Wresting with pandemic fatigue

By Greg Basky

In the early days of COVID-19, many Saskatchewan physicians were feeling anxious.

“They were waiting for the huge spike in cases that was predicted,” said Brenda Senger, the SMA’s Director of Physician Support Programs. “They were worried about protective gear to avoid bringing the virus home to their families. They wondered if they had the skills they’d need if they were redeployed.”

Over a year and a half into the pandemic, it’s fatigue that Senger and her counterpart, Clinical Coordinator Jessica Richardson, are increasingly seeing in the physicians and medical learners reaching out for help. The ongoing uncertainty is wearing, she said, because physicians like to be in control.

“Every week, there’s some evolution to battling this pandemic, some change that has to be made,” said Senger. “The ability of the system to keep up with the changes has become the greatest challenge or frustration for physicians. The pandemic is a chronic situation and chronicity is very wearing on people.”

Many of the calls to the Physician Health Program (PHP) are from physicians who are recognizing this fatigue and looking for tools to take care of themselves. “Self-care is often the first thing physicians will let go of, but now they’re finding that if they don’t attend to those things, the chronicity of it (COVID) is having a greater impact on them”.

Physician Health Program sees increased demand

Senger and Richardson are the first point of contact for physicians who reach out to the PHP, Senger in Saskatoon and Richardson in Regina. The pair do an initial triage to determine what type of support doctors and learners need. While they provide a lot of counselling themselves, they also refer physicians to the program’s consultant psychiatrists.

Saskatchewan’s physicians and medical learners are demonstrating the “help seeking behavior” promoted by Senger and Richardson. So far this year, 210 new people have accessed the Physician Health Program, bringing the total number of participants since the start of the pandemic to 369. Of these, nearly a third (31.2%) reported they were experiencing stress or burnout at work, 42% were wrestling with mental health problems, 24% were experiencing occupational challenges, and close to 16% flagged struggles in their personal relationships at home. Many PHP participants reported that they’d contracted COVID while providing care to others.

While more physicians are reaching out for support, that’s actually a positive, according to Dr. Alana Holt, one of the consulting psychiatrists who works with physicians and medical students referred through the Physician Health Program. “We feel it is very positive that physicians are paying attention to their own mental health and wellness at this time. It is vitally important that physicians and our healthcare teams remain well so they can provide sustained, quality care to the community during the pandemic.”

ASK YOURSELF AT THE END OF THE DAY: WHAT WAS ONE THING I DID TODAY THAT MADE A POSITIVE DIFFERENCE? WHAT IS ONE THING THAT FEELS REWARDING AND MEANINGFUL IN MY WORK TODAY?

Senger agrees. “There’s been a change in the culture as far as giving themselves permission to seek help. People are calling earlier and they’re not in crisis. They’re saying, ‘I need some more tools in my toolkit,’ or ‘I am really struggling more than I thought I would and I need some help.’ ” For many physicians, normal coping strategies such as socializing with friends and family were taken off the table by the pandemic.

A big focus for the PHP team has been helping physicians better manage uncertainty and stress. This often involves coaching doctors to reframe their perspective, says Dr. Holt, so that rather than feeling a lack of confidence because of all the uncertainty, they can instead focus on their strengths and how to use these to help patients.

What physicians can do to take care of themselves

Physicians need to be vigilant, said Dr. Holt, not to fall into old negative coping habits and instead practice strategies that will benefit their physical and mental health. It’s only by taking care of themselves that doctors will have the endurance to carry on providing top quality care to their patients through to the end of the pandemic.

With the increased workload from the pandemic and out-of-province travel curtailed, Dr. Holt said many physicians have continued to work week after week, month after month, without a break because they find it hard to stop and thus continue to work if they can’t get away. “It’s important that doctors take vacation time for restoration to reset and recharge, to prevent burnout and illness themselves.”

For many physicians, “making the conscious effort to take care also of themselves does not come easy,” said Dr. Holt, given their “sense of responsibility, commitment, and compassion for the patients they serve.” She encourages physicians to reflect on what brings purpose and meaning in their practice. She says staying mindful of the value of one’s work and the parts that are rewarding helps manage stress, prevent burnout, maintain wellness and even grow during this challenging time: “Ask yourself at the end of the day: ‘What was one thing I did today that made a positive difference (for a patient, a colleague, or team)? What is one thing that feels rewarding and meaningful in my work today?”

While some doctors have wrestled with burnout or feelings of loneliness from lack of social contact, the profession as a whole is holding up well, Senger said. When we emerge on the other side of this pandemic, there will be greater appreciation for how resilient people actually are, she said.

“We don’t know how resilient we are until we’re faced with a challenge,” she said. “Doctors get up every day, they go to work. They do what they have to do because it’s about taking care of patients and their colleagues. They’re coping. They’re adapting. And they’re adjusting...that’s what resilient people do.” ◆