Peer support during the era of COVID-19

Burnout has been an issue for those in health care long before the COVID-19 pandemic, but the increased stress and anxiety we face now have caused a host of new problems.  The current environment health care professionals (HCPs) find themselves in has brought issues of physical and emotional exhaustion, compassion fatigue, and moral injury, not to mention more instances of second victim syndrome (the effect of an unanticipated, adverse medical event on a clinician).  If left untreated, these issues will contribute to burnout, which is already of epic proportion.

What is peer support for HCPs, and why is it needed now more than ever?  Perhaps we should start with the definition and explore how peer support can effectively combat stress.  In the strictest sense, “peer support” refers to a process through which people who share common experiences or face similar challenges come together as equals to give and receive help based on the knowledge that comes through shared experience.  In the medical world, peer support of HCPs comes from those with direct experience and understanding of medicine’s challenges.  Traditionally, peer support has been seen as a tool to help those facing the challenges of second victim syndrome. Still, today’s medical environment has brought on many more scenarios where this support is needed.

Physical and emotional exhaustion. Clinicians are working long hours, with the additional burden of a highly contagious virus that is overwhelming the health care system.  Additional requirements of adequate PPE, appropriate donning and doffing, and awareness of new protocols instituted by their facilities all contribute to this exhaustion.  In fact, emotional exhaustion is one of the primary symptoms of burnout.

Compassion fatigue. When clinicians are constantly bombarded with traumatic events (i.e., critically ill patients), the ability to empathize diminishes over time; HCPs have given all of themselves and cannot give anymore. Compassion fatigue, a.k.a. secondary traumatization or vicarious traumatization, is caused by the stress of caregiving work, and may lead to the following:  blaming others, bottling up emotions, isolating from others, substance abuse, feelings of apathy, and recurring nightmares or flashbacks.  It is easy to see how this phenomenon can readily cause one to decompensate into a state of PTSD or severe depression.

Moral injury. When clinicians are prevented from doing the right thing because of restrictions on their autonomy, lack of resources, or financial restrictions, they suffer a violation of integrity.  As caregivers, HCPs put patients first, and when they can’t do that, they suffer distress, often in the form of moral injury. While the concept of moral injury isn’t new, the pandemic’s anguish has heightened its impact on those practicing medicine.

Considering all the challenges of health care today, it becomes obvious that there is a great need for the emotional support of our HCPs. Some very significant systems issues need to be addressed, but this will require a major shift in the way we currently practice medicine.  In the meantime, our clinicians must receive assistance to transition through this period.  Peer support (along with coaching and other mental health services) needs to be available to our HCPs. The stigma of seeking emotional support needs to disappear, and the culture of medicine must change.  Although wellness initiatives have been woefully inadequate for our HCPs, now is the time to invest in this valuable resource. If not now, when?

Susan Wilson is an emergency physician and physician coach.

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