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Perils of COVID-19: Managing stress during pandemic
NEED FOR STRESS MANAGEMENT EXACERBATED BY PANDEMIC
By David A. Kostival, Contributing Writer
As the United States exceeds 800,000 COVID-19 deaths, it’s important to recognize the number reflects only deaths resulting directly from complications caused by COVID-19.
It does not account for deaths resulting from drug overdoses or suicides as an indirect result of the pandemic.
And while we look to medical caregivers to help us safely navigate through the ongoing effects of the pandemic, physicians are not exempt from the stress.
The American Hospital Association says about 400 physicians die each year from suicide, and that hundreds more have serious thoughts of suicide.
WebMD states that about one doctor a day commits suicide in the United Sates every day, which translates to the highest suicide rate of any profession.
The suicide rate in the general population is 12.3 per 100,000 people, while the number of doctor suicides is between 28 to 40 per 100,000.
Monitoring and advocacy
The Foundation of the Pennsylvania Medical Society’s premier program is the Physicians’ Health Program (PHP). PHP provides monitoring and advocacy for physicians who have substance use disorders, mental health issues or behavioral concerns that impact their ability to practice their profession safely.
Dr. Edwin Kim, MD, MRO, serves as the medical director for PHP.
Kim said that prior to the pandemic, physician burnout had already become a growing concern.
“This was certainly exacerbated over the last two years,” he said. “Even physicians who are inherently resilient are at risk of neglecting their physical and mental health.”
Kim said some large health systems and academic centers have started programs to provide avenues for their physicians to seek additional support.
“This included ways to engage mental health or counseling resources available to their employees,” Kim said.
But not all physicians work in a large group setting where structured support systems exist.
For those situations, Kim said state and county medical societies or professional specialty associations have stepped up to create resources and toolkits for their constituencies, particularly independent practitioners and those in smaller group practices.
“We have even seen grassroots, physician-led support groups arise early in the pandemic,” Kim said. “I think increasing awareness of these programs and tools is crucial.”
Stress doctors face
Psychiatrist Dr. Mona Masood, with offices in Bryn Mawr and Ivyland, recognized the huge amounts of stress doctors face and became the founder and chief organizer of the Physician Support Line.
The Physician Support Line is the first of its kind because it provides physicians with a resource for counseling while remaining completely anonymous.
continued on next page Dr. Edwin Kim serves as the medical director for Physicians’ Health Program, an initiative of The Foundation of the Pennsylvania Medical Society.
Psychiatrist Dr. Mona Masood is founder and chief organizer of the Physician Support Line.
– Dr. Edwin Kim
“The Physician Support Line was started in March 2020, right at the beginning of the pandemic,” Masood said. “And it really came from an ‘if-not-me-then-who?’ attitude.
“I saw the writing on the wall in regard to mental health,” she said. “We, too, were building the plane as we were flying it.”
Being part of large physician social media groups, Masood said she began seeing posts about how poorly some were feeling in regard to mental health.
Masood said an anonymous hotline was absolutely needed to give physicians an outlet for the stress they faced.
“We started with 50, and have grown to having over several hundred volunteers who run this nationwide,” Masood said.
“When we looked into it, what we found is that there continues to be a barrier to mental health care for physicians,” she said. “Mental health resources affiliated with health care systems pose a problem. There is a systemic barrier for physicians seeking mental health care.”
Masood explained when physicians attempt to seek care from their own health care systems, they do not feel secure and potentially put their practice or profession at risk.
“We are penalized for seeking mental health,” Masood said.
“Medical boards ask information to be disclosed on those seeking help for mental health,” she said. “Many doctors find they don’t get their licenses renewed or have to go through programs. There are a lot of systemic barriers, so no wonder that we have one of the highest suicide rates. COVID-19 has blown the lid off of it.”
Masood explained that the Physician Support Line remained unaffiliated with any healthcare system on purpose in an effort to maintain integrity.
Loss of empathy
As the COVID-19 pandemic progressed, Masood said one of the things physicians needed to watch out for as a warning sign was a loss of empathy for patients.
“That is something that really affects outcomes,” Masood said. “What has really been a red flag is a caller saying that they now do not know why they ever went into medicine. When losing the essence of why they went into medicine, they do not feel the same. They don’t recognize themselves. This is incredibly related to COVID-19.”
Kim said doctors should be alert to a low mood that persists over time.
– Dr. Mona Masood
– Dr. Mona Masood
“Disruptions in sleep and appetite are clear signs that there is stress occurring, either physically or mentally,” Kim said.
He advises physicians to conduct a daily or weekly personal check-in.
“A physician may be facing burnout if one is finding it more difficult to recognize their passion for medicine, recognize increasing feelings of cynicism toward their profession, feelings of dread or unrelenting fixation on past difficult clinical situations or a sense of distrust toward coworkers or leadership,” Kim said. “The inability to cut down on alcohol, gambling or other uncontrolled behaviors can be warning signs of uncontrolled stress or strained mental health as well.”
Masood said that what made COVID-19 illnesses incredibly unique, was that everyone was trying to find blame for what they were suffering.
“There’s the people who will not mask, don’t believe in the science and will not vaccinate,” she said. “When you have that, you start feeling resentment. The human politicization and polarization have caused a lack of empathy.”
When the pandemic started, Masood said calls focused on fears of becoming infected, but now calls are more focused on compassion fatigue, losing empathy and losing sight of what drew them to medicine in the first place.
Preventative measures
Kim reminds physicians that preventative measures go a long way to help preserve physical and mental health.
“Maintaining a healthy diet, exercise and sleep have never been more important to mitigate the effects of what can become chronic stressors,” he said. “Sometimes physicians put their own health last and have forgotten that they too can ask for help. Seeking professional help, asking your peer groups and leadership for more assistance or resources is key.”
Masood believes the pandemic has created a permanent change in health care.
“We are having hopeful discussions on the line, and perhaps this is an opportunity for change in health care,” Masood said. “It may change what we choose as acceptable behavior from health care administrators, including hours, hazard pay and knowing our own limits as human beings.”
Masood wants to see a cultural shift in health care where physicians have to care for each other outside of patient care.
“We can only talk about it with hope,” she said. “We’ve built a movement with hundreds of doctors behind systemic changes. Individual conversations become validating and normalizing.”
Expanded efforts
As a direct result of her work, Masood said she has expanded her efforts on working on the stigma of mental health within medicine.
She organizes ongoing seminars with medical students and is working with medical boards to try and change licensing questions.
Kim said that the pandemic may have provided an opportunity for the Philadelphia-area hospitals and academic centers to create an inter-institutional solution.
“The creation of a chief wellness officer, wellness group or taskforce can be a great first step in addressing the needs of their employees,” Kim said.
More information on The Foundation of the Pennsylvania Medical Society can be found at www.foundationpamedsoc.org.
Information on the Physician Support Line can be found at www.physiciansupportline.com. The phone number for the anonymous hotline is 1-888-409-0141. •
David A. Kostival is a contributing writer to Philadelphia Medicine.
