Speaker 1: Hi everyone. Before we begin this episode, we just wanted
Speaker 1: to issue a content warning that this episode does contain
Speaker 1: discussions surrounding depression, anxiety, substance use, self harm, and suicide.
Speaker 2: So my name is doctor Kurtica Capoli. I'm an infectious
Speaker 2: disease physician at the Medical University of South Carolina. My
Speaker 2: background is in emerging infections, biosecurity, and global health. And
Speaker 2: over the past ten years since I finished my training,
Speaker 2: I've spent half the time living internationally and the other
Speaker 2: half of the time living domestically, and the time living
Speaker 2: internationally has been spent really working on emerging infections and
Speaker 2: pandemic response. I was in West Africa during the twenty
Speaker 2: fourteen of Bowl outbreak whereas the medical director of an
Speaker 2: ebola treatment unit, and after that I was part of
Speaker 2: a US government initiative helping to develop a clinical trial
Speaker 2: capacity for therapeutics in the event of a high consequence
Speaker 2: pathogen outbreak. I've also worked in numerous disaster zones in
Speaker 2: the aftermath of natural disasters, and I feel like all
Speaker 2: of that background really has helped prepare me to work
Speaker 2: during this public health crisis for facing here in the
Speaker 2: United States and in the world because of the COVID
Speaker 2: nineteen pandemic, and this has been a really challenging year.
Speaker 2: Sometimes I forget that it's only been a year and
Speaker 2: a half because it feels like it's been ten years.
Speaker 2: And there are days when I am walking into the
Speaker 2: hospital that I'm exhausted and I feel empty, and I
Speaker 2: don't want to hear the word COVID anymore. And I
Speaker 2: think that sometimes I hear people use the word hero
Speaker 2: and it makes me cringe because I don't feel like
Speaker 2: we are heroes.
Speaker 3: I feel like we are really lucky that we are.
Speaker 2: Trained to be able to take care of patients that
Speaker 2: are sick and need our help, and that I'm just
Speaker 2: doing my job, just like anybody else would be doing
Speaker 2: if they were in this situation. And I feel like
Speaker 2: that label at times puts undue pressure on us to
Speaker 2: do some superhuman type of thing that we may not
Speaker 2: be able to do, when all we need to do
Speaker 2: is just treat our patients with the care and compassion
Speaker 2: that they need. And about how this pandemic is going
Speaker 2: to affect our healthcare workers. I feel like I have
Speaker 2: some insight because when I returned back from West Africa
Speaker 2: after the Abola outbreak.
Speaker 3: It was really difficult for me.
Speaker 2: I had visions of some of the patients I took
Speaker 2: care of. Some of the situations I had been placed
Speaker 2: in continued to run through my head and it took
Speaker 2: me a long while to work through that. And I
Speaker 2: fear that some of our healthcare workers who have been
Speaker 2: in extremely intense situations are going to have the same problem.
Speaker 2: On top of the fact that this pandemic has been
Speaker 2: drawn out for so long, and I feel like every
Speaker 2: time we see another surge, it's just another layer of
Speaker 2: exhaustion that people feel, and I hear it from my colleagues.
Speaker 2: I hear it from my friends who are just really tired,
Speaker 2: and I'm starting to see it as well. I see
Speaker 2: personality changes in people that I never even used to
Speaker 2: hear a crossword from. I've seen people who are older
Speaker 2: thinking about retiring or stepping back, and this will affect
Speaker 2: our entire profession. I think for myself, some of the
Speaker 2: things that I worry about is when I came back
Speaker 2: from West Africa, I noticed that I had somewhat of
Speaker 2: a more disconnected feeling, and I noticed that I have
Speaker 2: that now. It's not so much that I don't care
Speaker 2: about my patients or I don't care about people, but
Speaker 2: there's definitely some sort of detachment, and I think that
Speaker 2: part of that is to protect myself, and I think
Speaker 2: other people do that too, as a way to protect themselves.
Speaker 2: And I think we should all be cognizant of that
Speaker 2: because this has been a very difficult time for all
Speaker 2: of us in the healthcare field. We don't just have
Speaker 2: the same structures as everybody else, but then we also
Speaker 2: have the increased demands of trying to care for our patients.
Speaker 2: And since this has been going on for over a
Speaker 2: year now, it's felt like a marathon, and it's a
Speaker 2: marathon that for some of us we don't see ending
Speaker 2: anytime soon. We need support just like everybody else. And
Speaker 2: I hope that people who are out there listening to
Speaker 2: my story and everybody else's story remembers that, and hopefully
Speaker 2: as we see this small light at the end of
Speaker 2: the tunnel with our vaccines, which are wonderful, we can
Speaker 2: all remember that and remember that we need to come
Speaker 2: together as we try to end the coronavirus pandemic. Thank you.
Speaker 4: I work as an ear nurse in a regional hospital
Speaker 4: in Montana. The second wave of COVID was really our
Speaker 4: first and while we were not nearly as devastated as
Speaker 4: places like New York or Houston, we were pretty battered.
Speaker 5: You know.
Speaker 4: It was a series of crises of you know, short
Speaker 4: staffing because coworkers were getting really sick, a huge surge
Speaker 4: of patients from all around the region that needed hospitalization,
Speaker 4: with our capacity well above one hundred and twenty five
Speaker 4: one hundred and fifty percent. I mean, it was wild
Speaker 4: holding vented ICU patients in the er, dealing with the
Speaker 4: just rampant misinformation, but you know, just worst of all,
Speaker 4: it is just you know, dealing with how sick these
Speaker 4: patients could get. I wanted to share specifically Mikes experience
Speaker 4: with two patients. I think they're both good representations of
Speaker 4: what COVID can do to people and what we've been
Speaker 4: seeing at the bedside. You know, patient number one. She
Speaker 4: was my mother's age, in her fifties, and I had
Speaker 4: started my shift with her on two leaders nasal canula,
Speaker 4: which is basically just bare minimum boxygen requirement. And I
Speaker 4: ended my shift calling your family to let them know
Speaker 4: it did not look good. She had progressively worsened throughout
Speaker 4: the day with her work of breathing getting worse and worse,
Speaker 4: and she was she entered that third stage of COVID
Speaker 4: that we all so dread, and she went in to
Speaker 4: car to pulmonary arrest four times after we had intibated her,
Speaker 4: and then she arrested four more times in the ICU.
Speaker 3: Before they finally called time of death that night.
Speaker 4: Patient two was a thirty something year old that you know,
Speaker 4: had started again with just bare minimum oxygen requirements just
Speaker 4: three days prior. I mean, she was borderline and home,
Speaker 4: you know, when she'd come to the hospital and I
Speaker 4: assumed care of her as an er impatient a few
Speaker 4: days later, and I just I knew in my heart
Speaker 4: when I walked in her room, I was going to
Speaker 4: interbate her by the end of my shift.
Speaker 3: Within four hours of that shift.
Speaker 4: No matter how much proning we did, how much oxygen
Speaker 4: we gave her, you know, how much support there was,
Speaker 4: I could never get her above about seventy eight percent
Speaker 4: saturation normal, being of course ninety five to ninety eight.
Speaker 3: At one point she dropped to thirty percent, a true
Speaker 3: real life.
Speaker 4: Thirty percent of the monitor. And I have only seen
Speaker 4: that a few times in my career pre COVID. Within
Speaker 4: that time, the hospitalist had transferred her care to the
Speaker 4: ICU doctor, whom I called down saying, you know, it's
Speaker 4: it's time, she's were it's this or nothing.
Speaker 3: You know, it's this or.
Speaker 4: She dies, and we intibated her and then eventually I
Speaker 4: got her transferred upstairs for a time I'd heard that
Speaker 4: she was making some recovery. I do not know, though,
Speaker 4: how things have turned out. And you know, sorry, these
Speaker 4: guys really they tellget my hearts because they just there's
Speaker 4: particular things with these patients that you know, I got
Speaker 4: kind of close to them, and you it's a sense
Speaker 4: of failure in a way once you get to that point,
Speaker 4: once you know, you start intubating because we just we know,
Speaker 4: we know that there's nothing more we can do. And
Speaker 4: I'm really tired. I'm so tired of COVID. I have
Speaker 4: spent time as an ICR nurse. I'm no stranger to death.
