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This Pandemic Threatens the Mental Health of Medical Providers

At your next office or Telehealth visit, take a deep look at your doctor’s face. Gaze above their tattered mask just below the greying hair and furrowed brow.

You will see what doctors are desperately trying to hide: despair.

Sadness, anxiety, and pessimism is a new pandemic infecting healthcare workers around the world. I see it daily. I feel it myself.

My colleagues are brave, professional, and committed. They are also fatigued, scared, and suffering. Many doctors lost patients, colleagues, friends, and family to COVID-19. Most providers have not; they are coming to work each day while the world is locked down. The anxiety stems from something deeper and more profound.

The uncertainty of the future

The uncertainty of the future is part of the problem. Intellectually, we know the virus will pass one day. Treatments will evolve. Vaccines are in various stages of clinical trials. Moderna reported positive early trial data. We will achieve herd immunity one way or another. The world will make it to the other side. But as we try to visualize these days on the horizon, our minds struggle to picture it.

Our future is fuzzy, hazy, and slightly out of focus. Short of a medical breakthrough, a surge is highly likely this fall. White House task force Dr. Fauci and CDC director Dr. Redfield are clear in their warnings. Medical workers dread a resurgence.

The thought of doing this again is unbearable.

The fear of the virus

For the first time in my career, I am not sure I am safe going to work. I think about my own death every day. Many of my friends updated their last will and testaments, making sure their families are protected.

I worry about getting infected. A nurse in Los Angeles, Celia Marcos rushed to perform CPR on a patient. She did her job but caught Coronavirus. She lost her life trying to save another. All healthcare workers see themselves in her story. We all would help a patient in need, and we can not help but wonder, “Could this happen to me?

I fear infecting others. We now know asymptomatic carriers of SARS-Cov-2 spread the virus before they develop symptoms. We wear face covers, wash our hands, and practice social distancing, including from our families. But still, we are concerned.

No doctor wants to be Patient Zero, the index case or vector that leads to an outbreak in a pork plant in Sioux Falls, South Dakota. No one wants to be the choir member who only wanted to share fellowship through music but infected the Skagit Valley Chorale in Mount Vernon, Washington.

Healthcare providers fear we may be the silent spreaders. When the fundamental nature of our job is to keep others safe, the idea we may infect others haunts us.

It takes its toll.

Tragic Healthcare worker stories

The constant barrage of horrific news strains our ability to get through each day. All of us need a mental break, a moment of peace, and tranquility. But healthcare workers must stay up to date with the fast-moving science and guidance on the virus. We follow the pandemic to better serve our patients.

We stumble on stories like Dr. Lorna M. Breen, the medical director of the emergency department at a hospital in New York. She contracted COVID-19. Amazingly, she recovered and returned to work to serve her patients.

But on a break at home with her family, Dr. Breen took her own life.

I did not know Dr. Breen, yet I wept when I read her story. Colleagues describe her as a happy, fun, and energetic person who was an incredibly dedicated servant to her community. She is another tragic victim of the pandemic. Her death will not be counted in the now 90,430 Americans who have died from Covid-19.

Frontline doctors in hard-hit areas are worn out from treating COVID-19. My city is not experiencing an overwhelmed hospital capacity. Yet, like many providers, I understand what she must have seen and what she must have felt. I can imagine the feelings of hopelessness, leading her to think the only way to make the pain stop was to die.

Physicians die by suicide at twice the rate of the general population. One doctor per day takes their own life. I pray those numbers do not increase as a result of COVID-19.

Stories of our colleagues’ deaths make healthcare providers more susceptible to post-traumatic stress, anxiety, depression, insomnia, and potentially suicide.

Lack of resources puts lives at risk

We are months into the pandemic. Physician Facebook groups still report a lack of PPE (personal protective equipment). My heart breaks as I read stories of nurses wearing trash bags in a desperate attempt to find protection. Most of us have seen the viral photos on Instagram of nurses suffering horrific face rashes as a result of wearing N95 masks all day.

My mother’s friends started knitting masks to send to workers in need. Our medical practice started a community organization to help get cloth, washable, reusable face covers to our community. We united local sewing groups on Facebook.

While seeing the community unite demonstrates kindness is more contagious than the pandemic, the truth is doctors and nurses should not have to find their own protective equipment. Bandanas, knitted face masks, and Facebook groups should not be the way the United States of America manages a pandemic.

The lack of necessary medical resources puts healthcare workers’ lives at risk and adds emotional strain as they seek to solve this national problem.

Governmental inaction leads to pessimism

Physicians’ betrayal feelings go beyond the lack of personal protective equipment. The lack of a national strategic plan to combat the pandemic causes doctors to lose faith in the government and health institutions.

We rely on the CDC and the NIH for patient management guidelines. Without a national plan, every doctor and hospital must determine safety protocols on their own. I work with three hospital systems. Each one has different policies on testing, face masks, visitors, surgery, and all other aspects of managing the pandemic.

Each day we receive multiple hospital emails and text messages with updated policies and procedures. Many contradict themselves. Trying to sort through the mixed messaging takes its toll. Many providers simply tuned out.

The disparity in care should not happen. National recommendations based on the best understanding of the available science should establish best practices across the country.

We should not be managing this health crisis one hospital at a time.

Another emotional blow hit this week when The Associated Press obtained a copy of the CDC strategic plan for reopening the economy. It turns out there is a national plan. Sadly, it was shelved by the White House.

The betrayal is bipartisan. The CARES Act was signed into law on Friday, March 27, 2020. The law offered much-needed help to the acute needs of hospitals, facilitating the production of critical supplies such as ventilators and PPE. But the law failed to consider the needs of the doctors who will run the ventilators and wear the masks.

