experience with those patients. I have an interest in care of the elderly in my own practice. And so what happened was, again, about six weeks ago, one of the longterm care homes in our Markham area had one of the first COVID-19 outbreaks. And they were having some staffing issues. They were having some questions about infection prevention and control. Public Health was pretty overwhelmed as we've seen. And so they were really looking for different avenues of help and they approached our hospital looking for advice and support. And this issue was very important to my hospital - as most hospitals I'd say in the province and the country, because the hospitals were all preparing for this surge of cases that we were seeing elsewhere that we had just not experienced yet. And one of the fears was that if we didn't take care of the most frail patients - in this case, it was elderly patients in longterm care and retirement homes - that they may end up getting very sick and they may end up getting transferred to hospital , which would obviously affect capacity in terms of managing these patients. And so after this meeting with this particular longterm care home and providing advice and making sure all the right stakeholders were helping them out , my hospital approached me and said, "look, can you start an initiative to try to support these homes?" And to be perfectly honest, I wasn't given a huge amount of direction, but one of the pieces of advice I was given was they wanted me to connect all of the different players that impact the care of elderly patients in these settings. And so what I did was I kind of sat down and I made a list of all of the various stakeholders that would be involved with supporting longterm care homes and the list was as follows. So there were people in my hospital: so there was the emergency department - we wanted them involved because transfers of patients from longterm care end up going through the emergency room. We wanted to set up supports like internal medicine and geriatrics to deal with complex cases, even if those supports were virtual - and our hospital had already been providing such support even before COVID-19 hit. We wanted our nurse led outreach team that was already providing some support involved. We wanted our command center administrative staff involved so that we could keep them a loop in what we were doing. And then we invited York Region Public Health. We invited the Ontario Health Team. So that would be like the former central LHIN, because I know that the reorganizing all the LHINs right now. We invited our community palliative care team because they would have a significant impact on the care that was being provided for these patients. And then basically I got a list of all of the longterm care and retirement homes - and I have to thank David Kaplan, who's one of the family docs in our department and a former primary care lead for the central LHIN, he had a list of these homes and he gave it to me. I just started emailing all the homes and said, "we're going to get together and have conversations about this." And then I opened up my own Zoom account because I'd seen it use many times. And I thought, "well, if I'm going to be hosting these conversations, I might as well open up my own account." And then I just set up a meeting on a Wednesday and I invited as many people, as I just mentioned on this list. Originally, it was about 45 people. It's kind of grown more to like 70 people as we've realized all the different players that are involved. And somebody gave me some very good advice. They said, "don't do a doodle poll. It'll take too long, just set up two slots on a Wednesday. Some people will come in the morning, some will come in the afternoon." That's exactly what I did. And basically this has morphed into a weekly meeting with the various stakeholders that have an interest and can impact the care optimizing the care of patients in longterm care homes. And the first meeting was really just brainstorming. What are these homes need? Where are the gaps in care? What can the hospital do to support? What can the other stakeholders do to support these patients? And it was really about building a community, Jeremy, it was about letting the homes know that there were supports for them. We weren't gonna let them go through this alone. If there was an outbreak, we were going to do the best we could to get them the support that they needed. And that's really how this whole thing started from the beginning.

Dr. Rezmovitz:

That's amazing. As you were listing off the players who are engaged, I couldn't help but think of everybody. It just seemed like you were going to go with everybody. I thought soon you're going to list all the specialists that you might have to refer to support the internal medicine doctors who then have to continue to refer. But I mean, that's what the system is there for. The fact that you're creating a community - it sounds like you're creating a virtual community that is supporting the frail elderly during this time. And this is a new time for everybody. And I think that's amazing. It really is. And so is there any way you can give us some insight that the CBC hasn't? Because they've been covering some other stuff about longterm care homes right now. Do you have any success stories?

