I’ve been telecommuting for two weeks, and I already feel like Bill Murray’s character in the film Groundhog Day. A college friend of mine had a term for this feeling—déjà movie. I ease into my day with the repetitive normalcy of feeding the dog and sitting with my coffee while I watch the news.
A lead story included pictures taken by Dr. Colleen Smith, a young doctor at Elmhurst Hospital in Queens, deemed the epicenter of the epicenter in New York City. Tired and scared, she shared a photo of a refrigerated trailer backed up to the hospital as a makeshift morgue. Suddenly, I’m part of a very different movie.
Doctors like me, a few hours away from New York, are still in the early phases of battling this virus. My telehealth schedule now seems not only luxurious but the definition of “phoning it in.” There is special guilt that comes from sitting on the bench and still complaining about mundane glitches in the technology, keeping me safe at home.
Trauma is the next crisis
Technology developed to bring specialty care to underserved areas is now transforming how we practice nearly every medical specialty overnight; our eyes wide open to the best and worst of health care in a pandemic. With the scope of personal and financial losses and so many changes coming so quickly, the next crisis will be the nation’s mental health.
What is happening to Dr. Smith and other health care workers across the country is trauma. Health care workers will have little time to process their experience before getting back to business as usual in strained hospital systems.
Prior to this crisis, multiple sources, including Medscape’s National Physician Burnout, Depression & Suicide Report, note physician burnout at alarming rates (>40 percent). What would those numbers look like now?
Why doctors will need care
COVID-19 is particularly damaging to physician wellness because the response rocks the core beliefs of our profession. They train us to treat patients, not to decide who will and won’t get ventilators. It’s devaluing when we cannot provide the care we want to give; it’s dehumanizing when we are placing ourselves and our families at risk.
We can rationalize that these are imperfect times, but even AT&T Wireless commercials understand that “just OK is not OK.” We don’t have a switch to turn off what makes us talented doctors—our drive for perfection. Health care demands it and constantly reminds us there is little room for error.
Licensed providers can’t accept this is the best we can do and tune out years of practice in complex medical decision-making or delicate procedures. We won’t be able to unsee COVID-19.
Perfectionism is a hurdle
When the clinical demands settle, an administrator or well-meaning colleague will say, “I think you should see somebody.” This is when the perfectionism that kept us alive and caring for patients during the pandemic will keep many doctors from seeking mental health care.
Getting over that you are a capable physician but just can’t heal yourself is a big mental hurdle. I get it, I’m a psychiatrist and couldn’t fix my obsessive-compulsive disorder (OCD). For years I dealt with impostor syndrome, like I can’t be a very good psychiatrist and need help with OCD.
There aren’t enough providers
Doctors who move beyond the unique form of the stigma I described and seek counseling will find it difficult to access care. Even large health systems struggle to recruit and retain enough psychiatrists. The pool is even smaller when you search for providers to treat professionals with the trauma-informed care and confidentiality they have earned.
The system discourages help-seeking behavior
The lucky doctors who find mental health care will live with a new fear—that their treatment will interfere with their ability to practice. Credentialing applications, state medical boards, and malpractice carriers often ask antiquated and illegal questions.
“Have you ever seen a psychiatrist?” has nothing to do with current functioning or ability to care for patients. Listing a simple antidepressant medication on a pre-employment physical shouldn’t trigger a cascade of paperwork to prove you are not a danger to patient care. These questions do not encourage help-seeking behavior or make patients safer.
So as a psychiatrist cocooning in Central Pennsylvania, what can I do to help? I know right now it’s my job to stay healthy for what is coming and be emotionally available for those who seek my advice. It was still difficult to get to back to my practice after watching the news, so I opted for some retail therapy. I went online and bought a pair of scrubs, a uniform I haven’t worn for twenty years, just in case.
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