BY NOW, we are all too familiar with news videos of the selfless physicians, nurses and other staff working long hours to save the lives of covid-infected patients. Many look shell-shocked and exhausted. For some of us, those videos could have been shot in our own hospitals.
Without emotional support, we may never be the same.
In 2000, Albert Wu, MD, coined the term “second victim” to describe health care professionals who suffer secondary trauma following unexpected, adverse and/or traumatizing patient events. Without support to help clinicians process the injury, that vicarious trauma can have a long-lasting, even permanent, impact on their careers, their ability to function and, potentially, the quality of their care. Some turn to unhealthy ways to cope like excessive alcohol or drug use, while others leave medicine altogether. Tragically, some take their own lives.
Given the scope of this pandemic, addressing the impact of vicarious trauma and fostering resilience are now critical mandates. Leaders must provide emotional care for their front-line clinicians.
Sharing a heavy load
What would that care look like? First, hospitals and health systems should assume that every physician is—or will be— suffering from vicarious trauma. While we are taught that clinical depersonalization is necessary, we know that tightly compartmentalizing personal feelings after our shift ends is not healthy or sustainable. Every front-line worker will need to process fear, sadness and despair, whether or not we outwardly exhibit them.
Without emotional support, we may never be the same.
Second, leadership should not wait for signs that staff have hit rock bottom before they intervene. Instead, we should be proactive with supportive, nonjudgmental initiatives. Research shows that at any given time, one in three physicians is experiencing some level of burnout. This pandemic is likely to push many past the point of exhaustion into depression and hopelessness.
In the last two months, clinicians in our organization, Ob Hospitalist Group (OBHG), have cared for numerous pregnant women and delivered babies of infected mothers, all of whom are coping with fear in what would otherwise be a joyous occasion. To avoid letting vicarious trauma overwhelm our doctors and nurse midwives, we set up programs to help them acknowledge that trauma is both real and unavoidable.
We reach out, for instance, to our entire team nationwide multiple times a week and encourage them to participate in what we’re calling “Purposeful Pauses.” These are Zoom meetings held on different days and different times each week. Facilitated by Renee Lockey, MD, an OBHG hospitalist and team lead, each meeting features a different physician leader speaking on a topic such as gratitude, trust, morale and “what the new normal will look like.”
Attendance is voluntary, and attendees are encouraged to share as much as they want—or say nothing at all. We conclude each session with a collective moment of silence where we simply breathe together. Participants report feeling recharged by the opportunity to talk about experiences and connect with each other to help share a heavy load and feel less alone.
Opportunities to enhance well-being
Our teams also use our Web-based Ob Exchange platform to share experiences and crowdsourced advice.
Although clinically focused, Ob Exchange allows our national network to collaborate as though operating in one labor and delivery department, exchange new studies and approaches to care, and access the latest evidence about coronavirus. The platform helps onsite leadership work with hospital administrators on operational changes, such as training colleagues on the latest directions for PPE usage and authoring safety protocols on labor and delivery units.
That helps combat some of the uncertainties creating high anxiety for onsite hospitalists.
Hospital leaders should commit to similar short- and long-term programs that address the “second victim” phenomenon and enhance employee well-being. According to the National Institute of Mental Health, post traumatic stress disorder takes time to address. Some people recover within six months, while others have symptoms that last much longer. Even physicians who haven’t reached that level of trauma will need a safe space to recover.
It shouldn’t take a pandemic for organizations to recognize that this is a pervasive and ongoing need. A few years ago, our group took note of the growing trend of physician burnout, particularly as it affects obstetrics, where clinicians are responsible for not one life, but two, in a practice fraught with the potential for unexpected adverse events. Our research found that nine in 10 physicians did not feel adequately supported in coping with stress related to clinical care, while eight in 10 reported that they would be interested in counseling after an adverse event occurred.
In 2018, we launched the clinician-focused CARE (Clinician Assistance, Recovery & Encouragement) program, a first-of-its-kind peer support initiative for clinicians suffering from the psychological and emotional impact of an adverse event. The program is based on the “first responder” approach: After a traumatic event is reported, a volunteer CARE team reaches out to offer immediate emotional first-aid, followed by ongoing, peer-to-peer wraparound support.
We have no time limit on that support. Instead, clinicians proceed at their own pace and are encouraged to participate as long as they benefit. Although they are encouraged to avail themselves of other support programs, including those that are multidisciplinary and hospital-based, our research suggests that peer-to-peer communication with other OB hospitalists helps lessen any chance of stigma associated with seeking help.
We also encourage our clinicians’ support teams— either in the hospital or at home—to make confidential referrals to the program. That maximizes the potential to connect with clinicians who may not even be aware they need additional support.
It is our job to mend and cure and to “do no harm.” When those efforts fall short or patients suffer despite our best efforts, we often feel we have failed. By providing paths for clinicians to regain emotional health and find compassion for ourselves, hospitalist programs and hospitals can help the healers heal.
Mark N. Simon, MD, is an ob/gyn and chief medical officer of Ob Hospitalist Group, the nation’s largest provider of obstetric hospitalist services.
Published in the June 2020 issue of Today’s Hospitalist