Dr. Grill:

I do. I do. And you're right. Like, there's been a lot of constructive criticism about longterm care and retirement homes, not necessarily about the homes themselves, just about some of the stories that have come out of them. And there's always several sides to every story and I think that when you have a pandemic, a global pandemic of this size, you can try to prepare as much as you want, but sometimes there are factors outside of your control. But instead of focusing on the negatives, let's focus on some of the positives. So first of all, we got ahead of this in our community early. So by setting up this meeting, bringing everybody into one room or one Zoom together and brainstorming what they needed, it gave us some lead time on trying to set those up. So to give you an example, the homes told us that they found discussions with families about advanced care planning and goals of care to be difficult. And you can imagine why. I mean, we know that frail elderly patients who get COVID-19 and are symptomatic to the point where they need to be hospitalized let's say, they don't do very well. The survivor rate is poor, and we know that when they get intubated in ICUs, the prognosis is quite poor. And we know that from neighboring countries and colleagues that have dealt with this already, but having those conversations with families who may not be as up to speed of what's happening with COVID-19, or obviously have strong emotional relations with patients it's not easy. And so the first thing we did was we found people within our department that had expertise in conversations around goals of care to give us resources. And there were already resources that were published around these discussions related to COVID-19. So it was just a matter of getting them to the homes. The chief of staff at Uxbridge Hospital - Carly Jensen - she created a video designed specifically for patients to watch and substitute decision makers so that they could engage in these conversations and understand the importance of them. So again, we gave those to the homes and they found them extremely helpful. The next thing we did was we got our emergency department to tell us what they thought was important. I mean, they said they wanted those conversations to be done early because it can be very frustrating to have them in the emergency department where things are busy, they're hectic, they're acute the relationship with the patient isn't there. And so they really said, "please do us a favor, give the supports that the homes need, give the doctors what they need and the nurses to have those conversations." And then what they said was if patients still need to be transferred - because there's still a lot of reasons why elderly patients need to be admitted to hospital, they helped us set up an algorithm so that it wasn't just pick up the phone, call 911 and send over. It was aligned to the emerge where you could speak to the emerge doc who was working. You could run things by them. So maybe they could give you some advice on how to keep the person at home if the transfer wasn't necessary. And if the transfer was necessary, they wanted to minimize the impact on the patient. So least amount of time they would spend in the emerge if they didn't have to be admitted. And if they had an investigation or blood work or they needed hydration, they wanted to do it quickly. So nobody was sitting there for a long time, if it was really busy. So we got emerge involved. Then we heard from the homes that they wanted internal medicine and geriatric support for complex cases where maybe the family doctor just needed some advice on what they could do with limited resources in some of these homes. So we got the internal medicine department to agree to provide 24/7 virtual access by phone. We gave the homes information on how to locate them when they were on call Monday through Sunday. And we got our geriatrician who has more expertise in behavioral problems in those patients with cognitive impairment, he also made himself available 24/7 to these patients. And I think the other big thing that was already in place, but we just connected everyone was our community palliative care team. I mean, this team is really unbelievable. It's got a group of doctors and nurses. They continue to do in home assessments despite COVID-19. The ability to refer to them and get them involved quickly is outstanding. And what did they do? They made sure everyone had the referral form and their direct line. And they offered in house training if they want it on some palliative care issues and medications to use. So again, it was really just bringing all those people together. We got Public Health to give us a direct line. So you weren't on hold for an extended period of time. We got the LHIN to tell us how to access Health Force Ontario, if staffing was needed. So again, we just had multiple people on our agendas at these meetings, giving these homes the supports that they needed. And it was really about doing it in a way that they didn't have to waste time looking for information that was already there.

Dr. Rezmovitz:

That's amazing. Now I have two questions. One, have you done a QI project around this? Just kidding.

Dr. Grill:

Oh, that was a good one. You had me going for a minute there.

