COVID-19 and a Vision for Wellness

COVID-19 and a Vision for Wellness

Steve Bird, MD

After more than six months of uncertainty, we are beginning to see light at the end of the tun-nel of the COVID-19 pandemic. But during this time (and likely for the foreseeable future), healthcare professionals have faced increased stress and risk of burnout. The continued well-being of all healthcare professionals is paramount to ensure the health and well-being of our patients, all staff, and our healthcare institutions.

Burnout can be defined as a syndrome of emotional exhaustion, depersonalization, and a reduced feeling of personal or professional accomplishment. But one does not need to exhibit symptoms in all three domains to be burned out. A 2017 Medscape study found that 50% of all physicians experienced burnout, with some specialties having burnout rates of greater than 70%. While signs and symptoms of burnout are varied, they often include irritability, frustration, increased interpersonal conflicts, depression, social isolation, and decreased job satisfaction.

What is also now clear is that physicians and other healthcare professionals are also at higher risk for secondary traumatic stress during the pandemic. Secondary traumatic stress is a stress reaction that results from exposure to someone else’s traumatic experiences, rather than from direct exposure to a traumatic event. Signs of secondary traumatic stress mimic those of PTSD, but the most common are excessive fear or worry, an exaggerated startle response, persistent ruminations about the traumatic event, as well as sleep disturbances.

It is well known that physicians are not great at self-care. Our medical education system has conditioned us to prioritize the needs and care of patients over our own. Now, more than ever, it is important to make personal well-being a priority and to manage the various stresses we experience in check. Below are a few ideas and suggestions for managing stress and promot-ing your own well-being. For your own wellness is important not only for you (and your family), but also for your patients.

1. know that what you’re feeling is a normalstress response

Physicians are encountering stressors that may include direct exposure to COVID-19 while treating patients; the death of patients from COVID- 19 (or other disease) without the benefit of the presence of families; working in more difficult situations with PPE and the lack of personal contact; and the fear of bringing COVID-19 home to their families. We know from the UMass-Memorial Peer Support Network that physicians are experiencing more stress than is typical. So, allowing yourself some self-compassion and acknowledging what you are feeling (and that it’s normal), is a good first step.

2. personal wellness check-in

Take a few moments at different points throughout the day for a personal wellness check-in. Although time pressure is felt by all of us, and perhaps even more now as there is a rush to make up RVUs lost during the height of the pandemic, taking the time for self-care is an im-portant aspect of managing stress. Some emotional signs of stress include the persistence of fear or anxiety, irritability, anger, or perhaps a feeling of hopelessness. Some cognitive or men-tal signs of stress include an inability to concentrate, an inability to make decisions, and mental exhaustion.

To help with this stress, you can add some well-validated breathing exercises to your personal wellness check-in. Try the 4-7-8 breathing method: close your mouth and inhale through your nose for a count of four. Hold your breath for a count of seven. Exhale completely through your mouth for a count of eight.

3. prioritize your own needs

Physicians are generally not good about prioritizing their own needs in normal times, let alone during a pandemic. Try as best as possible to eat at least three healthy meals every day, while avoiding food high in sugar and fats. To make this easier, I have taken to making a spinach and frozen fruit smoothy each morning and bringing it to work in a hydroflask.

It’s also important to take some breaks during the day to rest and reset your mind and body. Short walks of just 10 minutes have been shown to have valuable mental and physical benefits. If, as the weather turns colder you can’t realistically go for a quick walk during the day, identi-fying a quiet space where no one can bother you for a short duration and doing the 4-7-8 breathing or other mindfulness technique might be just what you need.

4. maintain supportive connections with yourcolleagues

Check in with your colleagues and be open to receiving reciprocal help. One program that we initiated at UMass was the Check You, Check Two. That is, check in with yourself and then brief-ly check in with two colleagues each day. This can be a simple text, email, or call. Let them know

COVID-19 and a Vision for Wellness Continued

that you’re thinking of them and acknowledge the unprecedented experiences of today. Such validation will help normalize the feelings that both you and they are experiencing. Fur-thermore, nonstop media coverage of the pandemic can overshadow the bright spots of your daily work. So talk about the positive things that are occurring in your life, with your family, and with your institution or place of work.

5. seek professional help to cope withmoral distress

Symptoms of moral distress may include self-criticism or feelings of shame, guilt, and regret. This moral distress and the anticipatory grief that often co-exists is likely something with which you are unaccustomed. Coping with such novelty may be difficult. Therefore, additional help and support may be needed to address their insidious and harmful effects.

Although physicians are generally reluctant to seek help, seeking early help is important to ad-dressing the trauma from moral distress. Peers have been found to be valuable when coping with moral distress. If you have access to an employee assistance program (EAP), you can often receive free and confidential help as well as referrals to help you cope with moral distress. You can also contact your health insurance provider for referrals to mental health professionals who provide telemedicine therapy, or contact the Physician Health Services (http:// www.massmed.org/Physician_Health_Services /About/About_Physician_Health_Services/#.

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Steve Bird, MD, is professor of emergency medicine and the Clinician Experience Officer (CXO) at UmassMemorial Healthcare and the University of Massachusetts Medical School. Email: Ste-ven.bird@umassmemorial.org