Surgeon general: Amid pandemic, clinicians can take measures to avoid burnout
Physicians are facing considerable challenges in 2020 that could contribute to increased burnout, according to U.S. Surgeon General Jerome M. Adams, MD, MPH.
Adams, speaking at the virtual Summit on Promoting Well-Being and Resilience in Healthcare Professionals hosted by Ohio State University, told attendees that “there’s never been an instance in our lives that more exemplifies the phrase ‘trying to fly the plane while we’re building it,’ but you’ve done that, and again, you deserve thanks, you deserve gratitude, and you deserve to know that your sacrifices made a difference.”
He said by making efforts to address health disparities and advance health equity, clinicians can improve their wellness and potentially prevent burnout.
Address social determinants
Adams said “an underlying theme throughout all of my work is addressing and understanding the reasons for existing disparities and finding effective ways to advance health equity.”
He said the reason for clinician burnout is not simply “not enough tai chi, or not enough chai tea,” long hours or complicated electronic health records systems.
Instead, Adams said the main reason for burnout is that clinicians are treating patients and expecting to see certain results, but they are not seeing enough improvement, particularly among patients from underrepresented and vulnerable populations.
“This virus has highlighted a multitude of risk factors, but most of them are really rooted in pre-existing social conditions,” Adams said.
He added that “this virus has shown us something that those of us in public health have been trying to shout from the rooftops for most of our careers: that before you get to those pre-existing medical conditions, there are really pre-existing social conditions that conspire to reduce our resilience, our opportunity and our health.”
While general health care is critical to overall health, clinicians need to “remember that health actually begins at home,” Adams said.
An individual’s social and community determinants of health contribute to their medical determinants, he explained. Therefore, he said it should not surprise clinicians that if they only focus treatment on patients during their time in the hospital rather than also considering social factors, patients could continue to have problems and present for care.
He added that, in the case of COVID-19, many social factors make people more susceptible to COVID-19 infection and complications, such as living in densely populated areas, multigenerational homes, being unable to telework and having other medical conditions that worsen the virus.
For instance, he said that if a patient presents with COVID-19 and the clinician tells them to go home and isolate for 2 weeks, but does not ask about their living situation, that could potentially lead to the spread of disease. In the example, he said that the patient may live in a small apartment and share a bathroom with multiple people, leading them to be exposed to the virus and to seek care at the same clinic or hospital, potentially contributing to the clinician’s workload and burnout.
“We all must do our part to keep this virus at bay in the hospital, in the clinic, but also in the community and at home,” Adams said.
COVID-19 and burnout
Adams noted that while the ongoing pandemic has affected physical health — as seen in the more than 220,000 mortalities to date — it has also considerably affected mental health.
“This pandemic again has revealed the interconnectivity between a threat to our physical health and our mental health; it’s revealed the negative psychological impact of physical distancing, which ironically is the tactic we strongly recommend in order to slow the spread of the virus,” Adams said.
He added that even health care workers must face the mental health effects of physical distancing, as well as multiple other stressors stemming from their work on the front lines of COVID-19 response.
In addition to COVID-19, events such as the impeachment trial of President Donald J. Trump, the ongoing social justice movement and a divisive presidential election all contribute to the stress of the public, Adams said, and “clinicians are particularly susceptible to burnout, depression, substance misuse, and acute and chronic stress — factors that are, unfortunately, associated with higher rates of suicide compared to other professions.”
Adams said clinicians and the public alike should be encouraged to use health coping mechanisms during this time and should work to incorporate dimensions of wellness — including healthy eating, sleeping habits and exercise — into their lives.
He also said clinicians themselves should stay up to date on their health appointments, as they can now be done through telehealth visits.
“My own wife had a delayed cancer diagnosis this year because of COVID-19, and that is another stress that I carry with me as the nation’s doctor,” Adams said. “Don’t let you or your loved one end up in that situation.”
Preparing for influenza season
According to Adams, clinicians can also reduce burnout through their efforts to prepare themselves and their patients for the 2020-2021 influenza season.
He said if there are as many patients with influenza this year as there were last year — 39 million — clinicians could face considerable stress.
According to Adams, patients presenting with fever, cough and runny noses, who need to be evaluated to determine whether they have influenza or COVID-19, will create stress that could potentially have been avoided with vaccination.
“This is going to be the most important flu season of our lifetimes,” Adams said during the presentation.
Therefore, he said that clinicians will increase their risk for burnout if they do not do everything possible to ensure patients have been vaccinated against influenza.
Additionally, encouraging patients to continue to take measures like masking, handwashing and physical distancing to prevent the spread of COVID-19 could help lower the spread of influenza, Adams said, citing recent research on mild influenza seasons in South America that were attributed to COVID-19 mitigation efforts.
Adams noted that other times of struggle have led to advancements in medicine. For instance, he cited the growth in transfusions following World War I and the improvement in trauma care after the Gulf War.
“We’re in the midst of a sad time, of a tragic time for many families,” Adams said. “But I also think that there is a tremendous amount of opportunity for us to really reshape some fundamentally flawed systems that we work within, and that cause our burnout.”