Lester Liao is a pediatric rheumatology fellow at The Hospital for Sick Children in Toronto and Canadian liaison of the International Doctor As A Humanist Association.
Damon Dagnone is an associate professor in the Department of Emergency Medicine at Queen’s University in Kingston, a committed medical educator, and the author of Finding Our Way Home: A Family’s Story of Life, Love, and Loss.
Over the last two months, the COVID-19 pandemic has reshaped our lives. People used to commuting through major cities, mingling among colleagues, enjoying restaurants and bars, visiting family members and travelling with relative ease have had to stay isolated at home, cooped up and glued to our screens. Video-conferencing programs have become primary modes of communication, replacing parties, gatherings, weddings and wakes. But now, as experts look at the numbers of new cases and deaths with cautious optimism, governments across Canada are beginning to lay out their plans to return to a life that’s as close to normal as possible.
But for some of us, this unprecedented moment has been compounded by a ramping-up of work that has filled us with increasing fear – and that might not change when we’re through the pandemic. Physicians and other health-care workers in particular have faced daunting obstacles: shortages of personal protective equipment (PPE), the threat of infection of a mysterious coronavirus, increased isolation from family members, and the psychic burden of knowing that numerous patients may die – or will soon.
There have been wonderful responses from our communities that have boosted morale in the short term. Restaurants have teamed up to deliver food to hospital personnel, and we have seen cheering, parades, and banners in the streets.
But the pandemic’s stresses cannot be withstood indefinitely. We need to take a long view regarding the realities and dangers of physician burnout. And we need to help our health care teams before the dam breaks.
A pre-crisis survey by the Canadian Medical Association found that approximately one in three physicians in Canada reports symptoms of burnout, with rates being highest in younger physicians. This is mirrored by trends in both the United States and the United Kingdom. American studies show that burnout is typically higher for both trainees and staff, relative to the general population. The prominent medical journal The Lancet has called physician burnout a “global crisis.”
This matters because physician burnout affects the entire system. Emotional exhaustion and decreased satisfaction are associated with decreased physician productivity, more errors and poorer-quality care, as well physician mental-health problems such as depression and suicidality. One Canada-specific 2014 study pegged the cost of burnout in early retirement and reduced clinical hours for one cohort of physicians over 26 years at $213.1-million. If we don’t work together to fight burnout at a critical moment like this, we will all face the consequences.
There are systemic and individual factors that contribute to burnout. For physicians, reducing the clinical workload in the short term is likely not feasible, but coming together can be part of a collective effort to bring community to our shared burden, which can seem overwhelming. Developing coping strategies to “unplug,” sharing vulnerabilities, and customizing personal wellness initiatives are good starting points. Let’s also remember that there’s less stress for everyone when we are gracious and patient with one another. We must move away from mental-health stigma within the profession and foster mutual supports.
For the leaders of health-care systems, consistent messaging, expert co-ordination and providing adequate resources would go a long way toward fighting burnout. This includes prioritizing essential resources such as personal protective equipment (PPE) and COVID-19 testing kits.
For the public, too, there are some simple but powerful ways to support all health-care workers. Much has already been said about the importance of physical distancing and self-quarantine. But small acts of kindness, such as saying thank you, can also go a long way. Be understanding that hospitals are burdened, avoid the emergency room as much as possible, and work with your local teams for alternate care plans. This helps us all.
There is one last point to emphasize, for all groups: We are people before we are physicians. That means we struggle and we make errors. Dollar metrics and clinical demands must not diminish our humanity. Physicians must not be treated like machines following programmed instructions. These concerns predate COVID-19, but we’re more vulnerable now and will be in the aftermath.
There is no magic fix for burnout. But we have a new window into the lives of our front-line health-care workers and how important their health is to our society. As the potential for burnout increases during this pandemic, we need to do everything we can to support everyone who cares for us. We can all play a part.
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