Physician wellness post-pandemic

The COVID-19 pandemic has taken a toll on our mental health, with 42% of all Americans reporting depression or anxiety symptoms in December 2020 compared with just 11% the previous year, according to Nature. Physicians and other health care workers may be at higher risk for psychological distress because we must not only cope with our own feelings but also the emotional needs of our patients. A survey of health care workers found that 93% reported stress, 86% had anxiety, 76% reported exhaustion and burnout, and 75% felt overwhelmed. Caregivers also reported significant problems with insomnia, appetite changes, and physical symptoms like headaches and stomach pains.

Although we may not be experiencing the same stressors that we faced at the beginning of the pandemic—anxiety over personal safety and the health of our family members due to a lack of personal protective equipment, financial insecurity, and “lockdown” isolation — there are constantly new challenges to overcome. In the last year, we have been forced to develop new lifestyles, learning to work virtually, have kids at home, and avoid in-person social activities with friends and family.

Throughout this phase, physicians have been exposed to another challenge: public skepticism over COVID-19. Whether it is a debate about masking, vaccines, or whether COVID-19 is real, doctors must navigate a world in which acceptance of scientific authority is no longer a given. This is particularly difficult for physicians who are working on the front line, exposed to the harsh realities of the disease.

Now that the COVID-19 vaccine is ramped up, we find ourselves in a third stage — a tentative pivot toward pseudo-normality. We are back in the office and starting to engage in activities with others, all while wondering whether it is really over and we are safe.

Fortunately, there are steps that we can take to improve our mental well-being as we continue to navigate the (hopefully) post-pandemic world.

Accept that having negative feelings and emotions is normal.

According to psychologist Steven Cohen, PsyD, co-author of a book on physician wellness, physicians must learn to acknowledge their feelings nonjudgmentally. “Emotional reactions occur automatically.They are neither good nor bad — they just are,” says Cohen. He notes that although we cannot control these feelings, we can control how we choose to think about them.

Pay attention to your emotions.

“The worst thing that we can do is to try to suppress or ignore our negative feelings and emotions,” says Cohen. This doesn’t mean we must dwell on distressing feelings, but we do need to learn to identify these emotions and give them a label. For example: “I feel angry that my patient refused to believe that COVID-19 is real,” or “I feel overwhelmed and exhausted with seeing so many sick patients.”

“While it may feel uncomfortable to acknowledge these feelings, push through the discomfort,” says Cohen, who notes that this is where emotional growth takes place. He also advises physicians to take it a step further by asking themselves whether there is anything more triggering their feelings. For example, “When patients don’t believe in COVID-19, it means they don’t believe in science, which means they don’t believe in me as a doctor.” Or, ‘There are so many sick people. It feels like there will never be an end to this disease.”

Challenge your beliefs.

Consider whether there is any truth or evidence to support your negative thoughts. For example, if you find yourself thinking “this disease will never end,” evaluate the thought logically. Do you know for a fact that the disease will never end? Consider the fact that all pandemics eventually end and life gets back to normal. Critically analyze any negative thoughts that you have in this way.

Ask yourself how you want to feel, and practice cognitive reframing.

No one wants to feel angry, worried, or stressed. We want to feel calm, in control, and at peace.Visualize how you want to feel and ask yourself how you can achieve that goal. One step is to practice deliberate cognitive reframing, in which you consider alternate explanations for your beliefs and then choose to think more positively.

For example, if you become angry at a patient who calls COVID-19 a “hoax” and find yourself thinking that your patient doesn’t trust you as a doctor, choose an alternate belief. Perhaps, “Right now, this patient is in denial because it is too emotionally painful for them to accept that COVID-19 is real, but it doesn’t mean that they don’t trust me as a doctor. After all, they came to the office to see me. It is very likely that with patience, I will be able to help them see things differently.” If you would like to learn more about how to practice cognitive reframing, there are many online resources or you can make an appointment with a mental health professional for one-on-one practice.

Practice mindfulness daily.

Cohen is a strong advocate of mindful meditation practice. “Studies show that even brief sessions of mindfulness activities — five minutes daily for six to eight weeks — improves mental health.” The key is structure and consistency. “Make a schedule and stick to it,” says Cohen, who prefers to practice mindfulness in the morning before he starts seeing patients. Consider using an app like Headspace, Calm, Insight Timer, or just set a timer for 5 minutes and focus on breathing. “Allow yourself to feel the discomfort of wanting to check the timer or quit early, and resist the urge, drawing your attention back to your breathing — this is where your growth occurs,” says Cohen. The key is to practice every day, ideally at a set time that is conducive to being alone and quiet. Another way of practicing mindfulness is going outdoors and paying attention to nature, even if it’s just in your backyard. Try doing yoga or other exercise and note how your body feels during these activities.

Engage in some degree of in-person communication.

It’s time. We have been isolated for over a year, and most of us in the health care field have been vaccinated for COVID-19. At this point, we have developed new patterns and habits that can make interacting with others difficult. We need to get out of the virtual world and start to ease back into in-person socialization and relationship building with our friends, family and colleagues. Even if it’s as simple as talking outside in your yard with a neighbor or having coffee with a friend, start making plans to interact with others.

Know that you are not alone, and that distress can get better.

When we have negative emotions, we sometimes feel isolated and alone, and that we are the only people feeling this way. Sometimes we believe these feelings will never get better. Talk to a trusted friend or family member. Reach out for support from your colleagues. Even better, schedule an appointment with a primary care physician, psychiatrist or psychologist. You don’t have to wait for a crisis or emergency to call. It’s far better to talk about your feelings before they reach a critical state.Another option for help is the Physician Support Line, a free and confidential service offered by volunteer psychiatrists to practicing physicians across the country. You are not alone and you do not have to continue to feel this way. It can — and will — get better.

Rebekah Bernard, M.D., is a family physician in Estero, Florida, and the author of “Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare.”