Dr. Rezmovitz:

Yeah, I know. No, but honestly, how do you publish something like this so that other hospitals can copy what you're doing? That's my big question. Listen, QI - I will go back to QI for a second - is about being better. There are different models that you can follow. The typical one is the PDSA model. And I would argue that this event that's happened in our lives - this pandemic - is allowing for innovation to come out, is allowing for creativity and is allowing for people to align with the common goal of taking care of patients, which is what you're doing. You're being better in the face of frustration because the systems that we've had set up don't work in the current context. And so I'm going to find a way to support you that you guys write this up. I don't know what journal would probably love this, but you guys should write this up. Even in a newsletter for the hospital to say, look at the amazing work that's happening, because this doesn't just happen overnight. You've you've been on the ground. You've been doing the phone calls and the emails setting up the Zoom meetings. You're inviting people to collaborate. I mean, it's fantastic. Why weren't you doing this before?

Dr. Grill:

No, and it's a fantastic question. I will tell you this. I've made a promise to myself and to my hospital that whenever this COVID-19 thing is over - and I really can't give you a good answer of when that's going to happen. I am going to maintain the Zoom meeting that I've set up now. I don't think it'll be weekly. It might be monthly, but I'm not letting it go. I am not giving up on providing whatever support I can to this population. And we're starting to now provide more support for congregate settings. We weren't at all as on the ball with some of those settings, as I think others have experienced the same thing early on, but we're more on top of it now, but I'm not going to let these Zoom meetings go. And as long as there's people that are interested in joining and sharing ideas, I'm going to dedicate time for this. To talk about how do you get the information out there. So you've now just inspired me. I should probably write up a blog for Canadian Family Physician. There's been some very good blogs from members of our department, doing great things in COVID-19. I probably have the time to do that now, but to actually sit down and write a paper, I would need expertise from people like you to support on that. It's just takes a lot of time.

Dr. Rezmovitz:

I'm not an expert. I don't think you need CFP blog. I think you should go CMAJ. I think you're involving a lot of different physicians in this idea, are you not? Do you have -

Dr. Grill:

Yeah. You're right.

Dr. Rezmovitz:

[inaudible] groups? This is a completely Canadian Medical Association Journal piece . Just write your experience. Just write a story. Do a first draft.

Speaker 2:

All right . I will try to put that together. I will contact the CMAJ and see if they'd be interested in something like that. But the other thing I just want to mention quickly about getting information out - there's a couple of ways where I think this has been done well. One is you can use the media. We're all so busy so unless your particular hospital wants to share a story or somebody else gets wind of it - it's not like anybody's particularly looking for the camera - but some of the work that we've done was modeled after other hospitals, and I know that Michael Garron Hospital had some good media stories on some of the work they were doing. And one of their geriatricians, Jared Rosenberg also provided a video for longterm care about goals of care, and he let us have it. I spoke to him and got some advice on what they were doing. They were one of the early adapters of these mobile teams that have gone in to help out these communities. And to just tell you, our hospitals started a mobile team this week. I think it was influenced as well by provincial directive where hospitals have now been asked to help even more with these frail and vulnerable populations. And so we now have a mobile team that's going out to various homes that are deemed sort of more in trouble based on Public Health - Public Health has a list of homes that need more help than others. And they're going to go in and do things like swabbing in infection prevention and control, education, environmental cleaning, providing PPE, that sort of thing. So the nice news is that by putting together this community and by putting early supports in place, it was a pretty easy transition when the hospital said "we may have to do more. Now we may have to actually go into some of these homes and support our other stakeholders like Public Health and the LHIN, and we were able to transition pretty easily. So I would say that sharing stories with others, I've spoken for the LHIN. They had a big meeting in their region and they invited me to speak. We have a WhatsApp group text that we keep just share messages. So you're right. Publishing it would be great, and I will definitely look into that, but we've tried to network with those other ways , as much as we could. There's no secrets here. This is fully transparent. And what works at Markham Stouffville Hospital, I'm happy to share it with anybody else that thinks it could work in their backyard.

Dr. Rezmovitz:

I think that's the goal of why I was challenging you is to help people who may not be doing this already. Right? I don't know if you guys still have your monthly chief meetings, and if you're sharing all this stuff at each of your meetings to see what you're doing, but I think it's fantastic.

Dr. Grill:

Yeah. We have - I'm on a call three times a week, again, in the Ontario health central region with primary care leaders. And on those calls, we've been sharing ideas as well about supporting these homes. And so that's been helpful to share ideas and get get different advice from different people doing it in various places.

