Physician burnout in the wake of COVID-19

A doctor who has a contagious disease is not only suffering in terms of their health but also about being incapacitated in performing their life-saving tasks. Doctors with COVID-19 likely increase the community’s disease burden, so the frontline staff in the fight against COVID-19 crisis cannot be sick or ill-equipped. Yet, that has been happening. With the surge in COVID-19 cases, physicians are overworked. I have an infectious disease colleague who has been on-call 24 hours regularly. She tells me they have to re-use personal protection equipment (PPE) because of inadequate supplies, which is placebo-use. Healthcare staffs are at higher risks of contracting the virus, yet they have been working without proper protection. According to one report, 14 percent of Spain’s COVID positive cases and over 30 fatalities in Europe involve medical professionals.

We did not just learn about coronavirus. In fact, Richard Horton in The Lancet chastised England’s National Health Service for their failure to act urgently after a January 2020 report thatCOVID-19 was about to be a global epidemic. The US now has the highest number of cases of and fatalities from COVID-19. Why was the United States healthcare system so wholly unprepared? Why are we choosing damage-control measures (waiting until things prove critical, until fatalities increase) before we do something, like order thousands of ventilators or a surplus of PPEs? Our leaders’ preventative and proactive actions have been irresponsible.

Before COVID-19 became a formidable foe, alarms have gone off about physician burnout. Over 40 percent of physicians are burned out, according to MEDSCAPE’s 2019 Physicians Burnout and Depression. Physicians—a group of dedicated individuals responsible for healing the sick—have more than two times the suicide rate of the general population! The same system failures that have contributed to physician burnout are present in the inadequate response to COVID-19 in the US: systemic disregard for physicians’ expertise and perspectives. While I suspect that physician’s experience of euphoria about answering the noble call as physicians is likely contributing to the inhibition of talks about the high levels of physician burnout, the COVID19 crisis will only lead to the collapse of an already vulnerable team, unless we change the status quo. Eventually, the euphoria will wear off, and there will be a crash that follows already burned out physicians who lose their remaining reserve amid a persistent crisis. Such a crash will be devastating to us all, as physicians are critical workers.

The term “burned out physician” is a pejorative term that perpetuates the referenced physician’s plight. This term does not encourage treatment or healing and, instead, blames the physician for their perceived inherent deficiencies. It masks the truth that such a physician is one who embodies the true passion, empathy, and love of medicine. Burned out physicians are demoralized physicians who have been practicing medicine contrary to their own ethos, an idea that Dr. Simon Talbot and Dr. Wendy Dean refer to as moral injury of physicians. I used to be that burned out physician. I worked even when I was not working. Even as I was trying to have dinner with my family, there are patient messages, questions, multi-page page description of symptoms being written and addressed to me. I had an administrator who knew nothing about practicing medicine, telling me what I can or cannot do with my clinic. I was also being monitored on my electronic medical record system; I had to address my inbox messages within a 24 to 48-hour time frame, so I can meet the ever-increasing quality metrics that I had no say in deciding to make a priority. I was unhappy and was struggling with being empathetic, and I didn’t want to practice medicine anymore.

I am, however, responsible for my happiness and health. I get to decide what type of life I want to live, even if it feels like Hobson’s choice. One of the turning points for me was when my daughter, on a questionnaire about her mom for a school assignment, put “working” as what I loved to do. I love my job and feel honored to practice medicine, yet I do not love working. But this was her observation. It brought back times when I’ve had to leave my sick daughter to go take care of other sick people. I had to ignore the quiet voice that said, “Mommy, I want you.” I decided enough; I will make a change. I should be the one to decide how I want to practice medicine; it is my license, my name on the line after all! I left that job. I reconnected with the things I love, with all my passions, including writing. Suddenly, I couldn’t wait to practice medicine again.

Physicians are being trained to become hypocrites, and that’s contributing to burnout. We tell our patients to stay home if you’re sick, make sure you get eight hours of sleep (sleep is good for the immune system, for memory, for happiness, for stress reduction), eat a balanced diet, exercise, and do what makes you happy. Yet, if we were to do an evaluation, I predict that only a low percentage of physicians practice these healthy-living tips. I remember once when I was hospitalized, and I went back to work the same day that they discharged me. It was dedication, putting patient-first! But was this good … or was this a symptom of a much bigger problem? Is this the fruit of the conversation in medical school where my supervising resident told me, “Doctors are not allowed to be sick?” Being healthy is a requirement to be a physician. Doctors have the special ability to encounter many infectious patients and still not contract an illness. We are super-people with resistance to even kryptonite. We eat coronaviruses for breakfast.

My dear fellow physicians, it is time we heal ourselves, for our sake and for our patients’ sake. These patients whom we sacrifice for every day, these patients whom we love, they need us; we cannot dwindle away. Let us try harder not to be hypocrites. Let us rid ourselves of the infectious god-complex.  Let’s be adamant about seeking change from our administrators about our toxic work environments, because our fellow physicians are dying. Let us not wait until the euphoria of saving lives in a pandemic wears out. We need to rejuvenate. We need to do whatever we can to be ready to run and win this marathon battle against COVID-19.

Rosemary Eseh-Logue is an internal medicine physician.

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