As an intensive care doctor, Kelli Mathew knows that her life is heading in the wrong direction. On the one hand, her sympathy has dried up. When the unvaccinated people came to her and suffered the effects of COVID, Matthew started to fight back. She can no longer speak comforting words, even neutral words.
“In my opinion, it’s like,’This is what you did. Matthew, who works at Deaconess Henderson Hospital in Henderson, Kentucky, said that you chose not to get vaccinated, but it turned out to be like this. Then?’ I’ll go. Open. And that’s not me.”
Finally, Matthew reached out a helping hand and entered the psychological consultation, trying to understand what happened. Her doctor-patient relationship collapsed in front of her, and she knew it was her cause. “I have always been the most sympathetic and sympathetic person for making mistakes,” she said. Obviously, some things have changed.
For nearly 18 months, intensive care workers have been on the front lines of one of the worst medical crises in American history. The death toll in the intensive care unit (ICU) of COVID-19 patients is almost unimaginable: the death rate is About 35%, According to a meta-analysis. ICU nurses served, suffered devastating losses and eventually left the industry exist In groups. We have read their stories about sadness and pain.
Only now, in the long tail of COVID, have we begun to understand the severe losses that the pandemic has caused to frontline doctors. Although this is not surprising, the news is not good.
“Critical Care Medicine Association President Greg Martin said: “Intensive Care Medicine Association President Greg Martin said: “Doctors in the intensive care unit are experiencing the highest levels of stress, burnout and fatigue brought about by COVID-19. “Maybe with Compared to any other major, they continue to experience the full impact of COVID-19. “
In the past few weeks, I have talked with many people Critical Care Physician, Mental health consultants and other health experts.The agreement is almost unanimous: COVID is destroying some of our Intensive care physician.
In the most recent nationwide Polls Of the approximately 12,000 doctors, more than half of intensive care doctors reported burnout.Shortage of staffing and personal protective equipment (PPE), death toll, personal safety issues, providing inadequate feeling Emotional support For patients and their families-all this has led to a wave of difficulties, and this wave will continue to intensify in the summer of 2021.Currently Case surge The emergence of Delta variants in various parts of the United States almost guarantees that these situations will be repeated, as the ICU is filled again, and in some places, Beyond their normal abilities“This is really a kind of re-traumatic,” said James Jackson, an authority on depression and post-traumatic stress disorder at Vanderbilt University Medical Center.
“I have seen many ICU doctors exhibit some unusual outbursts, apathy, and sloppiness in patient care that I have never seen before,” said Gabe Wardi, an intensive care specialist at the University of California, San Diego and two smaller institutions. “I think as doctors, especially ICU doctors, we are proud to be able to handle any task or patient load. COVID reminds us that we need to rely on others to protect our mental health and patient care.” Wardi is afraid of bringing the infection home To his pregnant wife and young children, he felt guilty for the time he spent in the hospital. He said that his medical school roommate did not return to work until a year after he left, because seeing so many COVID patients die in his ICU, his job has been traumatized.
Neil Greenberg, lead author in the UK learn A professor at King’s College London said that among the people surveyed, ICU doctors confirmed that “the level of post-traumatic stress symptoms and depression is very high” [and] Anxiety, some people are also at risk of abusing alcohol. ” more than One in seven ICU staff Reported thoughts of suicide or self-harm. (In the U.S., it is estimated 300 to 400 doctors Suicide every year, about double The ratio of the general population. )
Experts say that since the beginning of the pandemic, doctors have had to deal with a lot of uncertainty, which has weakened their normal sense of control and confidence in practice. As an emergency physician for 25 years, I can prove my desire to control medical results and my tendency to perfectionism. We want to do our best for our patients. However, COVID rejected this certainty. “Either succeed or fail,” Matthew said. “Some people are alive, some people die, you can’t choose.”
For some intensive care professionals, part of the frustration is the belief that the most serious damage is largely avoidable. In Henderson County, Kentucky, where Matthew works, only 36% The residents of Deaconess and about half of the nurses in Deaconess have been vaccinated (although the hospital will require employees to be vaccinated soon). “We are in the red zone,” she said. “This is horrible. I have a full ICU with only one code bed.”
