Physician Health & Wellness in the Era of COVID-19: “If not now, when?”
It’s been a year. A whole year. On March 11, 2020, the World Health Organization formally declared COVID-19 a world pandemic. Now, more than a year later, we are still in the midst of the COVID-19 world pandemic with hope for an end in sight but also with great uncertainty ahead. Not since the 1918 Influenza Pandemic, the so-called “Spanish Flu,” has a natural disaster had such a profound and global effect. The year 2020 has been the deadliest in regard to a natural disaster in US history. The impact the pandemic has had on doctors cannot be overstated. Presently, the greatest threat to physician health & wellness is the current COVID-19 pandemic.
If not now, when? It’s time to get serious about Physician Health & Wellness.
“I’ve seen so much suffering, lost patients to COVID, have seen tears & fears from patients, have other patients who feel the brunt of the economic and emotional breakdown lockdown has caused, other with non-COVID problems who have to cope differently and often less effectively with their own serious medical problems due to the new world that’s become because of COVID. Despite all this pandemonium and scrambling I am proud that we have found ways to adapt, found tests and treatments, and even a vaccine in record time. I feel a great joy and faith in science and that is rewarding.” – A Resilient Internist, Santa Barbara, CA
“It’s been a year of doctors courageously stepping up and caring for patients often at great risk to themselves and their families. It’s been a year when the character of the house of medicine has shone as it ever has at other times of great need.” – Psychiatrist, San Luis Obispo, CA.
COVID-19 EFFECTS ON PHYSICIANS
For most physicians, the practice of medicine is as much a calling as it is a profession. The calling of this practice is rooted in the character of the physician whose daily decisions and patient interactions are the outcomes of a commitment to values that supersede one’s own self-interest. However, though medical training is highly rigorous and most doctors are exposed to the inevitability of patient death in medical school, the unprecedented scale of severe infection and death associated with COVID-19 has taken a toll on doctors providing direct patient care.
In cities across the US and around the world, frontline health care workers (FHCWs) have been exposed to an extreme and sudden rise in daily work-related stressors witnessing severe illness and death at unprecedented rates, while experiencing threats to their own safety, leading to significant concern for the psychological impact of this crisis within this population. The overwhelming stress on doctors driven by a combination of witnessing and empathizing with the fear and suffering of very sick patients, many of whom were going to die, associated with profound helplessness to alleviate the suffering may be scarring to many doctors who are trained to be of help and be in control of situations. The stories in ER’s and intensive care settings of patient’s saying goodbye to loved one’s while being intubated, not knowing if they would live through the experience and see them again is just one touching example of this helplessness doctors experienced.
According to Medscape’s US & Int’l Physician’s COVID-19 Experience Report published September 11, 2020, Emergency medicine physicians are most likely to treat patients with COVID-19 in person. Due to COVID-19’s pulmonary effects, pulmonologists are also heavily involved. These doctors and their staff likely put themselves at the greatest risk.
“I have personally felt significant fear of personal risk and vulnerability during the COVID-19 pandemic. Having attended patients younger than myself with no comorbidities, come into the ED with serious COVID illness and later learning that several of them went on to die makes one very aware of how real the risks can be. The fact that I could unknowingly bring COVID home to my family is constantly in the back of my mind.” – Emergency Physician, Nashville, TN
Physicians have consistently put themselves at risk despite risks to their personal and family health, their income, and emotional health have been sorely affected by the pandemic. According to Medscape, as of March 11, 2021, the anniversary of the day the WHO declared COVID-19 a “pandemic,” there have been more than 3030 deaths of healthcare workers from 90 different countries worldwide due to COVID-19. The overwhelming majority of these are the result of exposure to the virus in the performance of their duty, caring for patients.
Significant challenges exist for physicians in keeping up with and dealing with confusion around the myriad of changes regarding COVID-19. Changing protocols for treatment, changing schedules for vaccinations, “anti covids” and “anti vaxxers”, and any other type of change related to the care of patients who may or may not have COVID-19.
“Challenges being faced in the administration of care – from an internal medicine standpoint in primarily outpatient care, challenges include dynamically changing information, changing with testing criteria, testing options, testing availability, testing turnaround times, questions from the public about these things, about possible false results, questions and variations on quarantine times. changing to telemedicine overnight, inching back around to in office visits and migrating back to telemedicine… ” – Internist, Santa Barbara, CA
Though initial stresses arose with doctors treating COVID-19 patients without the provision of proper personal protective equipment (PPE), a year of working in and out of PPE brought significant stresses of its own. Adding to the stress, a majority of physicians saw some decline in demand for their services and earnings. “Most often, US physicians saw a decrease in income of 11%-50%. The US specialists whose incomes declined by 51% or more were ophthalmologists, allergists, plastic surgeons and otolaryngologists.” In some cases, it was emergency medicine physicians who saw a decrease in volume of work but significant increase in the intensity of it.
The COVID-19 world pandemic is presently the greatest threat to physician health & wellness worldwide. It is clear that overwhelming stress is at play in the routine practice of medicine and that this is going to have a profound effect on the health and wellness of physicians. It is predicted that this effect will outlast the COVID-19 pandemic significantly. If not now, when? It’s time to get serious about Physician Health & Wellness.
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Physician Health & Wellness in the Era of COVID-19: Better Days Ahead – the Rollout of Vaccines