By Dr. Marwa Saleh, MD
April 9, 2020
Scientists and manufacturers everywhere are working on vaccines, drugs, and low-cost ventilators to manage the coronavirus pandemic. Governments are building make-shift hospitals in many countries. It seems like everything is being covered, everything but the one irreplaceable link in the health provision chain—health care workers.
A Challenging Situation
In a population of health care professionals with soaring levels of burnout,1 the coronavirus pandemic has the effect of stabbing a fresh wound. Not only are doctors required to take on extra work load, their numbers are also dwindling by infection, quarantine, and even death. Health care workers risk their own health and risk carrying the infection home to their loved ones. With the worldwide shortages of protective gear, chances of infection are high, so if health care workers isolate themselves, they lose the much-needed emotional support their families provide.
To top it off, doctors have to make decisions they had never faced before, like deciding who should receive critical care when there are no longer enough ventilators to help save all patients. The system of triage is a new and confusing practice in high-resource settings. Having worked in a low-resource setting, I know that the stress is real. For every patient you send home because of the lack of resources, your heart cringes for fear that they may deteriorate.
Current Research and Reactions
Researchers in China conducted a cross-sectional study published in JAMA Network Open Journal in March 2020. The study involved 1257 health care workers in China during the coronavirus pandemic and reported troubling results; 50.4% had symptoms of depression, 34.0% reported insomnia, 44.6% reported symptoms of anxiety and 71.5% reported distress. “Working in the frontline was an independent risk factor for worse mental health outcomes in all dimensions of interest,” the researchers wrote.2
Leaders are advising health care workers to think of the pandemic as a marathon, not a sprint. But how long can health care workers hold up in these challenging conditions? According to the Associated Press, two nurses have committed suicide in Italy as the burden of the crisis bears down on frontline health care workers.3
“For every physician willing to risk their life to be on the front lines, I’ve heard another say, ‘I didn’t sign up for this,’ ” wrote Dr. JT Nakagawa (an ER doctor in New York) in an article for Medium’s new health and wellness digital publication Elemental.4
Expert Advice for Health Care Workers
If you ask any burnout coach, they will tell you that there is no magic pill—pulling out of burnout is an ongoing process of recharging and de-stressing.
Start by being compassionate with yourself. You are working in unusual circumstances under great stress and palpable fear. You have every right to feel frightened, anxious, and exhausted. You are in no way any weaker or less altruistic by having those feelings. Treat yourself kindly and acknowledge your feelings, don’t be guilty about them.
In an interview with Dr. Haidar Al-Hakim who is an ophthalmologist, author, and physician burnout coach based in the UK, I asked for advice to health care workers trying to navigate these difficult times. These are his recommendations:
Remember your mission
To counter the stressful effects of the crisis, look deep inside to find your “why”. “Remind yourself why you chose this path”, says Dr. Haidar. “We must learn to accept our present for what it is and have faith that everything happens for a reason,” he adds.
Build your resilience
Resilience will help you bounce back from stressful situations. It will help you view difficulties as challenges and become proactive in your response. Resilience is a trait that can be learned through practice. Dr. Haidar recommends building resilience through your preferred method, whether physical, psychological, or spiritual to help you face adversity.
Examples include: yoga, support groups, meditation, breathing exercises, and journaling.
Focus on the present
“Whatever you are going through shall end, and focusing on the present will give you the chance to be your best self,” says Dr. Haidar. Try not to think about the following weeks or months to come. Focus on doing the best you can with whatever means you have—now. Don’t stress about things that are out of your control.
Be realistic but stay positive
It is easy to drown in negative self-talk. “Reclaim your internal narrative and change it from a narrative of fear, division, and destruction to a narrative of construction, healing, and faith,” Dr. Haidar says.
Anticipate difficulties, but don’t let them turn you down. Quality of care may be affected but extraordinary times require extraordinary measures. Remember the patients you helped recover and the ones you helped comfort in the most difficult of times. What is more sacred than a life, and what is more noble than saving one?
The WHO advises health care workers to take care of themselves, eat healthy food, stay active, and rest sufficiently between shifts. They also recommend de-stressing in healthy ways and avoiding smoking or drugs.5
Try taking a walk home if possible, and while doing so, deliberately shut off thoughts related to your work day. Watching a funny movie or listening to soothing music can help lift your mood. Connect with your loved ones even if it is only through video-call. Journaling can be very effective and even therapeutic in dealing with stress.
Count your blessings. Even in the darkest times, we have things to be grateful about. Whether it’s your health, your family, your meaningful work. Being grateful will help you pull through difficult times.
Summing It Up
Burnout is common in medical professionals and the risk is even higher in frontline health care workers. Follow expert advice for self-care, de-stressing, positive self-talk, and focus on the present to help you fight burnout. Reach out to your peers for psychological support. You are in this together. If you are feeling overwhelmed, don’t hesitate to reach out for professional help. And even though it may not seem like it when you are deep in the trenches, rest assured, there is light at the end of the tunnel.
Harvard Medical School is providing complementary resources to health care workers managing COVID-19, which includes the recorded webinar: Coping with the Stress of Coronavirus.
1. WMA leader warns of global physician burnout. WMA press release. October 5, 2018.
3. Peltz J, Forliti A, Rising D, New York gets Chinese ventilators; Trump wants more thanks. AP News, April 4, 2020.
4. Nakagawa JT, This Is What Keeps Doctors Going During a Pandemic. Elemental. March 19, 2020.
5. Mental health and psychosocial considerations during the COVID-19 outbreak. World Health Organization. [PDF] March 18, 2020.
Author bio: Dr. Marwa Saleh is a cardiologist and medical writer who loves writing about cardiology, public health, and psychology. She combines her medical experience and writing skills to spread health literacy through writing. She is a proud member of AMWA and AHCJ.
*OPINIONS EXPRESSED BY OUR GUEST AUTHORS ARE VALUABLE TO US AT LEAN FORWARD, BUT DO NOT REPRESENT OFFICIAL POSITIONS OR STATEMENTS FROM HARVARD MEDICAL SCHOOL.