Recipe for More Burnout
Before the pandemic hit, 42% of more than 15,000 physicians responding to an online survey by the medical news website Medscape reported being burned out. High rates of depression and suicide in the medical profession have long been a problem.
Experts fear the coronavirus crisis will only make those numbers go up.
“When the stress of hospitals gets unbelievably high, it ceases to be a place where we get sustenance, or feel like we’re being helpful,” said Bradley Dreifuss, an emergency medicine physician and public health specialist at the University of Arizona in Tucson. “Instead we feel helpless.”
Dreifuss penned a New York Times editorial in June to draw attention to health care fatigue. He wrote the article from an Airbnb after nine consecutive shifts. For months he has lived there alone to protect his wife and 10-year-old daughter.
He says many of his colleagues are starting to withdraw emotionally and show increasing levels of cynicism, which inspired him to add mental health services to an initiative he started called HCW Hosted. At first, the online platform connected health care workers with temporary housing, but now doctors and nurses can access mental health support as well.
Dreifuss called the current situation “very, very challenging.”
“COVID patients are much sicker than our typical patients physiologically,” he said. “When you’re working with constrained resources and uncertainty, it makes it a lot worse.”
Extra Burden on Latino Doctors
The days began to blur together for Dinora Chinchilla, a pulmonologist specializing in critical care in Los Angeles County, where the virus has killed nearly 5,000 people.
“All I saw was COVID, COVID, COVID,” she said. “I didn’t know Monday from a Saturday. I felt like every day was on repeat.”
She is finally taking a few weeks off to refuel. Many days, when the 39-year-old looked around the intensive care unit, every single patient was connected to a ventilator. Most were older, overweight, diabetic and Latino.
“Seeing how disproportionately COVID has affected the Latino community and being able to be that person for them now is what I always wanted,” said Chinchilla. “But that comes with a big burden.”
As a kid growing up in East L.A., she dreamed of treating low-income families like hers. Bridging that barrier inspires her to work longer shifts than many of her colleagues, she says. Current COVID-19 protocols do not allow visitors inside the hospital, so she has insisted on personally calling the families of Latino patients, because she believes it’s kinder to deliver what is often devastating news directly rather than through a translator.
“It was just so emotional,” Chinchilla said, fingering the inside of a large silver hoop earring. “I can’t say that I didn’t cry often.”
The heartache didn’t end at work. When Chinchilla unlocked the door to her house, her two young children would run toward her. But she had to head in the opposite direction.
“How sad is that?” she said. “Not being able to hug your child when she’s so happy that you’re home because you’ve been gone for 14 hours.”
Chinchilla didn’t embrace her kids until she scrubbed herself raw in a scalding shower. And, now, even though she’s enjoying slower days at home recovering, her mind won’t relax.
“I feel that sense of duty,” she said. “This is my specialty. This is what I signed up for. I have to be there.”
Victor Cisneros, a 39-year-old emergency department physician, can relate. He treats patients in Orange County. His hospital is running out of beds for patients, many from families just like his.
“I grew up very underserved,” said Cisneros, smiling. “I come from a very humble family. I’m the first physician, the first person to graduate college.”
He’s originally from Mexico, but now much of his family lives in Los Angeles. Even though they live near each other, social distancing has made it hard for them to feel close. For Cisneros, the lack of physical contact is exacerbated because he lives alone.
“You just feel trapped,” he said. “Because you’re in the ER for 10 hours, which is intense, exhausting. It smells. People are vomiting. There’s blood.”
He used to disconnect from work by working out or going to dinner with friends. But now, his gym is closed and many of his friends don’t want to hang out, knowing he’s around sick people all day.
“So, I’m on a couch in front of a screen by myself. It’s almost like you’re in jail.”
He fears the current situation is not sustainable, especially for physicians who were already burned out. “This is probably the tipping edge for them,” he said.
Doctors aren’t known for seeking help, said Dr. Deborah Marin, a professor of psychiatry at Mount Sinai’s Icahn School of Medicine. “Suffering is kind of part of the profession to some degree,” she said. “But people shouldn’t be suffering.”
Marin directs a new program called the Mount Sinai Center for Stress, Resilience, and Personal Growth, designed to address mental health issues like depression, anxiety and post-traumatic stress disorder in health care workers.
“The idea is to shore up people’s resilience and be supportive of them,” Marin said. “They need to feel like they’re not in this alone.”
The program includes a hotline, a wellness app and workshops designed to help connect nurses and doctors. She says the most important step is to ask for help, which could mean starting a conversation with a supervisor, friend or a therapist.
Which could be good advice for not just doctors, but all of us.