Post-Pandemic Routine Is a Threat: Healthcare Professionals Will Probably Pay the Price
Will suicide rates for psychological decompensation increase? Can we prevent suicide amongst health care professionals, worldwide? How can we prepare?
As a urological surgeon with 35 years of clinical experience, I have gone through infectious ups and downs several times during my career. It frightens you. In a situation like a pandemic, health care professionals, local cleaning staff, lab assistants, janitors, are all exposed to infection every day. Most of them cope by performing, these have already disengaged. While professional behaviours are different from country to country, international news broadcasts allow us to see nurses crying from exhaustion with fresh lacerations on the back of their noses caused by masks; we hear of doctors collapsing from extensive working hours. Many grieve for the patients they had to let go.
In some countries, some professionals struggle with triage, the final judgment as to whether a patient should receive treatment or rather be left to die. They suffer that patients' relatives cannot see their loved ones one last time before they die. Some see corpses being transported away on trucks. In many countries, they are overwhelmed and in ethical conflict when there is a lack of personal protection gear for all at risk. Some feel left behind when they discover that protective personal equipment (PPE) is produced to fit the male body, not the female (when 75% of ICU personnel are female).
Images differ from country to country, even from region to region. Still, professionals do their job the best they can, even beyond their limits, without realising that time is passing without a specific date set to gain control of the pandemic. Uncertainty is something that many of theses specialists have not experienced in their profession before. At the moment, some governments are beginning to reduce the lockdown, while others fear a second or third wave of the infection.
How is this going to come to an acceptable end? How and when will we get back into safe territory - these are the fundamental questions that are not always constructively discussed.
Whilst more and more economic matters are currently pushed into the foreground of public discussion, there are no broad public discussions on the wellbeing of those who are currently still doing the work on or immediately about Corona patients: Will these professionals be able to continue working beyond their limits and return back to their routine once this is over? Or will they be stressed out after these weeks and months of devoted work? Besides their risk to be infected, will they get severely sick, psychologically, and physically?
In my research for this article, I look at the terms #burnout, #depression, #physician burnout, and #physician suicide. I found the following exemplary definitions: Burnout is roughly summarized as being drained to exhaustion without being able to recuperate. Whereas stress is being exhausted, but still able to recover from one day to the other.
What definition will apply to many or perhaps even most of the healthcare professionals after the pandemic? Will they be burned out, maybe even suicidal; how many will later suffer post-traumatic stress disorder? The answers to these questions will be different in every country, but their content will be similar.
As we cannot yet answer these questions, maybe KISS can help at this point: Keep it Simple, Sweety - i. e., be pragmatic answering these questions and take physician burnout as an example for burnout in other groups in- and outside the medical profession. One may consider KISS a rude and unscientific deduction, but it can help to realize that beyond COVID-19 there will probably be a greater lack of personnel throughout healthcare systems worldwide.
From my own experience, I consider working devotedly in an infectious environment a professional passion, however shortsighted, as continuous pressure bears a high risk of making everyone, not just a few, seriously sick. In full knowledge of these risks, many of these professionals continue helping patients for ethical and personal reasons, at the same time ignoring their own symptoms of increasing exhaustion.
Assuming this pandemic will keep us busy much longer than anticipated, we must see to it that healthcare professionals do not work themselves into exhaustion and burnout during the first phase of the pandemic. The preventive measures that we take now, must reflect the causes for burnout outlined in the American Medical Association's article.
According to the American Medical Association, in 2018 there were 9+ preventable common causes for physician burnout.
1) Long working hours
2) Sleep deficit
3) Lack of control over schedules
4) Experience of "depression" - left behind or overwhelmed
5) More-than-ever non-medical tasks
6) Excessive paperwork requirements
7) Little or no time to wind down
8) Family pressures
9) Fear for future
Two years after publication, these causes remain the same. We have seen how the pandemic is deeply influencing devoted work. Colleagues get sick and even die; some fear a second wave on top of their current exhaustion. I have mentioned that many feel left behind and helpless when confronting their administrators.
It is not just up to the physician to tackle their problems with burnout, as he or she might already be too affected to recognize the symptoms. It should remain the obligation of governments, employers, hospitals, organizations, and even family, to be aware of the consequences of continuous devotion at work that can appear later on in someone's life.
The treatment of burnout is not standardized. Often, the necessary treatment in the course of extreme workload is challenging, as it is a long-lasting process. Some of the suggested methods are, at least in part, controversial. They definitely do not apply in times of crisis.
Overall working conditions are the major cause of physician burnout. They should and can be tackled even in times of crisis. The major obstacle: Professionals and their teams feel that they simply lack time. Their approach to seeking help is frequently slowed significantly by the professional's own limiting beliefs.
What can and what must any medical professional do by him- or herself?
The Declaration of Geneva was adopted by the World Medical Association (WMA) General Assembly on October 14, 2017, in Chicago. It now states: ...I will attend to my own health, well-being, and abilities in order to provide care of the highest standard.1
It is not just a right, but an obligation to preserve one's own health, knowledge, and standard as a physician.
Personal prevention of physician burnout should start with mindfulness and self-awareness, and it could continue with peer coaching. The ideas resulting from such simple changes of attitude will not harm any patients, nor fellow colleagues. These measures should not consume more than 15 minutes per day. They can, in general, help to significantly improve burnout symptoms. If this should fail, professional help is still applicable, even in times of a pandemic.
My thoughts might sound in part fictitious, or idealistic, but the pandemic is real, what it has caused so far is visible globally. In my humble opinion, it is not only justified to think ahead, but it is also mandatory. If we do not take care of our devoted healthcare professionals by trying to tackle aspects of burnout prevention, the next wave of the pandemic will result in even greater losses of much needed specialists in healthcare systems globally.
A colleague recently noted that healthcare professionals are "molded to be led"; meaning: They are devoted to their profession. Turning this around, from passive to active: Although there are nine major causes for developing physician burnout, there is only one core cause for it: The lack of self-awareness.
If one actually does not know how to get out of a crisis, others will lead, however not necessarily into the desired direction. Then the following will become true: "after the crisis" will become "before the crisis" (adapted from "Nach dem Spiel ist vor dem Spiel" - Sepp Herberger 1954, Coach of the West German national soccer team: "After the game is before the game").
Written by: ©IV2020 - Dr. med. Markus Künkel, MD, Tutzing, Germany
About the Author
Dr. med. Markus Kuenkel, MD, FEBU, is working as a self-awareness coach, speaker and burnout consultant offering web-based support for healthcare and other professionals
Based on his own experiences as a urological surgeon and his research Markus advises his clients: Despite all the acute pressure, manage to plan ahead with your own life and career; become self-aware of your own physical and psychological needs; achieve peak performance without damaging your health, nor your soul; take your professional and personal future back into your own hands: In other words: Master self-management.
References:
1. Parsa-Parsi, R. (2017). The Revised Declaration of Geneva. JAMA, 318(20), 1971. doi: 10.1001/jama.2017.16230
2. Panagioti, M., Geraghty, K., Johnson, J., Zhou, A., Panagopoulou, E., & Chew-Graham, C. et al. (2018). Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction. JAMA Internal Medicine, 178(10), 1317. doi: 10.1001/jamainternmed.2018.3713
Related Content:
The Nine Most Common Causes For Physician Burnout and Nine Expert Ways To Tackle Them
Contact Dr. med. Markus Kuenkel, MD, FEBU:
For further information and support on burnout prevention: FB group "BuriedinBurnout".