While hospitals received millions from the PPP program, many independent doctors were left out. We see our friends losing their practices. Dedicated colleagues closing their offices. Meanwhile, three local nonprofit hospitals received millions.

Data reported in USA Today, an estimated 60,000 family practices will close and 800,000 of their employees will lose their jobs by the end of June.

Our country needs every available doctor in the country to fight the challenges of Covid-19. Independent medical practices face an immediate cash flow crisis threatening their ability to continue services. The pandemic created a cash-flow problem causing mass physician layoffs and closure of medical offices.

A world without doctors puts us all at risk.

We ask physicians to fight on the front lines, risking their lives without PPE and equipment. While most US physicians are committed to serving, are we really also asking them to lose their livelihoods?

From my personal experience, our practice successfully utilized the PPP program. We were one of the lucky ones. We combined the PPP program with across the board draconian temporary physician pay cuts. Finding a way to keep our office doors open, our staff employed, and our patients safe was our top priority.

The emotional weight was crushing.

Failing medical practices have a trickle-down effect. As the pandemic ravages our economy, unemployment rises to all-time highs. Patients lose their health insurance. The negative cascade will continue as the US uninsured population skyrockets. Patients’ only options may be taxpayer-funded Medicaid and public health options.

The domino effect triggered by a sudden shortage of healthcare workers will impact the sustainability of the private health insurance industry. A lack of action triggers an accidental move towards a single-payer system.

Some may favor the transition to a single-payer health system. A fundamental change in public health policy should not be an accidental, unintended side effect triggered by a pandemic.

Social media nonsense

Fear and panic fill our social media feeds. Click-bait headlines take us to untrustworthy news sites. Some friends do not take COVID-19 recommendations seriously. Some share false and inaccurate information. Each image of packed beaches or groups enjoying margarita’s on a patio is another punch in the stomach for healthcare workers.

The viral spread of unproven, misinformation is toxic for doctors. The popular internet meme of the day becomes the patients’ fears we face the next day. Politicians blindly endorsing Hydroxychloroquine is dangerous when not supported by validated scientific evidence.

After the hype surrounding Hydroxychloroquine, the FDA had to release a statement regarding the potential danger of using the drug outside of the hospital setting or in clinical trials. Now, we find out POTUS is taking it as prevention because in his words, “What do you have to lose?

Politicians promoting the curative effects of home cleaning agents forced Lysol to issue a warning not to inject or ingest disinfectants.

Televangelists exploit fear by peddling snake oil. The general public sees these stories. They spread online like wildfire. Celebrity physicians like Dr. Oz, Dr. Phil, and Dr. Drew have millions of fans who interpret their musings as facts. Their opinions may drive up ratings, but they are starting fires physicians in the field have to put out.

Doctors must be prepared to address these dangerous online falsehoods. We have a societal responsibility to provide scientific and validated care when using social media sites. It hurts all of us when we see colleagues promoting irresponsible content.

Youtube removed a controversial California Urgent Care center owners’ video downplaying the risk of COVID-19. The American College of Emergency Physicians and the American Academy of Emergency Medicine issued a joint statement against physician misinformation.

The conspiracy Plandemic video was almost too much to handle. Every doctor I know received multiple text messages asking our thoughts on this video. Dr. Zubin Damania AKA ZDOG MD’s response was better than any commentary I could possibly provide.

Case reports on Facebook should not trigger governmental actions. A small clinical trial posted on Twitter can not lead to changes in public policy. Doctors on Tik-Tok and Youtube should not determine when our economies reopen.

The lack of governmental leadership creates an information vacuum. Now doctors in the field must battle COVID-19 as well as the misinformation spreading faster than the virus.

Lack of testing

President Trump often says, “Everyone who wants a test can get a test.”

Doctors know this is not true. New York Colorectal surgeon Carmen Fong, MD shares her story of contracting the virus and her battle to get tested. Celebrities, NBA players, and a tiger at the zoo got tested. As a front line worker, she could not.

Even as testing scales across the country, the guidelines remain unclear. There is no national strategy or answer for basic questions: Who gets tested, where do they get tested, and what do we do with the results?

Physicians understand these are new technologies, and the accuracy studies are evolving. Regardless, those of us in medical offices every day need basic guidelines outlining the proper utilization of COVID-19 testing.

The lack of testing guidelines is another stress placed on healthcare workers who must implement a plan on their own. As testing systems improve, the next problem of contact tracing lies just around the corner.

Masks become the metaphor

Science shows face covers save lives by stopping the spread of COVID-19. The benefit of social distancing and face covers are supported by scientists, epidemiologists, hospitals, The Center for Disease Control, The World Health Organization, The Joint Commission, The American Medical Association, and The National Institute of Health.

But many people view face masks as a governmental intrusion on our freedom. We are Americans. We do not like being told what to do.

Physicians read contrarian opinions views on our social media feeds. Our friends have other views. The diversity of American opinions are part of what makes us a great nation. Our disagreements are also another source of frustration and social tension taking a toll on healthcare providers.

Doctors and nurses worry about ways to keep patients, staff, and their families safe. My children have not left the house in eight weeks.

As a physician, I openly admit I do not enjoy wearing a mask all day. Masks are hot, sweaty, sometimes suffocating, and fog up my glasses. Masks also interfere with my ability to interact with my patients. I like to see my patient’s faces. I want them to see my smile.

I wear a mask to protect my patients. The temporary discomfort of placing a mask over my face is a minor inconvenience with infinite gain; protecting those around me.

My mask is an act of kindness towards others.

Every unmasked face is a gut punch to healthcare workers around the world.

Previously Published on Medium

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