Speaker 4: Bad bad flu seasons in the past have of course
Speaker 4: been devastating, but you get used to saving thirty, forty, fifty,
Speaker 4: even sixteen seventy year olds. You know, it's a It
Speaker 4: was a well established expectation that for that age group,
Speaker 4: that for the most part, barring complications, patients with respiratory
Speaker 4: illnesses have a good chance of making recovery with you know, careful,
Speaker 4: with the right care and you know ventilator management.
Speaker 3: Just now, there's no such expectation.
Speaker 4: And if we have to put a patient on BiPAP
Speaker 4: or god forbid yet the incubatum, it's like a sinking
Speaker 4: feeling of loss. And in all my years of nursing
Speaker 4: and nursing education, I've just I've never seen anything like it.
Speaker 3: Hello.
Speaker 6: My name is Christy and I'm a registered nurse in
Speaker 6: New York City. I graduated in May twenty nineteen, and
Speaker 6: when the pandemic hit, I was still in a fellowship
Speaker 6: training to become an er nurse. I remember the panic
Speaker 6: that started hitting all of us as we saw more
Speaker 6: and more patients show up to the er with COVID symptoms,
Speaker 6: And what really shocked us was how young they were,
Speaker 6: how unpredictable this thing seemed to be. In April, I
Speaker 6: got a phone call that I was being reassigned to
Speaker 6: a makeshift COVID floor that had been refashioned from an
Speaker 6: outpatient surgical center. The first thing I arrived to start
Speaker 6: my shift, I saw a giant truck outside the building.
Speaker 6: It reminded me of the truck to see around New
Speaker 6: York when they were filming a movie. I was later
Speaker 6: told that this was the refrigerated truck to hold the
Speaker 6: dead bodies that were outpacing the hospital morgue. Every shift
Speaker 6: began that way, walking past that truck like a symbol
Speaker 6: of what felt like the futility of trying to save
Speaker 6: the people who were dying. Working on the floor was
Speaker 6: a type of nursing that I hadn't trained for and
Speaker 6: that I never planned on doing. Most of the patients
Speaker 6: where I worked had do not resuscitate and do not
Speaker 6: intobate orders, so I was there to provide them comfort
Speaker 6: care as they died. The image of these people gasping
Speaker 6: for air as I slowly slipped away, as an image
Speaker 6: I can't erase from my mind, and I think it
Speaker 6: will hold onto my whole life. I spent twelve hour
Speaker 6: shifts in this windowless floor and layer upon layer of
Speaker 6: protective gear. I saw patients die, and I saw other
Speaker 6: patients have emotional breakdowns from being sequestered from their families.
Speaker 6: I think most people that become a nurse do so
Speaker 6: so they can help comfort and heal people, and for
Speaker 6: so many of us, we didn't feel like we were
Speaker 6: able to do either for our patients, and that, more
Speaker 6: than anything, has broken in our spirits. Eventually, when the
Speaker 6: surge lifted, I got to go back to the er,
Speaker 6: where a new normal has set in of wearing protective
Speaker 6: gear for entire shifts, always concerned that any patient could
Speaker 6: be carrying this virus. I'd say at least half the
Speaker 6: staff has gotten COVID and many are dealing with long
Speaker 6: haul symptoms such as brain fog and shortness of breath.
Speaker 6: I was able to get my vaccine on the second
Speaker 6: day it was available in the United States, and although
Speaker 6: I was nervous and had my concerns, I had seen
Speaker 6: the devastation and the long term effects of COVID enough
Speaker 6: that I was willing to take the chance. I thought
Speaker 6: it would give me some sort of peace of mind
Speaker 6: to be vaccinated. But work is still full of anxiety
Speaker 6: and fear due to the variants. So many patients who
Speaker 6: are now testing positive admidst taking vacations or going to
Speaker 6: large underground parties in New York. And there's nothing that
Speaker 6: frustrates us of healthcare workers more. For a brief time,
Speaker 6: the world was clapping for us, and everyone seemed to
Speaker 6: tire of that and tire of trying to stop this
Speaker 6: thing from spreading and mutating. I've started attending therapy for
Speaker 6: my sleep issues and have been told I have pta
Speaker 6: SD From the last year of work, I'm haunted by
Speaker 6: the faces of people I watched die, but I also
Speaker 6: try to remember the rare, beautiful moments of the last year.
Speaker 6: I had one patient who wanted to watch baseball last spring,
Speaker 6: and I had to explain to him that the sport
Speaker 6: had been canceled for the season, so instead I pulled
Speaker 6: up an old Mets game on the iPad and sat
Speaker 6: with him for a couple of minutes to watch it.
Speaker 6: He told me he wished he could buy me a
Speaker 6: hot dog. A year later and baseball is happening again,
Speaker 6: but he is dead. I, like so many people, desperately
Speaker 6: want this thing to be over, but part of me
Speaker 6: doesn't know if I see an end date anytime in
Speaker 6: the future.
Speaker 1: Thank you again to everyone who provided a first hand account.
Speaker 1: Those were incredibly powerful, and we really appreciate you taking
Speaker 1: the time to share your story with us, and for
Speaker 1: also everything that you're doing to fight this pandemic.
Speaker 7: Yeah, definitely. Hi, I'm erin Welsh and I'm erin Alman Updike.
Speaker 1: And this is this podcast will kill you.
Speaker 7: It sure is. Welcome to the seventeenth episode. What it's
Speaker 7: a lot of episodes, it's a lot of our Anatomy
Speaker 7: of a Pandemic series. In each episode of this series,
Speaker 7: we've been taking a closer look at a certain aspect
Speaker 7: of this pandemic, from virology to economics, from spillover events
Speaker 7: to schools. And in one of our earlier episodes, we
Speaker 7: discussed some of the mental health impacts that this pandemic
Speaker 7: has been having on the general public, as well as
Speaker 7: some coping strategies for how to deal with the stress
Speaker 7: and anxiety that a lot of us are feeling. With
Speaker 7: this episode, we wanted to revisit the mental health impacts
Speaker 7: that this pandemic is having, but on a very specific
Speaker 7: group of people, frontline healthcare workers.
Speaker 3: Yeah.
Speaker 1: But before we get into that, it's quarantiny time, It's
Speaker 1: quarantin any time. What are we drinking this week?
Speaker 7: Well, Aaron quarantiny seventeen, yeap quarantiny seventeen.
Speaker 1: Ey oh, I like that the quarantine seventeen or seventeeny
Speaker 1: is essentially a clover club, which if you don't know
Speaker 1: what that is, it is basically gin grenadine or raspberry syrup,
Speaker 1: lemon juice and egg white and you kind of shake
Speaker 1: it up and it looks quite beautiful.
Speaker 7: I must say, it's so gorgeous. I think it's one
Speaker 7: of the prettiest quarantinies ever.
Speaker 1: I think so too. Yeah, we will post the full
Speaker 1: recipe for our Quarantine seventeen as well as the non
Speaker 1: alcoholic place rita on our website this podcast will Kill
Speaker 1: You dot com as well as on all of our
Speaker 1: social media channels.
Speaker 7: Yeah, any other business, Aaron, our usual suspects?
Speaker 1: Yeah, why don't you take us through it?
Speaker 7: Aerin all right, we have a website. You can find
Speaker 7: everything there.
Speaker 1: Yeah, basically, we have a website.
Speaker 7: We have a website. It's this podcast will Kill You
Speaker 7: dot Com.
Speaker 1: Check it out. There's a bunch of fun stuff there.
Speaker 7: Okay, moving on, moving on.
Speaker 1: So let's get into the actual meat of this episode.
