Applause every evening, volunteers sewing masks, personal phone calls, and check-ins – these are a few examples of the support that helped us get through the initial, brutal onslaught of COVID in New York City last spring.
A year later, many hospitals across the country are full to bursting, the staff is exhausted, and medical science is still unable to save thousands of patients from dying in isolation. And we know from experience that COVID-19 patients and families are not the only victims of this pandemic – the caregivers are suffering as well, from emotional overload, physical and mental burnout, even trauma.
Pandemic conditions have exacerbated burnout among physicians and other clinicians. Resentment stoked by the administrative burdens of practicing, the focus on productivity, unwieldy electronic medical record systems, and the loss of a sense of professional autonomy had already contributed to increasing physician dissatisfaction. We saw doctors leaving the field of medicine, others disengaging with burnout, some even self-medicating or ignoring their emerging mental and emotional health issues.
With the pandemic, we lost many of the opportunities that helped us stay connected with our colleagues. Our informal, day-to-day interactions became even more rushed, or disappeared altogether. The option of having dinners with colleagues is, well, not an option. Many of us practice remotely, further increasing our isolation, and maybe even longing for our once routine interactions with patients, staff, and each other. Meetings held by video conference call don’t foster the same collaboration as in-person interactions.
We are learning that – whether during a pandemic or “normal” times – we must be more deliberate in creating opportunities to support ourselves and each other. These systems and attitudes must be baked into our routines, interactions, and support mechanisms.
Here’s an example. After a particularly trying event, how often do we hear this from our colleagues – “I’m fine”? And how often do we take this assurance at face value and walk away? In a culture based on collegial support, that’s not enough. We need to probe, talk, offer to listen. In short, we need to make an effort to truly connect.
Dr. Vivek Murthy, who served as President Obama’s surgeon general and is poised to resume that role in the Biden administration, found through research how important human connection is. In his book, Together: The Healing Power of Human Connection in a Sometimes Lonely World, he brilliantly explains how loneliness and isolation may be the greatest threat to health in America. Taking a lesson from his analysis, we can promote good mental health within our profession by forging these opportunities for connection and communication.
Yes, there is still a stigma around physicians reaching out and being less than an emotional “iron man (or woman)” our profession is perceived to be – especially by us. But what if we changed that perception and instead saw actions to preserve our emotional and mental health as a strength, not a weakness? Consider the analogy with preventive health and medical care for an illness. If someone exercises, eats right, and avoids situations in which a virus might infect them, do we view them as weak? Do we counsel this patient not to be proactive, just wait until they get sick, and then help them? No, we consider such behavior as smart preventive care, building strength, and resilience.
Likewise, we should change our attitude about our own strengths. Even as we push back on administrative burdens, poorly designed EMRs, or unrealistic workloads, we should promote the acceptance of socializing, getting counseling, finding interests outside of work, and recognizing our own symptoms of burnout not as weaknesses but as positive steps to optimal functioning and health. We would counsel our patients to take such steps, so we should do this as well for ourselves and each other.
The call to raise our sensitivity to our colleagues’ situations is imperative. Burnout is the first step towards emotional and mental illness, towards self-medication that can lead to substance abuse and depression, leading to suicide. When someone seems to be withdrawing, changing their behavior, becoming irritable, blaming others for mistakes instead of taking accountability – these are the symptoms of burnout. If they manifest at work, they are already taking place in other areas of their lives and are getting worse. We have to speak up, to reach out, for our colleague’s sake, for the sake of our patients, and for our own well-being. We need to go beyond just taking our colleague’s “I’m fine” at face value when you feel it isn’t. Ask, are you really fine? Can I help in any way?
For those who are still struggling with the reality of the pandemic, here are some practices that we found helpful to help our clinicians cope on the front lines and in their personal and professional lives.
We had physicians reach out to other physicians personally, in an organized way. Nearly every doctor in our group got a call from another doctor for no specific reason other than to talk about how they were doing, professionally and personally. Questions like, “How are you coping?” “Are you sleeping?” or “How’s your family?” opens the door to meaningful discussions about that individual’s emotional status.
We sent thank you cards from our medical group’s leadership to all of our members, acknowledging the extraordinary work they were doing.
Because the usual options for socializing and connecting are not available, we created virtual “Zoom dinners” for clinicians to relax for a bit, connect and just talk. They were so successful that we created virtual special interest groups, where people with similar interests could get together and talk about their passions – books, wine, food, and sports.
We offered 24/7 confidential counseling resources and designated spaces where people can decompress when they need a break.
If you’ve found your own solutions, either through an organization or on your own, please feel free to share them in the comments section.
Let’s not waste the crisis of this pandemic by forgetting what we have learned about the power of human connection and empathy to keep ourselves healthy and functioning, even in extraordinary circumstances.
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