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- Page navigation anchor for RE: Mitigating the Psychological Effects of COVID-19 on Health care workersRE: Mitigating the Psychological Effects of COVID-19 on Health care workers
As a family physician in small-town Ontario, my heart sank when I read the CMAJ commentary “Mitigating the Psychological Effects of COVID-19 on Health Care Workers”. (CMAJ 2020 April 27; 192:E459-60). At first I wasn’t sure why, but upon further reflection it was the following statement that worried me: “Emphasizing the altruism of working in health care and serving of the greater good will help health care workers to be reminded of their purpose in a time of crisis.”
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I fear that the call to altruism may lead to worsening compassion fatigue and burnout among my colleagues. I would like to suggest that we encourage each other in the pursuit of meaning in our careers. Altruism and Meaning are quite different concepts.
Altruism is defined by Google as “the belief or practice of disinterested and selfless concern for the well-being of others”.
I believe that as physicians we limit ourselves by seeking only to be altruistic. Having a “selfless concern” for others implies putting my own needs last, or even worse, that meeting my needs and my patient’s needs are mutually exclusive concepts. I believe that couldn’t be further from the truth! Physician burnout contributes to poor patient outcomes, poor patient satisfaction and increased healthcare costs. (Panagioti et al, 2018) The personal toll burnout can have on a doctor’s life is also grim- contributing to the physician suicide rate being double that of the general population. (Albuquerque et al. 2019)
A...Competing Interests: None declared.References
- Peter E. Wu, Rima Styra, Wayne L. Gold. Mitigating the psychological effects of COVID-19 on health care workers. CMAJ 2020;192:E459-E460.
- Panagioti M, Geraghty K, Johnson J, et al. Association between physician burnout and patient safety, professionalism, and patient satisfaction [published online September 4, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.3713.
- Joy Albuquerque and Sarah Tulk. Physician Suicide. CMAJ May 06, 2019 191 (18) E505; DOI: https://doi.org/10.1503/cmaj.181687
- Burnout : the secret to unlocking the stress cycle. Emily Nagoski and Amelia Nagoski. New York : Ballantine Books, [2019]
- Page navigation anchor for Caring for Canada’s Care Providers Amidst the COVID-19 PandemicCaring for Canada’s Care Providers Amidst the COVID-19 Pandemic
The COVID-19 pandemic has drastically changed many aspects of our lives. These changes are increasingly amplified for healthcare workers on the front lines. Specifically, our healthcare workers have had to deal with several challenges including working under constrained resources, extended hours, challenges finding resting times, balancing out work and life outside of medicine, and exposure to COVID-19 (1). These challenges have affected the health and wellbeing of our healthcare workers (2). Evidence (2) shows that front line healthcare workers have reported symptoms of depression, anxiety, insomnia and distress during the pandemic. These findings are concerning given the mental health status of healthcare professionals before the pandemic. Results from the 2017 National Physician Health Survey, highlight the already heightened levels of mental health challenges our physicians face (3). Specifically, this survey found that 30% of physicians reported feeling high levels of burnout, 34% screened positive for depression and 19% revealed lifetime suicidal ideation (3). Therefore, this pandemic has resulted in even greater detriment for the mental health of our healthcare providers. It should be noted that 81% of physicians and residents surveyed said they were aware of physician health program services available to them, yet only 15% had accessed them (3).
Thus, it has now become more important than ever to provide our healthcare workers with resources that support t...
Show MoreCompeting Interests: None declared.References
- Sasangohar F, Jones S, Masud F, Vahidy F, Kash B. Provider Burnout and Fatigue During the COVID-19 Pandemic. Anesthesia & Analgesia. 2020;:1.
- Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open. 2020;3(3):e203976.
- CMA NATIONAL PHYSICIAN HEALTH SURVEY [Internet]. Cma.ca. 2018 [cited 28 May 2020]. Available from: https://www.cma.ca/sites/default/files/2018-11/nph-survey-e.pdf
- Maintaining wellness during a pandemic [Internet]. Canadian Medical Association. 2020 [cited 28 May 2020]. Available from: https://www.cma.ca/maintaining-wellness-during-pandemic
- Adams J, Walls R. Supporting the Health Care Workforce During the COVID-19 Global Epidemic. JAMA. 2020;323(15):1439.
- Page navigation anchor for RE: Psychological Support for Healthcare Workers during the COVID-19 PandemicRE: Psychological Support for Healthcare Workers during the COVID-19 Pandemic
We read the article by Drs. Wu, Styra and Gold with great interest. In our work, providing psychological support to health care worker (HCW) colleagues during this pandemic, we have found the following five principles helpful in organizing our responses.