Speaker 1: Let us frontline healthcare workers, doctors, nurses, respiratory therapists, nps,
Speaker 1: pas mas. So many people have been involved since day
Speaker 1: one in the direct care of people sickening and dying
Speaker 1: from COVID nineteen, and since so much about this virus
Speaker 1: and disease, especially in the early months, was unknown, it's
Speaker 1: been a really difficult road to say the least. Providers
Speaker 1: have been dealing with overloaded hospitals, a lack of adequate
Speaker 1: personal protective equipment, in watching patients die alone without family
Speaker 1: or friends there for comfort. And we've heard a lot
Speaker 1: of this healthcare heroes narrative in the media, but healthcare
Speaker 1: workers are human beings, not superheroes. And this year has
Speaker 1: put an incredible amount of stress on the healthcare system
Speaker 1: and on our providers as individuals.
Speaker 7: Yeah, and that is on top of a system that
Speaker 7: is already stretched, where healthcare providers are already suffering from
Speaker 7: things like burnout and depression at higher rates than the
Speaker 7: general public, and often with little or no support for
Speaker 7: their mental health from the healthcare system in which they work.
Speaker 7: So we wanted to focus today on the impact that
Speaker 7: this pandemic is likely having in the immediate and the
Speaker 7: long term the mental health of frontline healthcare workers. But
Speaker 7: also we wanted to take a broader view to examine
Speaker 7: what kinds of structural issues in the healthcare system contribute
Speaker 7: to the problem to begin with.
Speaker 1: Yeah, and we were fortunate enough to interview an expert
Speaker 1: on this topic, doctor Michael Myers, a psychiatrist who specializes
Speaker 1: in treating other physicians and healthcare workers, and who is
Speaker 1: also a professor of clinical psychiatry at Sunny Downstate Health
Speaker 1: Sciences University in Brooklyn, New York. His newest book, titled
Speaker 1: Becoming a Doctor's Doctor, is a memoir of his journey,
Speaker 1: and he joins us in this episode to answer so
Speaker 1: many of our questions about the underlying issues that contribute
Speaker 1: to mental health struggles and healthcare providers, as well as
Speaker 1: how the COVID nineteen pandemic has exacerbated these This interview
Speaker 1: was recorded on March twenty ninth, twenty twenty one, and
Speaker 1: we also wanted to mention that there were some sirens
Speaker 1: that went off a few times while we recorded, so
Speaker 1: you may hear those in the background, so just keep
Speaker 1: that in mind, and we will let him introduce himself
Speaker 1: right after this break.
Speaker 5: My name is Michael Myers. I'm a psychiatrist. I'm a
Speaker 5: professor of clinical psychiatry actually at Sunny Downstate Health Sciences
Speaker 5: University in Brooklyn, New York. I'm a former Training Director
Speaker 5: in psychiatry. But since I've semi retired, what I do
Speaker 5: now is that i'm the ombits person for our medical school,
Speaker 5: meaning that I investigate any complaints that our students have
Speaker 5: about miss treatment, and I also serve on the medical
Speaker 5: Student Missions Committee. So I'm a specialist in physician health.
Speaker 5: I've written extensively on that, and I'm excited about my
Speaker 5: most recent book, which is called Becoming a Doctor's Doctor.
Speaker 5: Mmoir excellent.
Speaker 7: Thank you so much for taking the time to chat
Speaker 7: with us today. We're really excited to speak with you.
Speaker 7: So our first question is just if you could tell
Speaker 7: us a bit about how you became interested in the
Speaker 7: field of physician mental health and what made you choose
Speaker 7: to pursue that as a kind of career.
Speaker 5: Well, this started with a tragedy. Actually, in nineteen sixty two,
Speaker 5: I lost one of my roommates, his name as a pseudonym,
Speaker 5: Bill this is his first name, to suicide. And that
Speaker 5: was over the Thanksgiving weekend. We were both first dramatical students.
Speaker 5: IR was the last person to see him alive, and
Speaker 5: it was awful. I was young, I mean I was
Speaker 5: only nineteen. I had never been exposed to suicide before.
Speaker 5: But I think what really struck me the most was
Speaker 5: how much his death was I don't know what I
Speaker 5: would say, perhaps covered up. The stigma associated with any
Speaker 5: kind of perceived flaw or whatever you might call that
Speaker 5: in medicine back in those days was so profound. So
Speaker 5: we didn't hear anything from the dean's office. I'm the
Speaker 5: one who made the announcement to my classmates. We didn't
Speaker 5: attend his funeral, we didn't send flowers, And I thought
Speaker 5: over the years, how different this would be a Bill
Speaker 5: were killed in a motivatal accident night of cancer or something.
Speaker 5: And I think that that got me thinking about the
Speaker 5: stigma associated with psychiatric illness and medical students and physicians.
Speaker 5: And then fast forward a few years when I was
Speaker 5: in training that in psychiatry in the early seventies, I
Speaker 5: saw my first physician patient on Christmas Day, nineteen seventy,
Speaker 5: the pseudonymus for doctor Monroe. And that's how I started
Speaker 5: my book. I actually about my memoir because I really
Speaker 5: wanted to capture how captivated I was really by his
Speaker 5: story looking after him and his family, And through the
Speaker 5: rest of my training, which is four years, I got
Speaker 5: to actually look after some other members of doctors' families,
Speaker 5: so that by the time I graduated and opened up
Speaker 5: my halftime private practice, I felt I had a little
Speaker 5: bit of a leg up. I wasn't quite as intimidated
Speaker 5: about looking after my peers or whatever as maybe some
Speaker 5: of my colleagues were. So that's kind of how it
Speaker 5: all got started.
Speaker 1: So, even in non pandemic times, physicians and other healthcare
Speaker 1: workers experience a multitude of challenges, such as burnout or
Speaker 1: isolation that can have a substantial impact on their mental health.
Speaker 1: So can you talk us through what some of these
Speaker 1: challenges are and what impact they have on the mental
Speaker 1: health of healthcare professionals? You know, does this field experience
Speaker 1: things like depression, anxiety, substance abuse, and suicide at higher
Speaker 1: rates than the general public.
Speaker 5: I'm going to do this in two ways because I
Speaker 5: like to think of like the big factors, that what
Speaker 5: we call the systemic factors of the situation in medicine
Speaker 5: today here in the United States, because that seems to
Speaker 5: be driving a lot of the concern that so many
Speaker 5: of our physicians today described as burnout. Some are unhappy
Speaker 5: with that term, and it's now being called moral injury.
Speaker 5: But then it can get worse though too, and you
Speaker 5: touched on that aeron that sometimes individuals then wonder is
Speaker 5: this burnout or perhaps have I fallen into a depression
Speaker 5: something like that. Now there is the illness of depression,
Speaker 5: things like that. So the systemic factors are felt to
Speaker 5: be the things that are really driving this, and physicians themselves.
Speaker 5: So in other words, you could take the healthiest doctor
Speaker 5: and he or she is going to succumb at some
Speaker 5: point with a system that is so demanding of them.
Speaker 5: And some of the things that you hear about so
Speaker 5: much of the electronic health records, for instance, or the
Speaker 5: increasing corporatization of medicine so that there's less less time
Speaker 5: with the patient having gathered so many things on the
Speaker 5: computer and having to do so much work that feels
Speaker 5: like deureaucracy. And there are a number of other factors
Speaker 5: that doctors describe. It varies a little bit on the
Speaker 5: branch of medicine, and so that can really make doctors
Speaker 5: feel demoralized. And you know, when we look at the
Speaker 5: definition of burnout, it really it's got to do with
Speaker 5: a loss of agency and control over your life. Or
Speaker 5: doctors on a treadmill and they describe this kind of exhaustion,
Speaker 5: an erosion of their spirit. Those are the terms that
Speaker 5: they'll often use. They'll talk about depersonalization, for instance, that
Speaker 5: sort of numbness or detachment from their patients in each other,
Speaker 5: like a loss of compassion, and that's very, very bothersome.
