While the coronavirus is taking its toll on thousands of lives around the world, the disease is also having its physical and emotional impact on those caring for patients with COVID19. The Dalai Lama noted, “Real care of the sick does not begin with costly procedures, but with the simple gifts of affection, love and concern.“ It’s clear that the current COVID19 pandemic brings unique stressors that thwart physicians and other healthcare professionals from delivering this level of exceptional, true care.
COVID19, with its upended life changing perspective on what really matters, has taught many things to those with open minds and receptive hearts. One indispensable moral is that the time to take care of doctors and nurses who are diligently taking care of others, is long past due.
Where once demands such as family responsibilities, time pressures, chaotic hospital and office environments, the considerable burden of electronic medical records, and a lack of control over their work pace led to a nearly 50% burnout rate among physicians, now it’s more than just burnout we need to be concerned about. It’s the lives of those treating COVID19 that are increasingly more vulnerable, if not fully in jeopardy. The Uniformed Services University’s Department of Psychiatry has identified the surge in care demands, ongoing risk of infection and equipment challenges as major challenges for healthcare professionals during this, and other, infectious disease outbreaks.
With hospitals and clinics inundated with seriously ill patients while insufficiently stocked with requisite medical equipment, with a dire lack of essential supplies, facing an ominous, dreadful scarcity of vital personal protective equipment for healthcare professionals, and with no real cure on the horizon, doctors and nurses are being asked to care for patients at the front of the front lines of life-threatening illness, and put their own security, welfare, safety, their lives, on that front line. And it’s not just their own lives.
When they return home, they find anxiety level of their family members has erupted. Some families are making the difficult decision to isolate from their physician or nurse spouse or partner for the foreseeable future. Some actively treating coronavirus patients report the heartbreak of not being able to see or hold their newborn infants or play with their home quarantined youngsters. Words like, “infuriating, frustrating and frightening” are being heard more frequently from doctors and nurses describing their emotions as they face going off to work.
Healthcare professionals, their families and friends are facing genuine peril to their mental, emotional, spiritual and physical well-being. Indeed, a recent report, of course with limitations in the design of the study, published in JAMA Network, found that among Chinese health care workers exposed to COVID-19, there was a high risk of developing unfavorable mental health outcomes and a need for psychological support or interventions.
Physician wellness programs have grown significantly over the last decade. Just this past year, at the American Society of Hematology 61st Annual Meeting, a colleague of mine, Lance Breger, M.S., and I were asked to lead a three-day intensive curriculum on physician wellness. Today, this type of offering has become ever more imperative.
The mental health needs of those at ground zero facing these external burdens is of primary concern. Burnout and stress have been linked to a loss of professionalism, increased medical errors, decreased patient satisfaction, depression, suicidal ideation and behavior. The physical pandemic is still unfolding, and yet there is a mammoth plague flickering alongside of it. That is the mental health pandemic that is progressing among nurses, doctors and other healthcare professionals responding to COVID19.
The WHO, the World Health Organization, suggests a number of steps that first responders and healthcare front line caretakers can take during this time to better manage their mental health and psychosocial well-being:
1. Take care of yourself at this time.
2. Use helpful coping strategies such as a) ensuring sufficient rest and respite during work or between shifts, b) eat sufficient and healthy food, c) engage in physical activity, and d) stay in contact with family and friends.
3. Avoid using unhelpful coping strategies such as use of tobacco, alcohol or other drugs. This is not a sprint; it’s a marathon.
4. Turn to colleagues and other trusted persons for meaningful social support.
I’d add that physicians and other health professionals would be wise to think well, to eat well, to move well, to sleep well, to love well, to live well. Yes, easier said than done. But this can all be achieved with the right mindset, the right rational self-talk, the right positive vision, the right stress reducing moments of deep breathing, and healthy reasonable protective boundaries, the latter especially with respect to absorbing too much minute to minute ever changing TV and online hype. Go to reliable sources only for necessary information. Of course, if anxiety becomes so intrusive that it interferes with your professional and personal responsibilities, it’s time to obtain help, ideally from a trusted counselor, one who focuses on cognitive-behavioral transformation.
In my work in this arena, I’ve found Edward Krall M.D.’s “Ten Commandments of Physician Wellness,” anchored in part, in the work of TD Shanafelt and others, to be of particular value in staying ahead of the evolving and progressing mental health crisis that is festering.
1. Thou shall not expect someone else to reduce your stress
2. Thou shall not resist change
3. Thou shall not take thyself in vain
4. Remember what is holy to thee
5. Honor thy limits
6. Thou shall not work alone
7. Thou shall not kill or take it out on others
8. Thou shall not work harder thou shall work smarter
9. Seek to find joy and mastery in thy work
10. Thou shall continue to learn
It’s not what’s in the black bag as much as it’s what’s in the heart of the person carrying the black bag that influences healthcare. That said, we have an obligation to attend to the hearts of those courageous healthcare professionals extending their lives for the sake of others in the midst of this COVID19 pandemic. The time is now.