Article by Lori Weichenthal, M.D., FACEP and Jay Kaplan, M.D., FACEP
Being a physician in our modern society has never been easy. Surveys over the last ten years have shown that physicians in all specialties suffer from chronic stress and that over 50 percent have some symptoms of burnout. Add the ingredient of a global pandemic and it is a recipe for disaster. Physicians on the front line face long work hours, heavy patient loads and an increased burden of caring for seriously ill and dying patients. They deal with this situation while having to pay extra attention to their own personal protection and with an increased sense of isolation from their patients, patient’s families and colleagues.
Given the unique and confusing features of the Coronavirus, including the undetected risk in some patients who become critically ill and the lack of any proven treatment, physicians worry for their patients, their families, and for themselves. Physicians not on the front line also face increased stress with the reality of decreased patient visits and the resulting financial implications, transitions to telehealth with having to learn new ways to relate to patients, and concerns about keeping themselves and their staff safe.
On top of these professional concerns, physicians face the same stressors that all people are experiencing during this pandemic. Fear of the unknown, concern for the health and welfare of their families, and increased isolation due to stay at home orders, are just a few of the stressors we face in this new world.
Even in the face of these significant stressors, we can engage in behaviors that help to relieve stress so that we are able to function at a higher level, both in our professional and personal lives.
Pay attention to basic needs. There is a tendency for physicians who are working on the front lines in high-volume and high-acuity settings to ignore even basic human functions, such as taking a bathroom break, because they are so focused on caring for their patients. This is actually counter-productive. It is important, even in the busiest setting, that we take breaks, eat, hydrate, and pay attention to the normal needs of the human body.
Self-care. Outside of the work environment, it is important to continue to engage in behaviors and activities that support health and well-being. Adequate sleep is of great importance as is eating healthy meals. Daily physical activity, even for short periods of time (20-30 minutes), is helpful and if you can do it outdoors, there is added benefit. Some daily time alone for contemplation and reflection can also help you to reset and recharge.
Stay Connected. Isolation is a serious consequence of this pandemic, whether it is due to the need to self-isolate to protect loved ones from potential infection or due to only seeing your colleagues fully suited up in PPE or via virtual meetings. Focus on connecting with people who are important to you in any way that you can, whether it is via texting, virtual video chats, conversations through a window, or time with family while practicing physical distancing.
Take an electronics break regularly. The amount of information coming into physicians’ email inboxes regarding the pandemic is overwhelming, but important. Add to this information from news sources and social media and it can feel like it is possible to drown in all of the information. Read the information that is important to you and your practice, but avoid extraneous information. Take a regular break from your electronics, at least every few days, to decrease information overload.
Give yourself space to let down and feel the entire spectrum of emotions and consider how you might transform those feelings. Any feeling that is accurately identified and fully expressed in a safe environment will dissipate. Journaling, painting or drawing, baking, cooking, or similar creative activities can help. Connect back to why you went into medicine in the first place, and how you are making a difference – consider starting a gratitude journal where once a day you write down 3 things that you are grateful for.
Check-in with yourself regularly and don’t be afraid to ask for help. We must break the culture of silence and be willing to admit when we struggle.Monitor your level of stress and make adjustments to your life to care for yourself when your stress starts to reach unmanageable levels. There are several online tools that can help you monitor your level of stress, burnout and other negative emotions, including the Professional Quality of Life Scale (PROQOL) (https://www.proqol.org/uploads/ProQOL_5_English_Self-Score_3-2012.pdf) and MindWise Innovations Screenings (https://screening.mentalhealthscreening.org/hyho). Find the online tool that is right for you and use it to monitor yourself on a regular basis. If negative emotions worsen or persist, don’t be afraid to reach out for professional help.
These are new and challenging times for all of us and stress is a normal response. Self-care is key as we continue to face this pandemic and the world that will be created anew on the other side.
Lori Weichenthal, M.D., FACEP Professor of Clinical Emergency Medicine Assistant Dean of Graduate Medical Education UCSF Fresno
Jay Kaplan, M.D., FACEP Medical Director of Care Transformation, LCMC Health Clinical Associate Professor, Emergency Medicine, LSU Health Sciences Center Attending Emergency Physician and Academic Faculty, University Medical Center New Orleans New Orleans, Louisiana
Lori Weichenthal, M.D., FACEP and Jay Kaplan, M.D., FACEP, contributing authors of Rosen’s Emergency Medicine. Get your copy here.
In the current epidemic situation, doctors and nurses are very important