Speaker 5: And at the end of the day, the other thing
Speaker 5: that they described is a sense of futility even though
Speaker 5: they really are helping people, that's not necessarily they don't
Speaker 5: really feel gratified that they're experiencing that. So that's the
Speaker 5: big systemic piece. But the one thing I never want
Speaker 5: to be left out is what we bring to the
Speaker 5: table ourselves as individuals. So in other words, we could
Speaker 5: be going through just stuff on our own personal life,
Speaker 5: having to deal with who we are as individuals. Are
Speaker 5: particular vulnerabilities, whether or not we've suffered from anything past
Speaker 5: in terms of health challenges, or there could be things
Speaker 5: going on in our family, and Aaron, I think you
Speaker 5: were kind of trying to get at maybe whether or
Speaker 5: not there are particular things that we might be prone
Speaker 5: to in medicine, because there has been quite a lot
Speaker 5: of research on this. It's mixed, but it's generally felt
Speaker 5: that especially during training, medical school and residency. And beyond that,
Speaker 5: our rates of depression are a little bit higher than
Speaker 5: age matched cohorts in other professional schools, for instance. So
Speaker 5: there's that piece. The second is also we don't know
Speaker 5: so much about anxiety disorders because I think that they've
Speaker 5: been underdiagnosed in the past. For instance, PTSD, which we're
Speaker 5: hearing about so much since the COVID nineteen pandemic, we're
Speaker 5: hearing about it before that, I would say only in
Speaker 5: the last maybe five seven eight years. Before that, I
Speaker 5: think it was not being picked up or not being
Speaker 5: talked about, because it's probably always been there at some level.
Speaker 5: And so, but the other one that that we're most
Speaker 5: concerned about is suicide and physicians, and that was the
Speaker 5: substance of the book I did just before the memoir,
Speaker 5: called Why Physicians Die by Suicide? Lessons learned from their
Speaker 5: families and others who cared. And that's my postvention research,
Speaker 5: interviewing family members and friends and colleagues of doctors who
Speaker 5: have ended their lives. And what we found is that
Speaker 5: the research varies, but it's been felt though for one
Speaker 5: doctor a day dies by suicide in this country. We
Speaker 5: don't know whether those rates are growing up or going down,
Speaker 5: or just how acrive were But even if it's that
Speaker 5: or something like that that's very serious, there tends to
Speaker 5: be a gender difference that the risk of suicide and
Speaker 5: women doctors compared to women in general is much higher
Speaker 5: than it is for male doctors as compared to men
Speaker 5: in general, for instance, those kinds of things. So I
Speaker 5: think I'm getting back to your question that even before
Speaker 5: COVID nineteen, you know, we're a group of human beings,
Speaker 5: you know, with some pre existing vulnerability, and that's that's
Speaker 5: the so called humanness that I'm trying to communicate in
Speaker 5: my memoir.
Speaker 7: Absolutely, and so although it seems like in a lot
Speaker 7: of ways we've made some strides over the past few decades,
Speaker 7: there still is quite a lot of stigma surrounding mental illness,
Speaker 7: not just in society in general, but also very specifically,
Speaker 7: like you mentioned, in the medical field, especially even in
Speaker 7: terms of things like licensure, like having to mark that
Speaker 7: little box to get your medical license. So what does
Speaker 7: this stigma look like and how, in your opinion, does
Speaker 7: it contribute to the high rate of mental health issues
Speaker 7: in healthcare workers.
Speaker 5: Okay, Aaron, thanks for that question. I try to always
Speaker 5: break this down into what we call interior or internal
Speaker 5: stigma and what's called enacted or external stegma. So with
Speaker 5: regard to the former, that internal stuff is what we
Speaker 5: feel when and if we develop some symptoms suggestive of
Speaker 5: a psychiatric illness. Actually that's pretty negative. We feel horrible,
Speaker 5: You just feel frightened, You feel less than you feel embarrassed, dreadful.
Speaker 5: That this is not something that is generally accepted that
Speaker 5: easily in society, as you mentioned, especially in the house
Speaker 5: of medicine and the culture of medicine. So there's all
Speaker 5: of that piece where we beat ourselves up and delay
Speaker 5: going for help, the external stigma, and you touched on
Speaker 5: really the most profound example is when we're judged or
Speaker 5: discriminated against external life. And the two areas that I
Speaker 5: think that's most manifest has been with regard to our
Speaker 5: application for medical licensure or their renewal, as well as
Speaker 5: credential applications for hospital privileges, medical center privileges, and things
Speaker 5: like that. Where this is problematic, then it's twofold. Doctors
Speaker 5: get frightened that, oh my god, if I go see
Speaker 5: a psychiatrist, or it's some help. I'm going to have
Speaker 5: to report this when I go to get a medical
Speaker 5: license or when I renew my license, so they avoid going,
Speaker 5: they don't get treatment, and doctors should be able to
Speaker 5: get the same kind of care that they so selflessly
Speaker 5: give to others. So with regard to licensure, that varies
Speaker 5: tremendously from state to state. I happen to practice in
Speaker 5: New York. We're one of I think about twelve states
Speaker 5: where no questions are asked at all of us when
Speaker 5: we apply for a medical license, No health questions, nothing,
Speaker 5: And contrasts that with some states which will remain unnamed,
Speaker 5: where the questions are draconium, so they violate the Americans
Speaker 5: with disabilities. That good news, though, is that this has
Speaker 5: been looked at very strategically and carefully over the last
Speaker 5: five years. The last two to three years, there's been
Speaker 5: a recommended template for what's called the Federation of State
Speaker 5: Medical Boards that if you feel you do have to
Speaker 5: ask a question about a physician's health, this is what
Speaker 5: we would recommend to a doctor. Are you currently suffering
Speaker 5: from any illness that is affecting your ability to practice
Speaker 5: safe and competent medicine? If so, phrase explain. So there's
Speaker 5: three things about that that we feel are you know,
Speaker 5: for those states that feel that they need to ask
Speaker 5: that are acceptable. The first one is that currently so
Speaker 5: this is just about a current illness. The second one,
Speaker 5: because it's current, it's about possible impairment as opposed to
Speaker 5: just having an illness. The third part that we like
Speaker 5: in my field asy chuntry, is that doesn't partition off
Speaker 5: psychiatric illness and substance use disorders from say general medical
Speaker 5: conditions like diabetes, high blood pressure, multiple sclerosis, something like that.
Speaker 5: So that's kind of where that sits. In More and
Speaker 5: more state licenses are modernizing their questions or perhaps moving
Speaker 5: to not asking any questions at all.
Speaker 1: Yeah. Yeah, So the higher rate, as you mentioned, of
Speaker 1: these mental health issues among healthcare workers is well known,
Speaker 1: though maybe not as widely discussed as it should be.
Speaker 1: It's been measured quantitatively and studied qualitatively, but these measurements
Speaker 1: don't often tell us about the roots of these issues.
Speaker 1: And you've touched on sort of the bigger picture of
Speaker 1: what some of these issues at the root are, But
Speaker 1: can you talk about where these bigger picture problems originate
Speaker 1: and how each step of medical training and beyond contributes
Speaker 1: to the problem.
Speaker 5: Okay, Yeah, and I'm going to largely put a positive
Speaker 5: spin on this because it's been worked on over the decades,
Speaker 5: and I'm going to confine my remarks through medical students
Speaker 5: and physicians. What's happened in medicals school. So it is
Speaker 5: applicants to medical school are making up their list. Sometimes
Speaker 5: the bottom line is they say, I want to go
Speaker 5: to a school that really does seem to be a
Speaker 5: place that cares about its students for four years, not
Speaker 5: just that we're going to get a first rate education,
Speaker 5: but that indeed this feels like a big home or
Speaker 5: something for four years. Or they found the other medical
Speaker 5: students friendly, a little less competitive with each other. So
Speaker 5: when you have a culture that starts with the dean
Speaker 5: who's setting a tone or an example for the entire
Speaker 5: medical school, that makes a huge difference than all the
Speaker 5: associate games. Okay, then you've got pure wellness groups where
Speaker 5: the second year medical students reach out to the first
Speaker 5: year medical students, where you've got free services, mental health
Speaker 5: counseling services for your students, where there's stuff that just
Speaker 5: sort of builds in on the website, where you've got
Speaker 5: people like me who have a possession of being ombits
Speaker 5: person because because mistreatment is not on you know, it's
Speaker 5: tough enough going through four years of medical school. You
Speaker 5: don't need to be experiencing this treatment at the hands
Speaker 5: of a resident or a professor or something like that.