Mona Masood Doctor support hotline; Since the spring of 2020, volunteer psychiatrists have answered more than 3,000 anonymous doctor calls requesting mental health support.Masood said that in the first few months of the pandemic, doctors in the intensive care unit “climbed a creek without paddles—that is, they did everything they could to survive.” Among other things, the Line of psychiatrist After receiving untreated sad phone calls, some doctors said that they did not have time to resolve the loss of 20 patients within a week.
Ramnath Venktesh, an ICU doctor at the University of California San Diego Health Center, said: “The psychological loss is huge and it continues.” The harbingers of the four waves, people worry that earlier experiences and mistakes may repeat themselves.”
Doctors, especially intensive care physicians, are trained to respond in the present and push emotional considerations into the future. In the COVID era, with the seemingly relentless wave of illness and death, it turns out to be impossible, in part because “later” seems to never come.
Erin Hall is a clinical health psychologist who worked closely with the ICU team at Geisinger Medical Center in Danville, Pennsylvania, and witnessed the trauma experienced by providers, usually because obstacles beyond their control prevented them from providing what they deem appropriate Nursing. “Watching people die without a family member, there is a stranger in the room (usually a nurse), so this person is not alone-over time, this thing does affect you,” Hall said. “You can be the most resilient person, but it’s still difficult to bring these things home.”
Mental health specialist You can quickly separate terms. Burned out This is of course very common, but for ICU clinicians and other health care professionals, more and more people are now joining Moral harm, Feeling they cannot provide the care they usually expect.
Ethically challenging decisions, such as quantitative care due to shortage of resources, put mental and emotional pressure on ICU doctors. “There are some young patients who have died, and they have at least a chance to fight ECMO [an oxygenation machine],” Vardy said. But this is not possible in some smaller, community-based facilities, and because hospitals are overcrowded, patient transfer is hindered.
Despite the systemic obstacles, doctors are also required to convey bad news to their families. They carry the grief, blame, and grief that patients often target them. Masood said that some doctors thought, “‘Maybe I messed up things. Maybe I was wrong.” She described the process as the doctor’s psychology “killed by a thousand paper cuts.”
There is a practical healthcare aspect to this trauma. Before the pandemic, the United States faced a shortage of intensive care personnel, especially in remote areas. Patricia Pittman County Labor Estimator, The agency that tracks labor shortages in hospitals says that 198 counties in the United States are experiencing such shortages and require “crisis” level staffing. The pandemic “intensified this problem,” Martin said.In an international survey of 2,700 ICU providers worldwide, it was reported that the shortage of intensive care physicians in the United States was 12%.
We have a Dysfunctional healthcare system The United States before the pandemic, but with the COVID, the dams have been opened. The problem has been exposed: insufficient Staffing, low efficiency, Increase in expenditure and Pharmaceutical corporatization (With its escalating productivity requirements, documentation requirements and relative value units, or RV, and Metric expect). All these factors combine to make medicine lose its personality and draw soul from many providers.
Need to change now, not later, I got some advice from experts in my conversation.Make mental health resources It is necessary to make it available to doctors more publicly.Efforts to eliminate the stigma associated with doctors seeking help or admitting that they have been harmed—especially removing mental health issues from state and hospital license applications—will All doctors have access to much-needed care.
We need healthcare leaders who are willing to become fragile and face their struggles honestly—confirming that they are indeed anxious, taking antidepressants, seeing a therapist, etc. These actions will help normalize the experience and make other providers vulnerable. “Suddenly, we all took off our masks and had a deeper level of communication,” Jackson said.
Dealing with structural issues-hospital dysfunction, staff shortages, leadership failures, etc.-is essential. A study by the Mayo Clinic determined that The most effective strategy The goal of alleviating doctor burnout “will target organization-oriented change, not the individual level”, which shows that the health industry often resists such large-scale changes.
“This may be an annual issue of healthcare,” Martin said. “How do we really support suppliers? Because it involves the question of why people leave the industry-and obviously they have already left.”
If you need help
If you or someone you know is struggling or has suicidal thoughts, you can seek help.Call the National Suicide Prevention Lifeline 1-800-273-8255 (TALK), use online Lifeline chat Or contact the crisis SMS hotline by sending SMS TALK to 741741.
This Doctor support hotline It is a free and confidential service provided by volunteer psychiatrists to provide support to doctors And American medical students. If you need help, please call 1-888-409-0141 between 8 a.m. and 1 a.m. Eastern time.
This is an opinion and analysis article; opinions expressed Author or author Not necessarily those Scientific american.