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Panelists discuss how to manage wellness during pandemic winter :

December 2, 2020

Be honest. How much time are you spending on self-care right now? For many pediatricians, the answer is “Not enough.”

To be effective in practice, pediatricians must take care of themselves, according to panelists at an AAP town hall, Physician Resilience in the Time of COVID-19.

Anne R. Edwards, M.D., FAAP, AAP chief population health officer, led panelists in a discussion on how to address high stress levels, communicate and connect, give and get help, replenish resilience and maintain a growth mindset.

Connect with others

The pandemic has caused patient volume to drop and forced practices into new routines. Robert J. Riewerts, M.D., FAAP, of Southern California Permanente Medical Group and KP Care Management Institute, noted a silver lining. Phone time at his practice increased from between 3% and 7% to about 40% as pediatricians reached out to check in on patients and families.

Early in the pandemic, Dr. Riewerts’ group also arranged weekly discussions with experts to allay concerns about the virus. Pediatricians unaccustomed to seeking support from colleagues were encouraged to reach outside their comfort zone.

“This year, physicians are being stretched to the limits in all kinds of specialties,” he said. Supporting one another can help pediatricians model a positive example for their patients.

Routine team check-ins can build support within practices and hospitals, according to Riva Kamat, M.D., FAAP, co-lead of the AAP Section on Hospital Medicine Subcommittee on Provider Wellness and a hospitalist at Inova Fairfax Hospital for Children.

Dr. Kamat suggests asking colleagues if they are feeling stressed. “Then let them, what I call, ‘slime you.’ Let them share what’s bothering them.”

Because most problems cannot be solved in one vent session, Dr. Kamat said it is important to stay connected with the person. She asks colleagues how they would like her to check in again, such as by text or a phone call. Her institution also uses accountability partners to ensure people are taking care of themselves.

COVID-19 has isolated us in every way, said Melanie L. Brown, M.D., M.S.E., FAAP, chair of the AAP Section on Integrative Medicine Executive Committee and member of the Wellness Advisory Group. But that shouldn’t stop pediatricians from maintaining connections. This can be done locally or through AAP connections such as Extension for Community Healthcare Outcomes groups, collaboration sites and COVID-19 discussion boards ( login required).

“Being able to find connections with other like-minded colleagues, you’re also modeling for other people the importance of them also finding connections,” she said.

Refuel resilience

The dark days of winter can be challenging for many, which is why pediatricians should take time to figure out what refuels their resilience and identify barriers preventing them from replenishing it, said Christine Moutier, M.D., chief medical officer, American Foundation for Suicide Prevention.

“Sometimes, we react in ways that we are pleased with and other days we don’t. We don’t have to feel like that is fate,” she said. “We can actually make small tweaks that allow us to have whatever that substance is, that reservoir of resilience, that will allow us to keep drawing from that moment by moment.”

Ideas include meditating, journaling, exercising, getting outdoors and confiding with like-minded colleagues.

Dr. Moutier also cautions not to make major life decisions when extremely stressed. Pediatricians should be aware of tendencies toward anxiety or depression, shed stigmas and be proactive.

Manage your mindset

When stress reaches a boiling point, Dr. Moutier suggests trying the “Put It In Perspective” approach to redirect thoughts from irrational to rational. The approach, developed by Martin E.P. Seligman, director, University of Pennsylvania Positive Psychology Center, includes four steps:

  1. Ask yourself: What is the worst possible situation?
  2. Force yourself to think about the best outcome.
  3. Then consider what is most likely to happen.
  4. Finally, develop a plan for the most realistic scenario.

When problems fester, Dr. Moutier said, “Give yourself the gift of just a moment of time that’s set aside to work that through. Any time and effort we spend on that is going to bear fruit for us.”

Dr. Brown added, “Taking care of yourself is not selfish. It’s what’s needed in order for you to go out and then care for others.”

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