Speaker 5: So when you can create all of that, I like
Speaker 5: to believe that that guarantee is like more of a
Speaker 5: safe passage. And even if there's a tragedy in the
Speaker 5: medical school, for instance, say where or if a medical
Speaker 5: student dies by suicide, we now have national basically a
Speaker 5: toolkit that I was instrumental in consulting on through the
Speaker 5: American Foundation for Suicide Prevention that walks you through what
Speaker 5: you do on day one, day two, with regard to
Speaker 5: the other students, to the professors, to the family, to
Speaker 5: the media, all that sort of stuff all meant to
Speaker 5: reduce copycat suicide or things like that. So it's making
Speaker 5: a whole change in the culture of medical education. And
Speaker 5: then then after medical fill it's kind of the same
Speaker 5: thing through residency training, which should be anywhere from for
Speaker 5: to six years. Again making sure that you don't like
Speaker 5: the health of your trainings, offering services for instance seven
Speaker 5: days a week perhaps or in the evening because of
Speaker 5: the long hours that they work. They reduced duty hours
Speaker 5: per week again built in services, changing the whole culture
Speaker 5: having to do with microaggressions and micro inequities that women's
Speaker 5: students have faced, that LGBTQ students have faced, that Asian
Speaker 5: and black and other minority of a matteral students have faced.
Speaker 7: Yeah, so kind of looking at all of this big picture,
Speaker 7: how much of this is a problem that is unique
Speaker 7: to the United States and our medical training, and how
Speaker 7: much of it is something that we may be among
Speaker 7: healthcare workers more universally. And if there are other countries
Speaker 7: or other places that are doing a better job when
Speaker 7: it comes to the mental health of healthcare workers, what
Speaker 7: can we learn from them.
Speaker 5: Okay, that's a very good question. In my lecturing around
Speaker 5: the world, I've certainly visited some countries where my area
Speaker 5: of expertise in physician suicide is pretty frightening. For some
Speaker 5: countries that they're looking at physician and suicide is sort
Speaker 5: of just an unusual, outlying event due to the individual
Speaker 5: that's got nothing to do with the system. We're fine,
Speaker 5: she wasn't. On the other hand, I visit countries or
Speaker 5: I receive now I get on conference calls with physicians
Speaker 5: from various parts of the world that are really open
Speaker 5: to learning some of the advances that we have here.
Speaker 5: For instance, in the United States, they wouldn't necessarily want
Speaker 5: our system because it's a confusing system with all the
Speaker 5: insurance coming for instance. And I spent the bulk of
Speaker 5: my practice years in Canada, where we have a universal
Speaker 5: healthcare system, but we weren't without our problems as well
Speaker 5: in terms of with physician health. The one piece though,
Speaker 5: that I can sort of speak clearly about it so
Speaker 5: proudly of, was that I could see I could treat
Speaker 5: a medical student, I could treat a physician or the
Speaker 5: family member without ever having to worry about insurance. I
Speaker 5: think one thing that is universal, though, is this increasing
Speaker 5: perception that people in medicine for too long have been
Speaker 5: sort of treated as workhorses, and you know, they're used
Speaker 5: to hard work, and seat of just pile more work
Speaker 5: on them. We think what we're seeing is that that's
Speaker 5: not work right.
Speaker 1: So, your most recent book, Becoming a Doctor's Doctor, is
Speaker 1: a memoir of your thirty five year career as a psychiatrist,
Speaker 1: primarily treating other physicians. So over that time, you must
Speaker 1: have witnessed a lot of change in the way that
Speaker 1: we talk about or in the way that we deal
Speaker 1: with mental health in physicians. So can you talk about
Speaker 1: some of those changes. What some of those changes are
Speaker 1: you know, and have we gotten better or what are
Speaker 1: the areas in which we have failed to make significant improvements?
Speaker 5: Okay, there's lots of good news, and there are some
Speaker 5: things that I would like to see happen. The one thing,
Speaker 5: even though we've been talking a lot about stigma, it's
Speaker 5: much less than it used to be, but unfortunately it's
Speaker 5: still there. There's much more research on these systemic and
Speaker 5: personal vulnerabilities that you know we've been talking about. The
Speaker 5: Other thing that I'm excited about is that we have
Speaker 5: more and more role models through self disclose in both
Speaker 5: scientific and lay journals that they've suffered from depression, alcoholism,
Speaker 5: an eating disorder for instance, something like that. And we've
Speaker 5: got more resources for doctors tovarious state physician health programs
Speaker 5: very a little bit from state to state, but largely
Speaker 5: though right there to certainly really help physicians in their
Speaker 5: hour of need and then to offer sort of follow
Speaker 5: up in advocacy, and that's very important. There's less sexism
Speaker 5: and abusive teaching, but yet we still have a me
Speaker 5: too movement in the house of medicine as well. Dudy
Speaker 5: hours or less. There are dedicated rest breaks, sleep breaks,
Speaker 5: Strategic napping, for instance, is something that's that. It's called
Speaker 5: areas that need more work. We've talked about the licensing
Speaker 5: and credential applications. Far too many doctors you're still leading
Speaker 5: their very unbalanced lives. This is now getting to the
Speaker 5: personal piece where there I feel it's altruistic, but they
Speaker 5: are working way too hard and they're not building in
Speaker 5: enough time in their life for exercise, for nutrition, for
Speaker 5: just quote unquote, taking time to smell the roses, for
Speaker 5: relationships for kids for now. You know, I never mean
Speaker 5: that in a judgmental way, because there are some individuals
Speaker 5: in medicine and say, look, I'm not interested in relationships.
Speaker 5: I just love my work. And that's fine. But I said,
Speaker 5: but at least, also, if you're going to keep doing it,
Speaker 5: then at least take some trips by yourself or something,
Speaker 5: you know, go to a yoga class or something, you know,
Speaker 5: things like that, just so you can protect your individual health.
Speaker 5: There's still too many doctors. Even with COVID nineteen going on,
Speaker 5: and how we've normalized all of the stress associated with
Speaker 5: being on the front lines steal so many doctors who
Speaker 5: kind of just suck it out or they it's that
Speaker 5: sort of macho rigor or something that is still very
Speaker 5: much a part of medicine. I mean, it's commendable a
Speaker 5: well nobile, but it should never ever feel like a weakness.
Speaker 5: If you go for mental health care, you don't feel weak.
Speaker 5: If you start to have blood in your yarn, I mean,
Speaker 5: it's scary, or if you notice a lump in your grass,
Speaker 5: that's scary too, but you go and get help. And
Speaker 5: I would like to see more physicians have primary care doctors.
Speaker 5: Too many don't. And one final thing I'd like to
Speaker 5: say is that I would like to see more psychiatrists
Speaker 5: who are kind of sort of dedicating at least part
Speaker 5: of the week to look after their colleagues, you know,
Speaker 5: if they're if they're so inclined because there's a you know,
Speaker 5: there's some science to it, and there's things that you
Speaker 5: need to do, and that person officing you is a
Speaker 5: fellow physician as opposed to perhaps you know, an attorney,
Speaker 5: are a realtor, teacher, or something like that, just because
Speaker 5: you're in the same field. You're both in that a
Speaker 5: sun that sort of thing. So those are the kinds
Speaker 5: of things that with that. Then I think that that
Speaker 5: doctor patient gets a higher level of care when the
Speaker 5: doctor looking after or him is comfortable looking after the doctors.
Speaker 5: So I do a lot of teaching in that whole
Speaker 5: around in my day to day work.
