MILWAUKEE—As physicians in hospitals across the country find themselves faced with the overwhelming task of treating—and frequently losing—COVID-19 patients, they are describing the experience as akin to battlefield conditions. Even the language used to describe the situation is borrowed from combat: “front line,” “at war,” “in the trenches.” And like soldiers, these frontline healthcare workers will likely face their own mental and emotional injuries.
While many areas have yet to reach the peak of the patient surge, some experts are anticipating a time when these physicians will need care themselves to help recover from the experience.
Ian Weissman, DO, FACR, a radiologist with the Milwaukee VAMC, had been working on combating physician burnout prior to the pandemic and believes that the emotional and mental well-being of healthcare workers is now more important than ever.
“I think this is going to be serious,” Weissman explained. “Clinicians before this were having problems with stress, depression, suicide and burning out. COVID for a lot of physicians is going to be a major challenge. It’s putting clinicians in situations they really have not been trained for.”
In 2016, Weissman began work with the American College of Radiology and its National Commission on Patient and Family-Centered Care. The commission’s goal was to find ways to better incorporate patient needs into the radiology process. As the commission did their work, the discussion moved to how to better support the other side of the patient-doctor equation.
“People have been talking about burnout for years. It started to come more to the forefront, because we were starting to see more clinicians who were depressed committing suicide. About 400 physicians kill themselves every year,” Weissman said. “We were seeing clinicians leave the profession. These are people for whom medicine is a calling. For them to leave, that’s really serious.”
Burnout, as described by the National Academy of Medicine, is “a workplace syndrome characterized by high emotional exhaustion, high depersonalization (i.e., cynicism) and a low sense of personal accomplishment from work.”
In 2017, NAM launched the Action Collaboration on Clinician Well-Being and Resilience, a network of over 60 organizations, including the ACR, dedicated to reversing trends in clinician burnout. In 2018, the ACR began developing a roadmap to foster wellness engagement in the workplace. And in 2019, the National Academy released a study describing a healthcare system that was failing to support its workers and put out a national call for change.
ACR answered the call by developing a well-being toolkit. Weissman was asked to lead the professional development workgroup tasked with creating guidelines for how organizations can foster change.
Christened the Well-Being Program, Weissman and fellow members of ACR have been raising the profile of the topic of physician wellness and making information available to clinicians and hospitals. This includes a radiologist-specific toolkit focusing on work-life balance, health behaviors and emotional concerns, as well as a survey developed by the Mayo Clinic that physicians can use to anonymously self-evaluate their level of well-being.
“We’re starting to get the word out. It’s started to build some momentum,” Weissman said. “The problem with well-being is that it’s a culture shift. There’s got to be buy-in. Everyone has to believe in it. And it’s still very recent.”
The good news, he said, is that he’s already seeing positive effects. In his own hospital, he’s seen department leadership begin addressing the issue.
“We have an organizational psychologist who has come by and spoken to us,” he said. “And we watched a video recently about how to support your colleagues. Again—changing the culture takes a long time. But I haven’t seen this before and I’ve been with VA for 12 years.”
With COVID-19, Weissman believes that physician well-being has become more critical than ever. While PTSD will certainly be an issue, physicians will also likely be dealing with the impact of moral injuries, he said. Moral injuries occur when a person commits or fails to prevent an act that goes against their moral beliefs.
“Your mission is to save people’s lives, and if you lose a patient you know you’ve done all that you could and that you had [everything you needed] to help,” Weissman explained. “Under COVID that has changed. We don’t have the adequate [equipment] in the heavier-hit states. We have articles coming out in the New England Journal of Medicine about how clinicians will have to make decisions about who will live and who will die.”
While physicians now are focused on the health of their patients and protecting themselves against being infected, the emotional ramifications could take years to manifest.
“There has to be psychologists and social workers monitoring these clinicians,” Weissman said. “We should step in like after 9/11 and keep these people under close watch. It may take a year. It may take two years. I think it’s shaking the fabric and the moral being of a lot of people.”
VA, with its robust and centralized infrastructure, is in a good position to keep a close eye on its physicians, following the COVID-19 crisis and moving forward.
“If anyone’s going to be a leader in making sure clinicians aren’t burning out, it’s going to be VA,” Weissman declared. “People should know that we’re all in this together. That we’re all working toward the same goal—optimizing patient care and optimizing our own care.”