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i)Pandemics can cause enduring HCW distress and even disengagement from the profession.1 Concerns include: capacity to care effectively, access to PPE and personal safety, risk to family, (re)deployment, ethics of care dilemmas, moral distress, stigma, loss, and grief.
ii)Social integration reduces stress and strengthens morale particularly with physical distancing and PPE use.2 Group support in person or online, should focus on enhancing safety, calming, efficacy of individuals and the team, connectedness, and realistic hope for the present and the future.3 We aim to ensure any individual’s confidentiality, but secure permission to use broad themes for advocacy and system change.
iii) Severe stress impairs the capacity to recall how to cope and maintain personal well-being. Make the implicit more explicit.4 Consider coping as three foci with matching aims and strategies: problem-focused coping: fix what is fixable, learn about stress management and self-care, improve interpersonal communication; emotion-focused coping: use social support and emotional ventilation; and meaning-focused coping: engage HCWs’ moral purpose and spirituality.5
iv)Leadership must demonstrate the organization’s valuing of H...Competing Interests: None declared.References
- 1. Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ 2003; 168:1245-51.
- 2. Southwick SM, Southwick FS. The loss of social connectedness as a major contributor to physician burnout: applying organizational and teamwork principles for prevention and recovery. JAMA Psychiatry 2020; Advanced online publication February 19, 2020.
- 3. Hobfoll SE, Watson PJ, Bell CC, Bryant RA, Brymer MJ, Friedman MJ, et al. Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence. Psychiatry 2007; 70:283-315.
- 4. Maunder RG, Peladeau N, Leszcz M, Romano D, Savage D, Rose M, et al. Applying the lessons of SARS to pandemic influenza. Canadian Journal of Public Health 2008; 99:486-488.
- 5. Folkman S, Greer S. Promoting psychological well-being in the face of serious illness: when theory, research and practice inform each other. Psycho-oncology 2000; 9:11-19.
- Page navigation anchor for RE: Self care and ProtectionRE: Self care and Protection
I will attend to my health, well-being and abilities in order to provide care of the highest standard;"WMA Declaration of Geneva,2017. Physicians and other medical personnel suffer from exhaustion, participate in decision making and provide maximum care to patients. The prolonged exposure to service following the cycle of quarantine results in burn out and some doctors have died from suicide unable to bear the devastating effects on patients. It becomes imperative to provide health care workers a virtual platform where they can share their feelings, day to day activities, patient care and the feel relieved from their mental tension. The management of hospitals need to provide such help to these doctors who save many lives while putting their lives in the altar of service. They need to be encouraged time and again with words of appreciation and psychiatric help if needed. They need to given the ways and means to provide an outlet including the facility to talk with their dear and near ones.The clapping and accolades do not minimize the mental agony of physicians unless and until they are provided with the best personal protective equipment
Competing Interests: None declared.References
- . RE: Self care and Protection. 2020;:-.
- Page navigation anchor for RE: Strategies to support Healthcare Providers during the Covid-19 PandemicRE: Strategies to support Healthcare Providers during the Covid-19 Pandemic
We thank Wu and colleagues’ for their important commentary regarding potential psychological effects of Covid-19 on health care providers (HCP) (1). Our group of multi-disciplinary oncology providers was formed to support oncology HCP, a group at high risk of burnout (2). We outline additional strategies we developed which complement this commentary.
HCP wellness is a spectrum from engagement to burnout; we recognize that individual characteristics, experiences, and organizational factors can influence one’s position on this spectrum (3). Our approach follows five key considerations for HCP during Covid-19, developed by Shanafelt (4). At the organizational level, our group advocates to ensure the first three principles (“hear me,” “protect me,” and “prepare me,”) are factored into decision-making and communication.
We developed resources aligned with the “support me,” and “care for me” categories. First, “CREATE” (Compassion and REsilience TEam-building) pairs a psychosocial professional with clinical managers to offer support and embed low dose interventions into clinical teams using a coaching and psychological first aid model. Second, we created a toolkit with information on accommodation, grocery delivery, safety, coping, and mental health resources. We also implemented the “Buddy Up” program to foster connectedness, by asking HCP to form groups of twos or threes and check-in daily via phone, email, or text message. Other interventions include “virtu...
Show MoreCompeting Interests: None declared.References
- 1. Peter E. Wu, Rima Styra, Wayne L. Gold. Mitigating the psychological effects of COVID-19 on health care workers. CMAJ 2020;10.1503/cmaj.200519.
- 2. Hlubocky FJ, Back AL, Shanafelt TD. Addressing Burnout in Oncology: Why Cancer Care Clinicians Are At Risk, What Individuals Can Do, and How Organizations Can Respond. Am Soc Clin Oncol Educ Book. 2016;35:271-9.
- 3. Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc. 2017;92(1):129-46.
- 4. Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA. 2020.