Speaker 7: Yeah, absolutely so. COVID nineteen is not by any means
Speaker 7: the first public health crisis that a number of physicians
Speaker 7: have had to deal with. There are a number of
Speaker 7: physicians out there who might have worked during other outbreaks
Speaker 7: such as ebola or even during the early years of
Speaker 7: the HIV AIDS epidemic. So how do these crises, especially
Speaker 7: COVID nineteen, amplify these issues that physicians are already facing
Speaker 7: in terms of mental health?
Speaker 5: Okay, and let me comment on that in my memoir.
Speaker 5: That's why I put a whole chapter in in my
Speaker 5: book on HIV AIDS, because that was occurring through the
Speaker 5: eighties into the nineties and after that first decade where
Speaker 5: it was so so much on everything on the front lines.
Speaker 5: There are some differences though, because one thing is that
Speaker 5: there isn't the same degree of stigma associated with patients
Speaker 5: with COVID nineteen, although at the very beginning though, there
Speaker 5: were some patients who someone fel stigmatized that they got
Speaker 5: it and somebody else didn't, and people, of course were
Speaker 5: afraid of them. We knew less about the virus than now,
Speaker 5: much like HIV at the beginning, but even doctors who
Speaker 5: looked after patients with AIDS were stigmatized. So you know,
Speaker 5: there and other than that, there are also lots of
Speaker 5: differences put the really calls to the four physicians, and
Speaker 5: so I've seen doctors through the COVID pandemic because my
Speaker 5: colleague that I doctor, fis We started support groups at
Speaker 5: University Hospital Brooklyn, our teaching hospital. This is our first
Speaker 5: year anniversary of starting weekly support groups for hospitalists and
Speaker 5: for emergency docs. Then we had groups for residents, for
Speaker 5: medical students, all for the nurses like that too. I
Speaker 5: remember a couple of physicians saying that I was kind
Speaker 5: of burned out before the pandemic, but I don't feel
Speaker 5: it now. Even though this is very scary work and
Speaker 5: we're not exactly sure what we're doing because we're still
Speaker 5: learning about this virus, I do feel that I'm doing
Speaker 5: what I was trained to do to look after critically
Speaker 5: ill people. Now again, that's in the face of concerns
Speaker 5: about PPE and all of the the masking and gowning
Speaker 5: and gloving and that depersonalization that you feel. And this
Speaker 5: is of course when relatives who are outside the hospital
Speaker 5: and they've got dying loved wins in the hospital, and
Speaker 5: the healthcare professionals having to comunicate by way of FaceTime
Speaker 5: with them, and oh, when I think back on all
Speaker 5: of that, it was just unbelievable. So that called to
Speaker 5: the fore those so many things in health professionals themselves.
Speaker 5: And now is when I think people are more concerned
Speaker 5: about the long term effects of this, which perhaps we
Speaker 5: could come to. The one thing though, if there's any
Speaker 5: silver lining to all of this, I have heard people
Speaker 5: say that there's been a more humanistic interpersonal space development.
Speaker 5: I've heard doctors talk openly about feelings that you would
Speaker 5: never expect that they would talk about before that they're
Speaker 5: talking with their trainees about what they're feeling in their heart,
Speaker 5: for instance, the sorrow of their feeling and the fear
Speaker 5: that they're having. Things like that where they're dropping at
Speaker 5: least some of that intellectual jargon medicales that we use
Speaker 5: in our health centers just to be human with each other.
Speaker 5: So I think there has been more of that sort
Speaker 5: of community of care, so that in a way is
Speaker 5: a good thing.
Speaker 1: Yeah, yeah, And so you know, as you mentioned during
Speaker 1: COVID nineteen, we have seen disillusionment and despair in healthcare workers.
Speaker 1: And this might be especially pronounced as public health measures
Speaker 1: are ignored or belittled by these large swaths of the country.
Speaker 1: And yet especially in the media, this narrative of the
Speaker 1: healthcare heroes seems to be perpetuated, seems to be constantly
Speaker 1: put forth, you know, putting a rosy spin on this
Speaker 1: pandemic or on the actions of healthcare workers during the pandemic,
Speaker 1: which in some ways maybe allows us, as people who
Speaker 1: are not directly involved on the front lines, to sort
Speaker 1: of ignore or you know, look through rose colored glasses
Speaker 1: at this excess stress, at the lack of ppe. And
Speaker 1: so can you just talk a little bit about how
Speaker 1: damaging this healthcare hero's narrative can be?
Speaker 5: The hardest part, I think, and this is where it
Speaker 5: gets back to moral injury, especially for all of these
Speaker 5: healthcare professionals, the ones who have been interviewed, these first
Speaker 5: person stories that you listen to, these of the nurses
Speaker 5: and this ones working in emergency of the intensity carrio
Speaker 5: mersus doctors and then you're exhausted after a shift. Then
Speaker 5: they get in the car, they drive home and see
Speaker 5: if people love partying. No masks on things like that
Speaker 5: or and I'm not going to get political, but the
Speaker 5: fact that it's become political is also so traffic that
Speaker 5: you know, we have to follow the science. And I
Speaker 5: know that sounds like a hackney phrase, but it is
Speaker 5: essential until we really are clearly, you know, really out
Speaker 5: of the woods. So that's where sometimes the healthcare professors
Speaker 5: will say, like, yeah, it's nice to be called a hero,
Speaker 5: but you know, do something yourself in terms of prevention
Speaker 5: so that we're not we're not having to be in
Speaker 5: this kind of heroic job. The other thing, too, is
Speaker 5: that I really like this when these healthcare workers just say,
Speaker 5: you know, I don't like being called a hero. I
Speaker 5: just it just it doesn't it doesn't feel right. I'm
Speaker 5: a doctor, I've trained to do this work, but I'm
Speaker 5: not a hero. So what I've always said to them,
Speaker 5: I said, look, just try to say thank you. That
Speaker 5: what it is is that people are just so touched
Speaker 5: and honored by the work that you're doing and putting
Speaker 5: yourselves at risk for others. And I said, and that's
Speaker 5: really because they do see you as heroic, even if
Speaker 5: you don't feel that yourself. I said, you are doing
Speaker 5: extremely important work. Then of course they say, yeah, but
Speaker 5: most of my but most of my patients have died.
Speaker 5: I said, But that doesn't mean, though, that you didn't
Speaker 5: do something. You were there with them, you showed up,
Speaker 5: you held their hand, because their actual loved ones can't
Speaker 5: do that, they're outside outside the hospital. I mean, it's
Speaker 5: very granular. These are the basic, you know, the basic
Speaker 5: covenant of the health professional patient relationship.
Speaker 7: Yeah, what do you think might be some of the
Speaker 7: fallout that we might expect to see in the long
Speaker 7: term future from the COVID nineteen pandemic in terms of
Speaker 7: its effects on mental health?
Speaker 5: I'm just going to confine my remarks to more of
Speaker 5: the medical psychological followed. The first one is PTSD and
Speaker 5: this is not a shock even to most people who
Speaker 5: are suffering from it. And certainly I'm looking after some
Speaker 5: people at the hospital trainees who are feeling feeling that
Speaker 5: and having symptoms, but they're getting better and time is passing,
Speaker 5: and there are you so called CPT, CAGAB, the therapy
Speaker 5: medications that can help and things like that support groups.