Dr. Rezmovitz:

Is Participation House on that list?

Dr. Grill:

Yeah. So Participation House - as you know, Jane Philpott is a member of our Department of Family Medicine at Markham Stouffville Hospital. She went in and did an unbelievable job. She's still doing it in supporting that population. The executive director from my family health team also went in to give some administrative support. The hospital's been helping them out as well. They had a pretty big outbreak, but things have gotten better. And either Jane or some of her colleagues at Participation has been on our phone calls, and we tried to give her as much support as we can. But I think this has shown us that protecting vulnerable patients in general is challenging and it becomes even more challenging when you have a global pandemic. And it's one thing to have IPAC in a hospital where things are a lot more controlled. It's a lot different when you're in a nursing home with cognitive impaired patients or patients with developmental disabilities that don't follow the same rules when it comes to social isolation and hand hygiene as others. And so you have to get creative and you have to really be sensitive to those challenges.

Dr. Rezmovitz:

Yeah, it is. It's pushing all of us to think creatively - which I love, but it's also exhausting after a while because when you innovate, you're going to fail. And so you see all this failure, you keep spinning your wheels sometimes going, what else can we do here? But having generative Zoom meetings probably is helping you lift out of some of the fog that comes with the suppression of isolation. So - oh, sorry, go ahead.

Dr. Grill:

No, I think the last point I was gonna make is that we've also been very fortunate at our hospital that the number of admissions that we've had to bring in from longterm care and retirement homes and other settings has been low up to this point. And I have to give a shout out to the family physicians and the nursing staff and the other interdisciplinary healthcare providers at these homes that have really - they dove in headfirst. They were already doing great work, but they put in extra efforts to make sure that they were prepared for this. They had challenging, but necessary conversations with families. And I've heard many stories offline from my colleagues in the community, that they were even surprised about how understanding some families were in terms of making decisions that were in the best interest of the patients. And that a lot of patients really did want to stay at home, whether they got infected or not with COVID-19. And I think that work that was done by them with some support from us, had a major impact on unnecessary transfers and admissions to our hospital. I mean, our hospital will take care of anyone that needs care, but I have to hand it to those homes that really put those efforts in and put them into overdrive in preparation for this pandemic. And they should - those efforts should not go unrecognized.

Dr. Rezmovitz:

I agree with you . Just turning our attention towards some of the other work that you're doing now. I caught you on a webinar the other day hosting. You have excellent facilitation skills. I should have you come in. We should switch roles one day. You'll take over my job and I'll just go on vacation. How about that?

Dr. Grill:

Listen, if you ever need a guest podcast host and you're in a pinch, I'm happy to step in for you, but I gotta tell you - my hosting skills have definitely been influenced by your hosting skills . I've listened to many of your podcasts, and I have a ways to go to get the smoothness and the presentation that you have. So -

Dr. Rezmovitz:

Well, thank you. It's completely rehearsed. I spend about two, three hours in the morning just doing mouth exercises like this for anybody who's on YouTube right now and watching us, but no that didn't go over as well as I had hoped on the radio. So , anyway, let's talk about the CFPC. Let's talk about this webinar series that you're doing.

Dr. Grill:

Yeah. So, I have to say also a shout out to my bosses at the CFPC. When COVID-19 hit , the CFPC to their credit was very progressive in terms of making sure that the way they do their business was in the best interest of their staff in terms of keeping them safe, as well as continuing to provide services to our members of the College of Family Physicians of Canada. And we had discussions early on about working remotely and what projects would be put on hold, et cetera. And I remember my own boss, Mike Allen, coming to me and Jeff Sisler, and they both said, "you're going to be a very busy guy in your clinical practice. So why don't you take some time away sort that out, and then we will come to you when we need you, and we'll provide the support you need with your awesome team here on some of the projects that became a bit less of a priority." And my team at the CFPC has been unbelievable. But about two and a half weeks into my world of the pandemic? The College sort of shifted from these monthly webinars on clinical topics related to primary care to a weekly series of COVID-19 webinars. And they did it because they wanted to continue to provide members with up to date information in a format to suit their busy lives. And so they came to me and said, "can you help us with this?" And it did not take me a long time to decide to say yes, I was already sort of knee deep into all of the COVID-19 impacts on my own primary care practice in my hospital that I actually thought it would be a nice way for me to contribute to the College, given that they gave me a lot of leeway to focus on my own clinical duties and leadership roles at the hospital and my practice. So basically how it works is there's a few physician advisors at the College. We work with a team of people, medical writers. We have a pharmacist. We have evidence-based epidemiologists and some managers that help us put this together. We discuss topics. We come up with relevant topics. And then each person that's going to host as a responsibility to come up with some questions, do a bit of research around the topic, but it's very collegial. The team completely helps each other out. So I've hosted a couple now - I hosted one on protecting patients and physicians in both the office and home environments. And then I led one, as you said recently, on optimizing care of the elderly in longterm care homes, which is directly related to the conversation that we just had. I would say that it's had two impacts. One is there's a bit of competition in terms of how many people watch these webinars, but I can tell you for the webinars that I hosted, we had about 800 to 1000 people view live. And then one of them had about 4,000 people that watched the recording so far, the other one had about 8,000 people. So that's pretty good. And overall, the entire team with all the webinars that have been done, 31,000 of our members so far have watched in total, and that number will keep growing as we have more webinars and they watch more of the recording. So yeah , it's had an impact that way on our members.

Dr. Rezmovitz:

I know. Make sure you record that for your CV.

Dr. Grill:

Right.

Dr. Rezmovitz:

Because that's 31,000 more than listen to this podcast.

Dr. Grill:

That's - okay. Well, you shouldn't sell yourself short. I think the other impact it's had on me to be honest is that it's provided me an opportunity to enhance my skills on researching a topic, coming up with creative questions on what to ask your guest speakers, making it a very easy environment like you do with your podcast, so that the speakers aren't intimidated and they know coming in, it's going to be relaxed. We don't make them do a lot of prep work - we know how busy they are. And to be honest, it's really made me feel like I've still contributed to the College, even though some of my other projects have been sort of shifted aside for COVID-19. And I've really enjoyed it, it's fun. And I think it's had a good - I think it's been good for our members who have tuned into watch some of this information because it's not easy for everybody to have information at their fingertips. And so offering this service to our members, I think has had an impact on them as well.

Dr. Rezmovitz:

Yeah, no, I loved it. I thought it was great. You guys are really bringing informative as up to date as possible information. So kudos. So with the time that we have left any last stories you want to tell the front line of COVID-19?

Dr. Grill:

I'll just tell one more quick one. And I think it's a very good lesson I've learned as a leader. I think sometimes in leadership, you have the luxury of having sometimes more time to read up on things. You think you really understand something, and you think by having that information at your fingertips, that will help you influence those you work with. And you sometimes go into a meeting, think it's going to be - thinking it's going to be a slam dunk. You've done a lot of work. You're going to convince everybody based on evidence that what you want to do is the right idea. And then you realize that it's not just about what's written in papers and what you , , you're learning from necessarily from IPAC . It's also about emotions and how people feel. And so the one story I'll share with you - they're very two small ones, actually. One is about halfway through or halfway after this COVID-19 thing started. I had a meeting with my physician partners, as well as the pandemic planning committee, which consists of a nurse practitioner, one of our nurses who's also our clinical program manager, and our executive director. And the discussion was about what type of PPE were we going to use in the office? And at the time it had not yet been recommended to use full PPE on patients - even the patients you weren't suspecting of COVID. Like our office was sending the patients that screened positive suspected of COVID to the assessment center. But the patients that had to come in for other reasons like well babies, prenatal patients - if they screen negative we were still bringing them in. And at the time it wasn't clear what type of PPE you had to wear. And I walked into the meeting thinking that we weren't going to make too many changes that day, but I listened to my colleagues and I listened to passionate requests and points about the importance of keeping our physicians and our other providers safe about making our admin staff feel safe, how our office was going to have to rejig the logistics of getting that done. And without going into all the details, we decided as a group that day, that we were going to use full PPE on anyone that came in the office. And I realized halfway through that meeting based on the temperature in the room, that it didn't matter whether I was right or wrong at the time about what PPE should be worn. What mattered was, was what was important to my colleagues to allow them to work in an environment where they not only could feel safe, but they could focus all of their concentration on our patients. And I have to hand it to a couple of my colleagues who were ahead of the curve in that regard, because about a week and a half later, everybody was wearing - I think - full PPE based on recommendations from the OMA and the OCFP. So again, listen to your colleagues and sometimes you have to make decisions that aren't all based on evidence or the best facts that you have. And the last thing I'll leave you with Jeremy, is when I was very stressed two weeks into this whole thing, two of my colleagues on my pandemic planning committee came to me offline and said, "Allan, do you need some help? We were recognizing some signs. We know you, you're taking on a lot. What can we do for you?" And I really tried to resist the urge to say, "I'm good. I'm doing everything I'm supposed to be doing. Thank you very much, but I'm going to carry on." But I didn't. I listened to them. And at our next meeting, I said to my group that I needed to delegate more responsibility. I was hanging on to too much. It was stressing me out. And I needed help. And my group was unbelievable. They listened to me, they offered great advice. They told me to take more walks. They told me to have dinner with my family every night. They told me to sort of share some of the time that I'm having at home, working remotely. I've had other colleagues take some of my clinical practice responsibilities. Like the nurse practitioner team has been unbelievable. And I have to tell you, it has allowed me to continue to do my job in a way that wasn't stressing me out. There's been a lot written about this, and I have to hand it to my team for reaching out to me and telling me that they recognize that there was a stress there. And ever since that happened on all of my weekly meetings with that team, I remind everybody to take breaks and take a breather because when you wake up the next day COVID-19 and our work is still gonna be there. And so I really want to thank my team for pointing me in the right direction.

Dr. Rezmovitz:

So it sounds - I mean, that's awesome that you're listening. Finally. I'm just kidding with you , Allan, as you take a sip there. I think your wife's been saying this for a long time, actually. "If only he would just listen to me." Take your advice and take it home. Anyway, that's just my two cents as far as that, but I think what you're really talking about is Maslow's hierarchy of needs. I've heard you talk for the last 40 minutes about support. Support, support, support. And I think that's what it comes down to. If you really want to help people climb out of the hole, you gotta support them. It's not like - it's show me, don't tell me. It's making sure they have their physiological needs met and then their safety needs met. So it's great and all to tell everyone, "well, you should wear a full PPE," but if you don't provide them with PPE, then they're going to be conflicted. "He told us to wear PPE, but there's no PPE. So how are we supposed to do this?" It really is physically and mentally and emotionally and spiritually supporting people so that they can do their jobs because the truth is if you create an environment where people can do their jobs, most of them will do their jobs. And they'll do it well. And they'll feel like they're part of something. As long as the vision's been set out by the leadership to take care of patients - if that's the simplest vision that people need - as long as you create that environment, where people can do their jobs, they will impress you over and over again.

Dr. Grill:

Awesome. I couldn't agree with you more. And I think the one thing that has really come to light for me in this is the idea of feeling part of your community, because right now everybody needs help and we all have to be there for each other. And I think there's a lot of strong relationship, as you mentioned earlier, that are being built here. And I think that those relationships will last for a very long time in both our profession and our personal lives.

Dr. Rezmovitz:

I agree with you. I look forward to our third installment with Allan Grill. Let's see how things go in a few weeks - maybe three, maybe four, and we'll check back in with you. How does that sound?

Dr. Grill:

Sounds great and stay healthy. And again, a big shout out to everybody on the front lines. Thank you for everything you're doing and stay safe.

Dr. Rezmovitz:

Agreed. Thank you. Take care, everyone. This podcast was made possible through the support of the Department of Family and Community Medicine at the University of Toronto. Special thanks to Allison Mullin, Brian Da Silva and the whole podcast committee. Thanks for tuning in. See you next time.