Promoting clinician resilience and mental health during a pandemic
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By Gregg Miller, MD, and Herb Harman, MD
What a difference a pandemic makes. Thinking back over the past four months, many things that seemed impossible in February 2020 have become our “new normal.”
To protect patients, colleagues, and families, physicians have innovated and improvised as if building an airplane mid-flight. They have cared for patients in cars and mastered new telehealth platforms. Health care leaders have raced from patient visits to Zoom meetings to virtual team huddles to late-night paperwork (sometimes while rocking a fussy infant or homeschooling a teenager).
It’s probably fair to say that most clinicians have experienced some level of trauma due to the pandemic. They are managing a disease about which so little is known. Some are sleeping away from their families to protect them. Others have been threatened with layoffs and pay cuts. Many medical leaders have stretched themselves thin, advocating for the safety of their teams and keeping up morale.
And of course, all of this happened in a year when 42% of physicians had reported burnout symptoms even before the pandemic.
As past disasters have shown us, both health systems and individuals can be strengthened by hardship. This phenomenon, known as post-traumatic growth, isn’t an experience anyone wishes for. However, pain can often be a catalyst for needed change that simply can’t get traction under more comfortable circumstances.
Even when the potential benefits are enormous, paradigm shifts are a hard sell. However, since the arrival of the pandemic, we have seen provider organizations finally shift their mindset away from “have the patient come to me” to “meet the patient where they are.” An example of this is the hospital-at-home model that expands patient access to care and better scales clinical resources.
For individual clinicians, on the other hand, post-traumatic growth will likely come later and be much harder won. Clinicians still work under a cloud of uncertainty. Will the second wave coincide with flu season? Will health systems have the resources to handle surges in their communities? Will patients come back?
One of the best ways that health systems can promote post-traumatic growth and resiliency in the coming months is to invest in people. First and foremost, we need to alleviate health care workers’ safety concerns by ensuring preparedness that includes adequate PPE and staffing. It’s time to recognize that what little flexibility exists in hospital staffing capacity comes from the goodwill of physicians, advanced providers, and nurses themselves.
Just as importantly, clinicians must invite all members of their care teams into the process to evaluate current state and plan for the next phase. Feeling a sense of control over the uncertainty will help each of us process the trauma and ultimately embrace the disruption of this pandemic.
Covid-19 may represent health care’s darkest hour, but also a once-in-a-lifetime catalyst for transformation. Health systems can foster long-term physician resiliency by creating environments that take advantage of new, more flexible care models that work better for both clinicians and patients.
About the authors:
Gregg Miller, MD, is Chief Medical Officer at Vituity, overseeing performance-improvement programs and the development and dissemination of best practices. He provides leadership in the areas of risk management, quality, continuing medical education, CMS performance, patient experience, operations flow, and data management.
Prior to being appointed CMO, Dr. Miller was Program Director of Quality and Performance for Emergency Medicine for Vituity. He has served as the medical director for the emergency departments at San Joaquin Community Hospital and Swedish Edmonds Hospital and has been involved in the implementation of multiple operational and quality-related initiatives.
Dr. Miller sits on the American College of Emergency Physicians (ACEP) Quality and Performance Committee. He completed an administrative fellowship with Vituity, with a focus on CMS quality-related programs.
Dr. Miller attended medical school at the University of California, San Francisco, and completed his residency in emergency medicine at Harbor-UCLA.
Herb Harman, MD, is Regional Director for Acute Psychiatry at Vituity. He has more than a decade of experience practicing psychiatry in inpatient, outpatient, and emergency care settings. Before joining Vituity, he served as a U.S. Air Force psychiatrist and was deployed to Afghanistan as a Combat Operational Stress Control Officer. After returning to civilian life, he worked in several psychiatric emergency departments and later served as a medical director of outpatient psychiatry and brain stimulation services. His approach is to quickly speed patients to settings that promote recovery while ensuring safety. Dr. Harman is passionate about using technology to transform patient care. In 2010, he assisted in the development of an innovative telepsychiatry program on the East Coast. He joined Vituity as Associate Director of Telepsychiatry in 2016.