Speaker 5: The other, though, is probably broader, and that has to
Speaker 5: do with grieving, and sometimes I think when we can
Speaker 5: articulate that for an individual who's feeling something but they're
Speaker 5: not sure what to call it, they are grieving. And
Speaker 5: if they're not actually grieving the physical loss, say of
Speaker 5: a family member or a friend to COVID or something else,
Speaker 5: it's one of the other losses that they've had the
Speaker 5: loss of, well, maybe attending their niece's first communion or
Speaker 5: their nephew barmits or uh an in person funeral for instance,
Speaker 5: or a wedding, things like that. That's all forms of
Speaker 5: grieving what we once had, you know, that type of
Speaker 5: thing and preparing for the quote unquote new normal as
Speaker 5: these things evolve through a lot of loss and this
Speaker 5: isolation of course that we've all had to live with
Speaker 5: people in relationships that's been really different. Sure, there's a
Speaker 5: set of problems there, you know, too much time with
Speaker 5: each other. You know, we've heard of an uptick and
Speaker 5: domestic violence in dysfunctional families because the kids are remote learning,
Speaker 5: and you know all of that stuff we're hearing about
Speaker 5: physician moms and what they're all dealing with. They're trying
Speaker 5: to run a practice at the same time as you know, homeschooling,
Speaker 5: their kids are hybrid schooling or not having available childcare
Speaker 5: as they once had. So that's that's all in that
Speaker 5: kind of all of the laws that even probably many
Speaker 5: of us aren't even exactly sure really what that is
Speaker 5: right now, but it'll unfold. And again, I'm always try
Speaker 5: to be positive though. I really follow things like post
Speaker 5: traumatic growth and my experience with that was long before
Speaker 5: COVID nineteen. That's through my brief at work the families
Speaker 5: who have lost someone to suicide, and yes, they look
Speaker 5: back and say, this has been a complete nightmare. But
Speaker 5: now if I have been my seventh year since losing
Speaker 5: my son, I'm seeing a bit of a silver lining
Speaker 5: to his premature death. I know that I'm a better person.
Speaker 5: I'm kinder and we're giving. I've got more emotional intelligence,
Speaker 5: I'm wiser, you know, I'm more gracious toward families who
Speaker 5: who do have a son graduating from university and I
Speaker 5: don't people just so amazing and so full. I think
Speaker 5: of a strength and grace and dignity and courage and love.
Speaker 1: Yeah, I think I think it'll be interesting to see,
Speaker 1: you know, in the next year and the five years
Speaker 1: from now and ten years from now sort of how
Speaker 1: we look back on this, and you know, maybe some
Speaker 1: things will have emerged that we didn't expect or you know,
Speaker 1: both good and bad. But yeah, hopefully a lot of
Speaker 1: it is more good than bad.
Speaker 5: Yes, exactly.
Speaker 1: Yeah. And so, as family members or friends or partners
Speaker 1: of healthcare workers, what are some worrying signs that we
Speaker 1: can look out for? And as someone who might be,
Speaker 1: you know, one of these frontline healthcare workers or just
Speaker 1: a practicing physician anyway, how do we recognize these signs
Speaker 1: in ourselves as well?
Speaker 5: Okay, so I always tell people look at just look
Speaker 5: for things if there's any change, And somedays tell people
Speaker 5: that behind the crankiness or something of a loved one
Speaker 5: and your partner and their spouse, or their withdrawal or
Speaker 5: their displacement or underworking criticism can sometimes just be a
Speaker 5: lot of pain or a lot of anxiety or whatever.
Speaker 5: The key is to kind of get at that and
Speaker 5: say look, we need time out, Okay, so we just
Speaker 5: need to talk of it. I need to reconnect with
Speaker 5: you in some ways. I've always told the spouses and
Speaker 5: partners of doctors, especially that you have as much right
Speaker 5: to a whole range of feelings. That your work, whatever
Speaker 5: it might be, is just as important. It's defined differently.
Speaker 5: It may not get the sort of kudos or something
Speaker 5: that people in the health professions got. That you're doing
Speaker 5: whatever you're doing, it all counts in the same degree,
Speaker 5: and so and so I think to just kind of
Speaker 5: stuff it and to try to always be strong and
Speaker 5: comforting and cairing you can get burned out or something,
Speaker 5: and also resentful. The other thing, of course, is always
Speaker 5: tell people that your bottom line is you're trying to
Speaker 5: protect family life, and for some of you it may
Speaker 5: also include spirituality or religion. Not always, but there's gone
Speaker 5: to be other archetypes of family rituals that will that
Speaker 5: will work.
Speaker 1: M hm, yeah, absolutely.
Speaker 5: So.
Speaker 1: Going back to sort of this big picture questions, and
Speaker 1: we've touched on a lot of these throughout this interview,
Speaker 1: but what do you think are the biggest failings of
Speaker 1: the medical system in terms of emotional or mental health
Speaker 1: support for those who are in medicine, and then, maybe
Speaker 1: most importantly, how can we begin to change things? What
Speaker 1: are the changes that we should make at the medical
Speaker 1: school level or at the hospital level, or what role
Speaker 1: do other physicians have to play in terms of providing
Speaker 1: or helping to provide this emotional or mental health support
Speaker 1: for other physicians or healthcare workers.
Speaker 5: Well, so, in addition to so many of the things
Speaker 5: that I think we've already talked about, the basic rule, though,
Speaker 5: is that all health professionals are human too. And I
Speaker 5: know that's that sounds so simple, but I think that,
Speaker 5: you know, we're kind of drawn to the field, like
Speaker 5: all health professionals because they care or want to make
Speaker 5: a difference or something like that, which is a laudable,
Speaker 5: wonderful et cetera, et cetera. But yet, you know, we're
Speaker 5: still still human beings. And so I've always felt that
Speaker 5: health professionals are They're used to hard work, but the
Speaker 5: fatigue if they feel after a twelve hour shift it's
Speaker 5: been a good day, is a different kind of fatigue
Speaker 5: than they feel if it's been twelve hours but half
Speaker 5: of it's been a nightmare or something where they just
Speaker 5: feel that this is such a dysfunctional place. I'm working
Speaker 5: that kind of thing. I mean, they need to feel valued.
Speaker 5: It's not always just so much from patients or their
Speaker 5: family members or something, but from the system itself. And
Speaker 5: again that's into all of these, all of the stakeholders,
Speaker 5: the CEOs of hospital systems. But yet when and if
Speaker 5: people feel that, it gives, it gives more meaning for
Speaker 5: purpose in your work, and you get through these these
Speaker 5: tougher days because you feel that there is you know,
Speaker 5: just lit of an ethos here and because without that
Speaker 5: that we know from the work for instance, it's coming
Speaker 5: out of Stanford led by doctor Tate channan Felt. He's
Speaker 5: always writing about making the business case for burnout prevention
Speaker 5: and he's done it in spades. That if if the
Speaker 5: CEOs don't get on top of this, there's just so
Speaker 5: much money because of attrition and turnover a staff. People
Speaker 5: just don't stay. They can loss of life for instance,
Speaker 5: long term visibility that your workers going because they're ill.
Speaker 5: Listen to a humane model for a healthy workplace. There's
Speaker 5: a strong business model for that.
Speaker 7: Thank you again so much, doctor Myers for speaking with
Speaker 7: us and answering so many of our questions.
Speaker 1: Yeah, thank you that was so amazing.
Speaker 7: Yeah, And as always, we want to end these episodes
Speaker 7: by kind of summing up the five most important takeaways
Speaker 7: that we learned. So Number one, healthcare workers, like many
Speaker 7: of us, are susceptible to burnout and moral injury, largely
Speaker 7: as an outcome from the systemic issues in the way
Speaker 7: that medicine and healthcare is practiced in this country and
Speaker 7: across the world. In this field, it can be hard
Speaker 7: sometimes to separate personal identities from our jobs as healthcare
Speaker 7: workers and physicians and healthcare workers often have really high
Speaker 7: expectations of themselves too, so burnout often stems from a
Speaker 7: loss of agency or control. Many physicians became doctors because
Speaker 7: they wanted to help people, and our current system has
Speaker 7: them spending hours of their day dealing with bureaucracy, insurance battles, paperwork,
Speaker 7: medical charts, things that don't have anything to do with
Speaker 7: patient care. It can make their work feel exhausting and futile,
Speaker 7: and on top of that, working in healthcare can be
Speaker 7: emotionally challenging in its own right. But one thing that's
Speaker 7: often overlooked in these conversations about burnout is that every
Speaker 7: healthcare worker is a person, an individual human that brings
Speaker 7: to the table all their own personal challenges that might
Speaker 7: have nothing to do with their work at all. And
Speaker 7: this is of course true for everyone in every job,
Speaker 7: but we often expect that physicians and other healthcare workers
Speaker 7: are superhuman and expected to ignore or suppress these personal
Speaker 7: challenges in the face of their challenging work environment.
