Editor's note: For the latest news on COVID-19, visit https://www.aappublications.org/news/2020/01/28/coronavirus.
As COVID-19 began to spread, questions piled up for Martha C. Middlemist, M.D., FAAP, and her colleagues in their Denver-area practice.
How will this virus affect children?
Can the practice continue to see patients?
How do we keep up with the constantly evolving research and guidance?
How will the practice survive financially?
How do we keep ourselves healthy?
How do we protect our families when we return home?
“The phase at the very beginning when all of this started to happen … it felt very frenzied, very chaotic and out of control,” said Dr. Middlemist, a member of the AAP Board of Directors.
Some physicians also are facing patient fatalities, shortages of personal protective equipment and extra-long shifts. The recent suicide of an emergency department doctor who had been treating COVID-19 patients in New York City sent shockwaves through the medical community and served as a warning about the emotional toll the pandemic is having on health care workers.
Regardless of the setting, Christine Moutier, M.D., chief medical officer at the American Foundation for Suicide Prevention (AFSP), is stressing how crucial it is for physicians to care for themselves in addition to their patients.
“Remember you are a human being and all human beings need rest and the basics of self-care,” she said. “You’re not taking a luxury by affording those things you would recommend to your patients for yourself. In fact, you’re ensuring you retain yourself as a resource for your patients the best you possibly can by prioritizing your rest and your well-being.”
Developing resilience through self-care
Dr. Moutier looks at resilience as a reservoir that is drained by experiences like loss, rejection, sleep deprivation, humiliation and triggers for past trauma. To prevent the reservoir from becoming dangerously low, physicians can fill it by practicing self-care through sleep, healthy eating, exercise, social connection and affirmation. Processing conflict also can fill the tank.
“By that I mean talking out anything that has created a sense of distress or uncertainty or conflict in your mind and that could be a thousand different little things or big things that happen during a work shift or in your relationship at home,” Dr. Moutier said. “I don’t think any of us in our society let alone physicians were trained and taught how powerful it is and how preventive it is to talk that out.”
This is especially crucial for people with a history of depression, trauma or substance abuse who should connect or reconnect with mental health professionals.
“It will protect your health and your ability to keep functioning at the highest level you can in your responsibilities and your patient care,” Dr. Moutier said.
Other self-care measures may include setting goals, practicing gratitude, reading, journaling, meditating, setting boundaries, making donations and creating retreat space in your home, according to the AFSP.
When uncertainty builds, Dr. Moutier recommends pausing to think about what is and is not in your control.
“It allows your mind to organize itself … putting some definition to what otherwise feels like a big ambiguous black cloud of unknown and uncertainty that just triggers our anxiety,” she said.
She also shared advice from Martin Seligman, Ph.D., director of the University of Pennsylvania’s Positive Psychology Center — think about the worst-case scenario, think about the best-case scenario, then think about the most realistic scenario and make plans based on that (https://bit.ly/2LkZV8g).
Caring for colleagues
In high-stress situations, caring for colleagues can be as simple as taking a few minutes to ask how they are feeling, if they are getting enough rest or if a recent patient took a toll on them.
Warning signs that they are becoming overwhelmed may be apparent in changes in their behavior like showing up to work late, looking haggard or losing their temper easily.
Dr. Moutier said gut instinct often will kick in and sound the alarm when someone has gone beyond normal stress. Physicians who are worried a colleague may be having thoughts of suicide can express their concerns to the colleague about what they’ve noticed, give them a safe space to open up, acknowledge their situation sounds challenging and ask if they are having such thoughts.
Find out what they are doing to cope and determine if thoughts of suicide are fleeting or if they are making plans, she advised. If it is the latter, immediately lead them to help.
The National Suicide Prevention Lifeline at 800-273-8255 can provide guidance.
Creative ways to boost morale
In Dr. Middlemist’s practice, pediatricians continued to see patients after putting some precautions in place. Several physicians started organizing wellness activities to boost the mood such as sharing memes and pictures of their pets. They also started posting videos on social media of their pediatricians, nurses and staff getting dressed up and reading children’s books, which they have dubbed Read with Peds5280, named after their practice. Donning a pig hat, Dr. Middlemist kicked off the initiative reading “Pigs Aplenty, Pigs Galore!”
She said morale has improved dramatically.
“It has brought a lot of happiness and people talking about something other than COVID,” she said. “And the feedback from our patients has been great.”
Dr. Moutier applauded the practice’s creativity.
“We love to help others, and if we see that happening and see the fruit of our labor, it’s very gratifying,” she said. “And something that builds up that resilience tank as well.”