HOW CAN HOSPITALIST GROUPS give their physicians the mental health support they need in a pandemic? Envision Healthcare, a national medical group, has found that peer support groups are a meaningful way to reach hospitalists, who often don’t want to talk to mental health professionals.
Envision’s peer support groups have been connecting hospitalists digitally during the pandemic. Stefanie Simmons, MD, vice president of patient and clinician engagement for Envision who lives in Ann Arbor, Mich., says talking to peers is key to getting hospitalists to open up.
“Research shows that physicians are much more willing to talk to other physicians than to clinical psychologists, social workers, hospital administrators and facilitators,” Dr. Simmons says.
“We acknowledge that what people are going through right now is trauma, not a hard day at work.”
~ Stefanie Simmons, MD
Here’s how the groups work: A physician peer facilitator begins a video conference session with a little small talk to warm up the group. Then, Envision works with a psychologist who talks about some common responses to trauma. “We acknowledge that what people are going through right now is trauma,” Dr. Simmons says, “not a hard day at work.”
The facilitator then asks participants some simple questions: What’s been difficult for you recently? And what are you doing that helps you get through those issues?
“You call on the first person and hear him or her talk about what’s been hard and what he or she is doing to make things better,” Dr. Simmons says. “The facilitator thanks that person for sharing, and we go around the whole group.”
Some peer support groups are centrally led across several hospitalist programs. Those sessions can attract as many as 30 clinicians.
Dr. Simmons says the sessions are designed to do two things. The first is to help build community. “You’ll hear people talk about the things they’re going through that are hard,” she explains, “and you realize they’re going through the same thing as you. That helps break down some of the isolation people feel.”
It also lets participants know that people they may admire, people who are doing a great job on the floor every day, are likewise struggling with something, she adds. “It makes it more acceptable for everyone to say, ‘This is difficult.’ ”
Another goal is to have hospitalists think about strategies they can use on their own through the use of the second question: “What are you doing to make things better?”
According to Dr. Simmons, group members have three basic answers to that question. Some say they don’t know what to do to help themselves and they’re not doing much. “That in and of itself can be an ‘a-ha’ moment for people,” she points out. “They think, ‘Is there something I should be doing that can help me?’ ”
Other people list the things they use to cope: going to the gym and working out every morning, or gardening on their days off and spending more time outdoors hiking.
“You get to hear what other people do,” Dr. Simmons says. “And you think, ‘I haven’t called my parents and checked in on them in a couple of weeks.’ Or ‘I don’t spend as much time in nature as I should.’ Or ‘I’ve drifted away from my faith, maybe I should reconnect on a spiritual level.’ ”
During a few calls, it becomes clear that someone isn’t doing well. At that point, the facilitator can follow up after the call and offer help. “You can say, ‘When we talked during the session, I could sense a lot of emotion in your voice. How are you really doing, and can we talk more?’ ”
A push to stay connected
Dr. Simmons has seen Envision’s clinicians using a variety of approaches to stay healthy during the pandemic. “They’ve been focusing on the positives and spending more time with their family,” she says. “People who have teens, tweens or college students back from school are really understanding that they would not have had this time were society normal now.”
They’ve also been having video gatherings with family and reconnecting with friends from medical school and residency, she adds. “Some have been keeping journals, writing down thoughts and reflecting.”
When one physician said the idea of keeping a journal made her feel like a 12-year-old girl, the group offered a suggestion. “They said, ‘Call it a captain’s log,’ ” Dr. Simmons recalls.
Mandatory for deployed physicians
One strength of peer support groups is that they are relatively low-cost interventions that small groups can use. “The interventions don’t cost anything other than organizational planning and human capital,” Dr. Simmons says. “They’re very portable.”
Because Envision is a leading national medical group with more than 27,000 physicians and advanced practice providers, it can give its clinician facilitators a 90-minute training course. Facilitators also receive a resource set that includes slides to use during the call and resources to refer people to afterward.
Envision makes the peer support groups mandatory for physicians who have been deployed to covid hot spots around the country. During the pandemic, for example, Envision sent hundreds of clinicians to New York and New Jersey at the height of the outbreak in the Northeast. It has also sent people to Texas, Arizona and Florida during surges in those areas.
“For deployed clinicians, we make the follow-up required because they have been in an extraordinary situation,” Dr. Simmons says. “In some cases, they’ve been away from friends and family for a month or so, working five days out of seven in a traumatic, high-stress situation.”
For physicians who haven’t deployed, attending peer support is voluntary. Given how busy everyone is, Dr. Simmons says, the goal is to offer the groups frequently and to make the meetings easy to attend.
“We encourage our facilitators to actively reach out to people to participate and to make the meetings happen at a time that works,” Dr. Simmons explains. “It may be right after a department meeting, and they may cut the department meeting short a half hour and then add this on. So the whole experience is 15 minutes longer, but you end up with 45 minutes of peer support.”
Edward Doyle is Editor of Today’s Hospitalist.
Published in the October/November 2020 issue of Today’s Hospitalist