Speaker 1: Yeah, and number two. In the realm of healthcare, workers
Speaker 1: experience both internal and external stigma that can contribute to
Speaker 1: mental health challenges. Internal stigma can make it difficult for
Speaker 1: us as individuals to accept or even acknowledge that we
Speaker 1: are facing a difficult time and need to seek help.
Speaker 1: This often results in a delay in seeking care or
Speaker 1: at worst, not ever seeking help. And I think this
Speaker 1: is something we all deal with to one degree or another,
Speaker 1: and it can be so difficult to overcome. Internal stigma
Speaker 1: can also be compounded by external stigma. External stigma can
Speaker 1: come in so many different forms, but essentially is the
Speaker 1: societal or workplace pressures that may make it so that
Speaker 1: someone who could benefit from mental health services, who is
Speaker 1: experiencing something like depression or anxiety or any other mental
Speaker 1: health issue, feels as though they can't seek help because
Speaker 1: of external pressures in medicine. One of the most egregious
Speaker 1: examples of this is having to document previous or current
Speaker 1: psychiatric treatment or conditions when applying for state medical licenses
Speaker 1: or hospital credentialing. This is something that used to be
Speaker 1: completely ubiquitous and is now fortunately changing and very state
Speaker 1: by state, but is one very strong example of a
Speaker 1: practice that really has the end result of preventing physicians
Speaker 1: and other medical professionals from seeking help or treatment because
Speaker 1: of this fear of repercussions.
Speaker 7: Yeah, number three, Let's consider all of these systemic issues
Speaker 7: in the context of COVID nineteen. Physicians and other healthcare workers,
Speaker 7: especially on the front lines, are facing an incredible amount
Speaker 7: of additional stress and pressure due to this pandemic. Early on,
Speaker 7: many were working without proper ppe with constantly changing recommendations
Speaker 7: and regulations, and as the pandemic progressed, ICUs reached capacity
Speaker 7: and yet cases continued streaming into hospitals. Some report feeling invigorated,
Speaker 7: as though this is what they have trained for their
Speaker 7: entire careers, but others say they're overwhelmed and frustrated at
Speaker 7: being called a hero when they don't feel heroic. This
Speaker 7: pandemic may be the first time in which many healthcare
Speaker 7: workers have had to watch more of their patients pass
Speaker 7: away rather than recover, or the first time they've held
Speaker 7: up an iPad as patient after patient says goodbye to
Speaker 7: friends and family, bearing silent witness to countless tragedies. And
Speaker 7: then if after a long shift in the ICU, they
Speaker 7: drive home to see lines outside bars or crowded sports
Speaker 7: events on the news, this can lead to a feeling
Speaker 7: of what's the point. Moral injury can come into play
Speaker 7: yet again, this healthcare hero's narrative can in some ways
Speaker 7: allow the rest of the public to fail to acknowledge
Speaker 7: their own personal responsibility for their role in slowing or
Speaker 7: speeding up the pandemic, instead relying on these heroes to
Speaker 7: step in and save the day. Of course, those who
Speaker 7: have fought and continue to fight so hard against this
Speaker 7: virus are incredible and we should all be extremely grateful
Speaker 7: for their efforts, But we need to be careful not
Speaker 7: to let the healthcare hero's narrative rid the rest of
Speaker 7: us of our responsibilities or make us forget or overlook
Speaker 7: that the conditions many have worked under are unacceptable.
Speaker 5: Yeah.
Speaker 1: Absolutely. Number four. As of the time of recording, this
Speaker 1: the pandemic has slowed, especially compared to the big winter wave,
Speaker 1: but in the months or years to come, we can
Speaker 1: expect to see a lot of fallout from COVID nineteen,
Speaker 1: especially in the form of things like PTSD and grief.
Speaker 1: And grief not just as in the loss of a
Speaker 1: family member or friend, which I'm sure many of us
Speaker 1: have experienced, but also the loss of the life that
Speaker 1: we once had and having to transition to this new
Speaker 1: normal that we all have to live in now. If
Speaker 1: you have someone in your life who is a healthcare
Speaker 1: worker right now, or if you are a healthcare worker yourself,
Speaker 1: recognize that this year has been a ridiculously trying one
Speaker 1: and it's okay to need help. It's okay to need support,
Speaker 1: especially right now. Essentially, It's okay to not feel okay
Speaker 1: or to not be able to take on all the
Speaker 1: extra things you maybe used to take on. It's okay
Speaker 1: to say no and just turn everything off. Turning off
Speaker 1: and focusing on connection with each other, with our loved
Speaker 1: ones can be really helpful for your mental health, and
Speaker 1: I think this advice applies in some way to all
Speaker 1: of us. It's also a important, as doctor Meyer said,
Speaker 1: that we may someday be able to recognize growth within
Speaker 1: ourselves through this experience.
Speaker 7: Number five. The good news, though, is that things are
Speaker 7: changing for the better in many ways. The first is
Speaker 7: that more and more states are not requiring any questions
Speaker 7: about health status, mental or physical for licensure, or if
Speaker 7: they are, they're at least refining the questions. Another trend
Speaker 7: is that when making their decisions or their rankless applicants
Speaker 7: to med schools and residency programs are taking into much
Speaker 7: greater consideration the way that students and residents and faculty
Speaker 7: are treated. So medical training is no longer viewed as
Speaker 7: strictly the quality of education. But how well a program
Speaker 7: is going to support students and residents. Do they actually
Speaker 7: comply with new work hours regulations and restrictions. Do they
Speaker 7: have confidential counseling services? Do the students and residents and
Speaker 7: faculty actually feel supported or even happy. Also, today there
Speaker 7: are many more resources available to all of us, not
Speaker 7: just healthcare workers. So even though the stigma isn't gone
Speaker 7: by any means, it has at least decreased in recent years.
Speaker 7: In part, we can really thank the physicians and healthcare
Speaker 7: workers that have self disclosed, that have told their stories,
Speaker 7: whether in magazines or journal articles, on social media, or
Speaker 7: even by providing a first hand account on a podcast.
Speaker 7: So thank you again to everyone who has shared their story,
Speaker 7: not just with us, but in general, and for anyone
Speaker 7: who is struggling, whether you're a healthcare worker or a teacher,
Speaker 7: or a bartender, or a grocery store employee, or a
Speaker 7: stay at home parent or anyone at all. Right now,
Speaker 7: know that you are not alone. And if anyone is
Speaker 7: suffering from suicidal ideation, the National Suicide Prevention Hotline phone
Speaker 7: number is eight hundred two seven three eight two five
Speaker 7: to five, and we have a link to their website
Speaker 7: as well as other mental health resources available in the
Speaker 7: US and worldwide in our show notes and also on
Speaker 7: our website.
Speaker 1: Yeah we do.
Speaker 5: Well.
Speaker 1: We want to thank you again doctor Myers for taking
Speaker 1: the time to chat with us for this episode. We
Speaker 1: really appreciate it.
Speaker 7: Yeah, your expertise was very welcome.
Speaker 1: And thank you again for everyone who provided a first
Speaker 1: hand account. It's it's been incredible to hear from all
Speaker 1: of you, and we really really are grateful to everyone
Speaker 1: that has sent in a first hand account.
Speaker 7: Yeah. Really, thank you also to Bloodmobile, who provides the
Speaker 7: music for this episode and every single one of our episodes.
Speaker 1: And thank you to the exactly Right Network, of whom
Speaker 1: we are a very proud member.
Speaker 7: And thank you to you listeners for listening to this episode.
Speaker 7: This is eating towards the end of this COVID nineteen series,
Speaker 7: so we appreciate that you listen.
Speaker 5: Yeah.
Speaker 1: Well, until next time, wash your hands
Speaker 7: You fill the animals