F E A T U R E
At the Intersection of burnout, COVID and systemic racism Deborah Saint-Phard, MD
We must make our institutions actively antiracist, writes Deborah Saint-Phard, in order to bring about actual change and healing for each of us and our nation. My name is Deborah Saint-Phard. I am a Black woman physician who works in a medical academic department and who founded and directs a women’s sports medicine program. And I live at the intersection of physician burnout, the COVID -19 pandemic and systemic racism. In 2016, during my annual review with my chairperson, I stated point-blank, “I cannot think about stress fractures anymore.” Since this had been my clinical area of expertise for more than two decades, that pronouncement was a bit surprising to us both. Instead, I wanted to work on emotional stress fractures, also known as burnout. My exploration led me to discover the epidemic of physician suicide in America. Was this a well-kept secret: 400 physicians in America die each year by suicide? Could it be true that the equivalent of two and a half medical school classes per year die by suicide? I wanted to call out to my former medical school peers and current doctors everywhere to make sure they knew suicide is an occupational hazard in medicine. Female physicians have 2.3 times, and male physicians 1.4 times, the risk of dying by suicide when compared to the general population. In May 2018, I convened a two-day conference in the Colorado mountains for physicians, physicians’ assistants, nurses, CEOs and hospital administrators to learn about this urgent concern. I read articles and presented grand rounds locally and keynotes regionally on this topic;
1 0 C O LO R A D O M E D I C I N E
attended local, regional and national conferences on physician health; joined committees on physician resilience; and worked to implement this topic into our medical school curriculum. My goal was to increase awareness about the new World Health Organization’s International Classification of Disease (ICD) code 11, which is a specific medical diagnosis category for physician burnout, and develop strategies for self-care and self-compassion. The ICD code 11 defines physician burnout as an occupational syndrome -- not a medical phenomenon -- caused by chronic workplace stress resulting in: “a) Feelings of energy depletion or exhaustion, b) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job and c) reduced professional efficacy.” By 2019, I felt that my efforts were meaningful. I had increased awareness of the insidious emotional toll a physician’s work can have on them. Then in early 2020, the infectious airborne pandemic COVID-19 struck us in the United States. Warnings blared about the insufficient amounts of personal protective equipment, or PPE, to keep healthcare workers safe while providing care to infected patients. The rationed PPE, falsehoods and misinformation about the seriousness of this pandemic from leaders responsible for public policy, and lack of a national mandate for social distancing and wearing masks or face coverings undermined my feeling of physical safety. While debates flared about rights
of individual choice versus public health directives to prevent community spread of this virus, I felt my vulnerability more and more acutely. If I became infected with COVID-19, my co-morbidities -- Black person, underlying respiratory condition, hypertension and overweight -- would predict a poorer outcome. As COVID-19 cases accelerated, our ambulatory clinics were closed, and we were furloughed. I was reassigned to help staff an employee-health COVID command center for several weeks to assist with the overwhelming number of calls, tests and dispositions. We were encouraged to use this downtime to be productive academically. We transitioned to providing care via telehealth from home. I saw and felt the emotional toll of the pandemic on physicians, compounding burnout, and read the research showing how providing care during pandemics leaves health-care workers at increased risk for depression, anxiety, substance use and PTSD. And then I learned about Breonna Taylor’s death in March. She was killed by multiple gunshots from police while she slept in her own bed. And then I watched George Floyd’s death on television in May -- his neck unmercifully kneeled upon by a police officer for eight minutes and 46 seconds. Those two events struck at the soul of the nation and broke my heart. They alarmed me to the core: I saw that I could not secure the physical safety of my Black body or those of my Black children.
