How Long Will This Be Going On?

- Dr. Alexis Polles, MD

The title phrase no longer takes us to first remembering the 1974 Ace song with a similar title, (“How long has this been going on,” Five-A-Side, 1974), but rather to the ongoing experiences related to the COVID pandemic.

Are you at risk, even post-pandemic? As the global crisis abates, many sources, including the Centers for Disease Control (CDC. org) and the American Veterinary Medicine Association (AVMA. org) emphasize that the risk of the physical and emotional stress of the pandemic will not soon disappear in the rearview mirror as you “drive on” with your life.

Unfortunately, the results, sometimes catastrophic, of burnout, stress, anxiety, depression and addiction are not new to veterinary professionals. This article will focus on veterinary medical doctors, but much of it also applies to other veterinary professionals.

STRESS AND BURNOUT

There are distinctions between stress and burnout. With chronic stress, emotions may be over-reactive, resulting in a sense of urgency and hyperactivity with a loss of energy over time. Anxiety disorders are a result, and there may be physical damage associated with those disorders, such as development or worsening of hypertension.

Burnout, on the other hand, produces feelings of helplessness and hopelessness, along with a loss of motivation, ideals and sense of efficacy. This leads to detachment, numbing, depression and even thoughts of suicide. The damage is mostly emotional.

Both stress and burnout can produce sleep problems and heightened perfectionism. Shockingly, 85% of veterinarians surveyed at the 2018 AVMA meeting endorsed having “stress and burnout” (Am Vet News, 10/11/18). Contributors to these conditions include intensive use of technology, regulatory and competency maintenance requirements, social media attacks from patient owners, and, for most, running a business.

COVID has exponentially increased the stress of the business aspects of practice with changing guidelines regarding practice settings and employee protection requirements.

CONSEQUENCES

The consequences of untreated emotional distress can be devastating, including the development of substance use disorders, diminished patient care that may include medical errors and reduced patient (owner) satisfaction, suicidal ideation, and leaving the profession (Shanafelt, et al, “Changes in Burnout and Satisfaction with Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017. Mayo Clin Proc. 2019 Sep;94(9):1681-1694).

The rate of suicide in veterinarians may be higher than in physicians and dentists, and 1-1.5% of veterinarians have attempted suicide since graduation (“When Caring Hurts: Dealing with Depression in Veterinary Medicine,” Today’s Vet Nurse, Jan/Feb, 2017).

In terms of means, they are readily available, and veterinarians more often use lethal euthanizing agents from their practice to attempt and complete suicide. The drug most often used is pentobarbital, typically at their home (Witte, et al, “Suicides and Deaths of Undetermined Intent Among Veterinary Professionals from 2003-2014,” JAVMA, 255(5), pp. 595-608, 9/1/19).

Both suicide and burnout in healthcare professionals are associated with substance use and substance use disorders. This is not surprising, since people take drugs, including alcohol, for similar reasons, i.e., to feel good (euphoria), to feel better (reducing or relieving feelings of anxiety, stress, and depression), for actual or perceived improvement of performance, and for curiosity or to fit in (sense of belonging).

Because prolonged stress, such as that of the pandemic, can have emotional consequences that do not show up for months or years, learning how to take care of yourself has never been more important.

The proliferation of tools on organizational websites and in the general media, such as online mental healthcare services and wellness apps, makes reaching out much easier than in the past. However, healthcare professionals tend to think, “I can handle this myself.” Thus, watching out for one another is something we must all commit to doing.

Engaging in or encouraging colleagues to engage with the FVMA’s Professional Wellness and Well-being Committee and programs is one great way to start. For those who need it, the Professionals Resource Network, which has acted as the Consultant to the Board of Veterinary Medicine on matters of potentially impairing mental health, addiction and physical/cognitive conditions since 1982, can provide non-disciplinary access to services that evaluate, treat and monitor the safe practice of veterinary medicine for the professional and the public. When it comes to taking care of lives, your own is the priority.

Whether it is the result of early traumatic experience, training, work stress, personal loss or the pandemic, veterinarians are at risk for emotional distress and its sequelae. It should not be borne in silence or solitude. Please, reach out.

About the Author

Dr. Polles is a fellow of the American Psychiatric Association and a diplomate of the American Board of Addiction Medicine. For more than 30 years, her practice has been devoted to treating healthcare professionals with addiction and co-occurring disorders at all levels of care, specializing in the treatment of trauma and addiction.

Dr. Polles graduated from the Tulane University School of Medicine, completed a residency in emergency medicine at LSU Charity Hospital and a residency in psychiatry at the University of Mississippi Medical Center. She serves on the Board of Directors of the Federation of State Physician Health Programs and is currently a member at large of the Board of the Florida Society of Addiction Medicine. She joined the Florida Professionals Resource Network as medical director and CEO in January of 2017.