Take Steps to Improve Your Own Mental Health during Pandemic, Experts Advise

BY SANDRA JACOBS, VITAL SIGNS EDITOR

With COVID-19 raging and the physician workforce exhausted, mental health clinicians are emphasizing the importance of physicians being proactive in getting support for themselves.

“Physicians tend to be problem-solvers, and our first instinct may be to try to solve our own problems alone,” says Wendy Cohen, MD, a physician health psychiatrist. “Physicians are human beings doing tireless work during a pandemic. Asking for support isn’t a sign of failure. It is a sign we are mortal.” She urges physicians to take stock of their feelings and reach out for help if they need support coping with stress and anxiety.

Dr. Cohen is the physician evaluation director at Physician Health Services, Inc. (PHS), the physician health program that is a subsidiary of the Massachusetts Medical Society. PHS offers many services to physicians and medical students, including free, confidential consultations; referrals; and a listening ear. “When physicians have their nose to the grindstone — and are all in with their face masks and COVID patients and the needs of their own families — they’re not thinking about their own mental health and well-being,” says PHS Executive Director Bara Litman-Pike, PsyD. “It’s helpful to get people thinking about their internal experience earlier. You don’t want to wait until someone is overwhelmed.”

MMS Members Rank Physician and Staff Well-Being as Top Challenges

In a November survey of MMS members, “physician and staff well-being” was the highest-ranked “operational challenge” of the pandemic, cited by 76 percent of respondents. Asked what resources related to COVID-19 would be most useful, “physician wellness support” ranked second, narrowly behind “guidance on telehealth billing.”

Despite these numbers, physicians may not be quick to seek help. Cohen and Litman-Pike note there has been an increase in substance use during the pandemic. While alcohol continues to be the most problematic substance for physicians, use of marijuana and cannabinoids have increased since their legalization.

In the moment of use, alcohol and cannabinoids are sedating, but they are known to heighten anxiety, depression, and insomnia after the intoxicating effects wear off, says Cohen. “Many physicians are surprised to find how much their sleep, mood, and symptoms of anxiety and depression improve when they cut back.”

“Physicians work in a safety-sensitive profession and our health affects the quality of our work,” she adds. “We need to consider how what we put into our bodies impacts our memory, coordination, and reaction time. For anxiety, depression, and insomnia, we have many effective treatments. Alcohol and marijuana are not among them.”

Physician Stress and the “Second Victim” Phenomenon

Beyond the current strains throughout society, from the pressure of children’s remote schooling to the burdens of daily life during a pandemic, physicians carry the extra vigilance of not exposing their own families to COVID. They may also feel the “moral injury” that occurs when clinicians are expected, in the course of providing care, to make choices that transgress their commitment to healing.

The “emotional work” of treating and managing COVID is something for which no one was prepared, Cohen and Litman-Pike note. This includes making ethical decisions about allocation of resources, caring for isolated hospitalized patients, and bearing witness to unprecedented levels of death and trauma. This secondary grief and traumatization on the pandemic’s front lines, they say, can lead to the “second victim” phenomenon, described by the Center for Patient Safety as when health care providers “become victimized in the sense that the provider is traumatized by the event.”

“As mental health professionals treating physicians, we expect to get busier as physicians have more time to reflect on their pandemic-related experiences,” says Cohen. “But physicians are having an emotional experience now. We want to promote intervention sooner rather than later. If addressed early, we can propose interventions that can have a big impact.”

“Just giving the care provider the words to talk about their feelings is healing,” adds Litman-Pike. “We destigmatize it by talking about it. If we are not attending to the health of the physician, the physician cannot do the work as effectively.”

Confidential PHS Is a Place to Start for Teams and Individuals

PHS is a nonprofit corporation founded by the MMS and annually supports about 400 Massachusetts medical students and physicians experiencing health-related and other challenges that have the potential to impact their work. Callers receive confidential guidance and direction toward the most appropriate and helpful resources.

For an initial, confidential meeting or to learn more about Physician Health Services, call (781) 434-7404 or email PHS@mms.org.

Additional Resources

The MMS offers online CME programs on physician wellness and burnout, including the following:

• Medical Professionals Empowerment Program (MedPEP), a podcast series that features experts from various disciplines offering practical coping techniques.

• Psychological First Aid: Healthy Recovery Now and in the Aftermath of the COVID-19 Public Health Crisis.

For more resources, please visit the wellness web page on the MMS website.