Failure to Rescue, Failure to Respond.

One of the most striking consequences of the coronavirus disease 2019 (COVID-19) pandemic has been how it has revealed and exacerbated preexisting disparities in the United States health care system. As Kaplan and colleagues1Kaplan E.F. Strobel R.J. Young A.M. et al.Cardiac surgery outcomes during the COVID-19 pandemic worsened across all socioeconomic statuses.Ann Thorac Surg. 2023; 115: 1511-1519Abstract Full Text Full Text PDF Scopus (3) Google Scholar importantly report in their article in this issue of The Annals of Thoracic Surgery, cardiothoracic surgery was not immune to this phenomenon. While outcomes in cardiac surgery worsened across socioeconomic groups, fewer patients from distressed socioeconomic communities were receiving care. Although we can only postulate on the reasons behind this, likely it was due to a strained health care system unable to address postoperative complications as effectively (or increased rates of failure to rescue) as well as patients from socioeconomically disadvantaged communities having even further limited resources to access potentially life-saving surgical interventions. The events of 2020 were a devastating presentation of the deep inequalities that persist in our society. For many, it was a stark reminder that the vast resources, opportunities, and privileges that exist within the United States are not equally accessible to all and that the health care system was far from exempt. As Kaplan and colleagues1Kaplan E.F. Strobel R.J. Young A.M. et al.Cardiac surgery outcomes during the COVID-19 pandemic worsened across all socioeconomic statuses.Ann Thorac Surg. 2023; 115: 1511-1519Abstract Full Text Full Text PDF Scopus (3) Google Scholar highlight, specialties such as cardiac surgery are not equipped to ensure equal access to care during times of resource strain, which then prompts the question: Are we as cardiac surgeons failing to provide equal access to care in times of relative stability and excess? The answer is undoubtedly yes. How then, do we go about making our specialty more just and equitable? The approach must surely involve political action and change at a structural level, but at an individual level, we as cardiac surgeons must formulate and tailor treatment plans to the patient, taking into consideration not just their pathophysiology but the environmental, social, and economic factors that impact their health. We must be sensitive to the difficulties patients and caregivers may face to take time off from as essential workers to make appointments or their ability to afford costly medications and therapies. We must also be aware of the potential limitations of new innovations brought about by the pandemic. For instance, although telehealth visits have made it easier for many to connect with providers, we should not neglect that the most vulnerable communities may be those with limited access to technology. And finally, change must involve personal reflection: Are we bringing assumptions or biases to our practice that may be differentially affecting patients from different backgrounds? As we reflect on the pandemic, a quote attributed to Mahatma Gandhi comes to mind: “the true measure of any society can be found in how it treats its most vulnerable members.” Although we must implement changes to forestall the same outcomes from occurring during the next period of resource strain, more importantly, we need to act to correct the disparities that plague our society currently. The true tragedy of the pandemic will be if we fail to respond to the evidence in order to ensure adequate care for all members of our community.