One may ask what the “Heron 8” is and why the relevance especially in this time. In simple mathematic terms, the “Heron 8” encompasses what we all need in our life’s journey – 3 things and 5 communities to thrive. The summation of these constructs is 8. The suffering is acutely seen in the patients I care for in my professional life as an Emergency Physician in a busy inner-city Emergency Department. An Emergency Department that cares for patient’s primarily of lower socioeconomic status who are predominantly people of color. People who look like me.
The number of patients from all backgrounds will undoubtedly increase due to the impact of the financial devastation of COVID-19. This impact will be personal and once again strikes a nerve. Reports note that women, particularly women of color are suffering the greatest economic loss from COVID-19. Caring for patients who look like me compels intentionality in taking a patient’s history, with focused attention and taking the time to listen with purpose to all my patients. Resisting the seduction of the electronic medical record and going back to the basics of medicine begins with this foundation.
As part of the history taking with my patients, I am reminded to focus first on 8 things. The first 3 things give a glimpse of the patient we see before us who is willing to share their life story. They are 1) something to do (what do they do in their professional life), 2) someone to love and 3) something to look forward to. In querying my patients, I ascertain whether they have those 3 things, which we all aspire to have while we are on this life’s journey. To augment the 3 things are the 5 communities needed to support them. The communities are 1) Origin – parents, grandparents, aunts, uncles, siblings, 2) Creation – who you partner and unite with to create a family 3) Neighbors – the neighbor who lives next door, across from you, or in your home or apartment that may have multiple people who live there , 4) Work – your colleagues and co-workers and 5) Faith – your religious or spiritual community. These simple constructs are an integral part of the social determinants of health.
The “Heron 8” is a tool I have used with learners during their patient presentations. I simply ask in the assessment and plan of the patient who may frequent our Emergency Department for substance abuse or who may be undomiciled, “How many of the “Heron 8s” do they have?” Invariably, the response ranges from zero to four of the 8. Mathematically to beat the odds, I believe one needs at least 50% of the 8 for the life journey to be easier. In reflection of how many of the “8” the learners working with me have, it is typically well over 50%. I share that I am someone who has all “8” and I consider my reality during each of my patient encounters. This fills my empathy tank as I work to assist my patients who are not as fortunate as I am to identify at least one of the 8’s.
The “Heron 8” will be inextricably changed by a wider set of forces and systems reshaped by the impact of COVID-19. The odds of recovering from COVID-19 and finding resilience through this unprecedented time, are formidable. The first 3 of the “Heron 8” may be lost, whether it’s one’s job, loved one, or hope for a better day. The 5 communities will almost certainly change as well. I believe the most important of the 8, is number 3 - something to look forward to. Summed up in one word, something to look forward to is called HOPE. We will all need hope in the aftermath of COVID-19.
The next time you see a patient with or without a learner, consider the “Heron 8.” These are the 3 things and the 5 communities we all need to strengthen our resilience. Ask the questions of your patients and listen to their answers. In the age of COVID-19 and I dare say the aftermath, we will need to do so more than ever. Our humanity depends on it.
Sheryl L. Heron, MD, MPH, is a Professor of Emergency Medicine and Associate Dean for Community Engagement, Equity and Inclusion and Associate Dean for Community Engagement, Equity, and Inclusion at Emory University School of Medicine. Sheryl currently holds a position as Vice Chair for Faculty Equity, Engagement and Empowerment in Emergency Medicine. Sheryl’s areas of professional interest include equity and inclusion, wellness, and injury prevention. Sheryl can be followed on Twitter or LinkedIn or contacted via email.