June 3, 2020

I am by nature a planner. I like to stay organized and operate within a clear structure. Prior to assuming the NHMS presidency last November, I spent months planning for my presidency year. After settling on a focus on the social determinants of health, I worked for hours outlining an approach to work through the various social determinants—housing, education, income, food security, employment, and others—over the course of the year, with attention to these factors through the lifespan. 

I figured that as a med/peds physician, it would make sense to think about these factors outside of healthcare that have an outsized influence of the health of our patients from infancy to old age, since I care for patients across that spectrum. I was excited to have this conversation with my physician colleagues across New Hampshire, to continue to learn more about the factors that affect the health of Granite Staters, and think of new initiatives, policies, and collaborations that the Medical Society could support to improve health across the state while continuing to support physicians and our critical role in health.

You all know how this story ends. The best laid plans of mice and men oft go awry…enter the COVID 19 pandemic this spring. My perfect plan for the year was quickly and thoroughly upended. Our medical practices and our lives were completely disrupted as the pandemic swept across the US and arrived in New Hampshire. Suddenly my practice was closed, my kids were going to school remotely, and we were planning for the potential that our hospitals could be overrun with critically ill COVID patients. Personally, I applied for and received emergency privileges for the ED and the hospital at my health system, and quickly learned how to do telemedicine visits and care for patients remotely. 

From the standpoint of the NHMS, we quickly started to publish not only our weekly NHMS Pulse online newsletter, but also a new COVID 19 Weekly Update. Weekly emergency meetings of our executive council were initiated that have focused on two main issues – public health and provider support in the face of a pandemic. The Medical Society staff, our Executive Committee, and our Governing Council have worked tirelessly to support NH physicians in mitigating the effects of this virus on our citizens. And so far New Hampshire, through the work of the Medical Society, countless other groups, and, of course, through the heroic efforts of all of you, has weathered this storm fairly effectively.

While we are not out of the woods yet, it does feel that as the Governor starts to lift some of the initial restrictions and we start to see some non-emergent patients in person again, that maybe we can start to transition out of a constant crisis mindset. At least now things are changing by the week, instead of by the day (or hour). Maybe we can even start thinking again about proactive planning? I might even dust off that social determinants schedule for 2020 that I abandoned back in March.

Even in the midst of a pandemic, we are starting to see some disparities in how COVID-19 has affected different populations that seem to break along racial and economic lines, which will be important to explore and understand. But I’ll try to remember, as this pandemic has resoundingly reminded me, that having a plan is great, but never get too comfortable, and make sure you build some flexibility into your plans and your thinking, because the world always seems to find a way to test your assumptions – a good lesson, I think, in medicine, and in life.

In health,

John Klunk, MD
NHMS President

Please send questions or comments to john.klunk@nhms.org