The hidden danger to physicians in the ongoing COVID-19 pandemic

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A guest column by the American College of Physicians, exclusive to KevinMD.

Practicing medicine has always been hard, and as all of us have experienced over the past several months, living and working through a (hopefully) once-in-a-lifetime pandemic has only made it more challenging.

For those on the front lines of patient care, the added stresses are obvious.  Treating patients with a highly infectious disease we are just beginning to understand, and at times being confronted with an overwhelming number of extremely sick patients, has altered our ability to practice in the way we were taught and what most of us have been used to over the course of our careers.  And even though we have always needed to deal with our patients’ illnesses and deaths, the nature of how this has occurred in the course of the pandemic – often rapid and unexpected deterioration, multiple devastating complications, and the fact that many will die alone and leave behind horribly grieving families – can easily exceed our capacity to personally deal with the loss of control, helplessness, and sense of failure we may experience.

But even those not directly engaged in COVID-19 care have been profoundly affected by the massive disruption the pandemic has caused in their ability to care for patients, and for many, it poses an existential threat to their ability to continuing medical practice and the professional lives they have built.  And this doesn’t even begin to consider the strain of the personal risk to which we expose ourselves by engaging in virtually any type of patient care, and other stress-magnifying factors such as the lack of adequate personal protective equipment.

By definition, what most of us have experienced during this time would be considered traumatic.

Unfortunately, as physicians, we are not accustomed to experiencing what we perceive as trauma, and are perhaps even less likely to see ourselves as being susceptible to it.  Trauma is something we diagnose in our patients, and as physicians we tend to believe that our training and experience somehow make us immune to its potential effects on us.  I also suspect that because of this, we are not well-equipped to recognize the consequences these traumatic experiences can have in our personal and professional lives, much less know what to do about it.

Fortunately, an increasing amount is being written about the acute trauma experienced by physicians (and all health care workers) during the onset and initial phases of the pandemic, and this seems to be leading to an awareness of the impact it can have on our well-being.  With this growing recognition, hopefully the support services we need to help us navigate this extraordinary time will follow.

However, I ‘m just as worried about the persistent, high level of stress, and yes, trauma, that is ongoing and appears as though it will continue for the foreseeable future.

Never in recent times have we experienced a medical emergency for so prolonged a duration and one accompanied by so many confounding uncertainties.  The medical aspects of the pandemic are certainly not over, and despite what we’ve learned about the novel coronavirus, we are seemingly light-years away from having a significant armamentarium of effective treatments or a vaccine.  And the lack of coordinated and consistent public health measures has resulted in a failure to suppress viral transmission, leading to poorly controlled spread that continues to burden the health care system and those who work in it.  A “second wave” of infection has been projected over the next several months when, in reality, it seems as though we haven’t truly exited the first.  Plus, the threat to our personal safety as caregivers continues, as does the ongoing disruption of how we are able to care for all of our patients under these circumstances.

Add to this the fact that the nation is awash in stress owing to economic uncertainty, civil unrest, and a political environment that is fueling cultural clashes around even basic public health measures intended to contain the virus.  And there is not a clear end in sight which makes it difficult to seek even brief respite from the effects of the pandemic on almost everything we do.

It is this cumulative stress and the resulting confusion, fear, isolation, and anger that are being added to the existing trauma we have already experienced during the course of the pandemic so far that is of greatest concern.  And although physicians tend to be highly resilient people, we are still human, and as humans, have limits in our ability to tolerate trauma, particularly when stretched out over time.

As physicians, we know that it is possible to heal from trauma in a positive way.  But if not addressed, it can negatively impact our connection with humanity, impair our ability to be effective caregivers, and rob us of our personal and professional well-being into the future.  Because of this, we need to truly focus on our own health during this time, recognizing and naming our feelings, acknowledging when we need help, and ensuring that our health care systems provide the support that we, and all of our health care colleagues, need to manage the effects the pandemic is having on our well-being.

Only then will we be able to find our work throughout this medical crisis as being one of professional fulfillment – one in which we were able to meaningfully impact our patients’ lives in a time of utmost need, yet personally grow in a positive way from the experience.

Philip A. Masters is vice-president, Membership and International Programs, American College of Physicians. His statements do not necessarily reflect official policies of ACP.

Image credit: Shutterstock.com

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