COVID-19 has changed health care, with lasting impacts for anesthesia specialists yet to be fully realized. Telemedicine is here to stay… we have seen the evidence for this in pain medicine and how it was transformed to interact with patients remotely for most follow-up visits and will most-likely change the future of preoperative assessment. Our understanding of risk and risk management has evolved, and now most would agree that both general and regional anesthesia can be safely performed on a COVID-19 patient.
At a recent webinar of the American Society for Metabolic and Bariatric Surgery, Rachel Goldman, PhD, FTOS, a licensed psychologist and consultant in private practice and a clinical assistant professor in the Department of Psychiatry at New York University’s Grossman School of Medicine in New York City, addressed care for caregivers to avoid professional burnout.
“For the past few months, we have been worried about a world where hundreds of thousands of people were dying,” Dr. Goldman said. “We were worried about getting sick and worried about others getting sick. So much about life as we knew it became uncertain. Maybe if you were a working parent, you also became a full-time employee and full-time home schoolteacher, while protecting your family and perhaps your patients from the pandemic.”
“Pandemic fatigue” describes the intense tiredness and weariness that many people feel, and the irritability and disorientation of not knowing which day of the week it is, Dr. Goldman said.
A recent review and meta-analysis in the British Medical Journal reveals that in the past 20 years, other viral epidemics have caused psychological problems for health care workers (Br Med J 2020;369:m1642). “The first research about quarantine in China found it can bring on insomnia, stress anxiety, depression, anger, emotional exhaustion and post-traumatic stress symptoms,” Dr. Goldman said.
To avoid burnout, anesthesia specialists can take several steps. First, people need to focus on what is in their control, which is behaviors, reactions and how they cope, and not on what is out of their control, which is daily stressors, other people’s behaviors and how other people react.
“Self-care” is a broad term that encompasses just about anything you do to be good to yourself. It’s about knowing when your resources are running low and taking a step back to replenish and recharge. ”Self-care is a necessity, not a luxury,” Dr. Goldman said. “Individuals who do not participate in self-care will eventually burn out and not be productive in any aspect of life, personal or professional. We will eventually get sick.”
Taking care of you and your health is not selfish. It is important to take good care of yourself so you can be healthy and available to care for others.
History Shows How the World Responds to Pandemics
COVID-19 has reshaped the way we live and die, altered international politics, and caused incalculable economic damage. Yet for all its cataclysmic effects, COVID-19 is but the most recent global pandemic. From Thucydides’s description of the Plague of Athens in roughly 430 B.C.E. to the coronavirus today, a series of infectious diseases have swept around the world, killing millions. Despite their biological differences and chronological separation, these events have elicited remarkably similar medical and social responses. Examining these parallels provides both clarity and perspective on the current pandemic.
In 1969, Elisabeth Kübler-Ross published her now-famous model showing different stages of grief and bereavement of societies coping with pandemics such as COVID-19. This model does not imply a strict progression, but it nonetheless provides a useful framework to help understand how society approaches and responds to a frightening, seemingly existential threat.
- Denial, delayed acceptance that a pandemic is underway.
- Panic, terror, chaos, fleeing.
- Arriving at one or more explanatory frameworks, which might be social, cultural, religious, medical or a combination of these.
- Reestablishment of some order and needed services; Enacting public health measures.
- Pandemic endings: Attempts to resume normal social life; Days of prayer and thanks; sometimes new knowledge; Plans for prevention; Return fo complacency.
Denial/Delayed Acceptance – Throughout history, societies and individual citizens have been slow to accept the arrival of pandemics. Sometimes, this reluctance is strategic: The 1918 Spanish flu got its name because other countries with the disease refused to admit the problem in an effort to maintain military advantage. In other cases, economic reasons predominate, like the slow recognition of the 1897 yellow fever epidemic in New Orleans, in an effort to stave off quarantine and the commercial implications thereof.
Panic – Viewed historically, pandemics wax and wane. In the immediacy of the attack, however, potentially affected countries and people who have never experienced these events in their lifetimes lack this perspective and respond with the most human of behaviors: irrational panic. This hysteria has led to the almost absurd run on toilet paper, for a disease that rarely causes diarrhea.
Explanations: Social, Cultural, Religious, Biomedical – Eventually, society strives to decipher the underlying cause of the scourge it is experiencing. Historically, multiple, often contradictory, explanations have arisen. Diseases can be sent from god(s), result from environmental conditions, originate from outsiders, be due to the misalignment of celestial bodies, or be caused by germs. These explanations reflect prevailing sociocultural–scientific beliefs of the time. Whereas it took scientists until 1933 to identify the causative agent of the 1918 flu pandemic, using 21st century biomedical tools and techniques Chinese scientists defined the entire DNA code of the coronavirus by January 2020, only weeks after the first documented case in Hubei Province.
Response – These explanatory models powerfully shape the approach to epidemics. If God caused the disease, then praying to God might end it, hence the groups of flagellants peregrinating around Europe in the 14th century. Debates raged in the 18th and 19th centuries over whether diseases like malaria, cholera and yellow fever were contagious, and societies elected to erect cordon sanitaire accordingly. More recently, belief in biomedicine has led to an international research enterprise laboring to find a cure or vaccine.
Aftermath – Eventually, all pandemics end, usually not with a bang but with a whimper. The number of cases dwindles and restrictions like travel bans and stay-at-home orders are lifted. Funerals for those who died can finally take place; memorials to victims are commemorated; and eventually society returns to normal. Memories of the pandemic fade, resulting in the same complacency that contributed to the spread of disease initially.
Perhaps a depressing conclusion, it is realistic, based on human nature and verified by thousands of years of history. Although, like the Plague of Athens, the Black Death and the 1918 Spanish flu, COVID-19 too will pass.
Inspiring Experiences for Anesthesia Specialists in 2021
Well, we’ve all been cooped up for far too long, and you doctors have been grinding it out since February. But with vaccines slowly trickling into American immune systems, hopefully the end of this pandemic is within sight. The question is, how do you plan to celebrate it?
PhysicianSense has a few suggestions for you. These ideas range from simple pleasures, to extravagant indulgences, to far-flung destinations. When it’s safe to do so, they strongly encourage you to have these 4 experiences in 2021 (or something similar to your liking).
- Attend a concert to lower stress levels
- Attend a live sporting event to feel a sense of community
- Travel at home (in your region or country) to reduce risk of stress-related diseases
- Travel abroad to increase creativity
The purpose of these experiences is that we’re social creatures, and social distancing, while absolutely necessary, has had psychological implications. Chances are, you haven’t had any ‘me’ time in a while, and you’ve accumulated quite a bit of PTO. Finally, you can start to look forward to planning that well-deserved personal time!
Preventing Burnout During the COVID-19 Pandemic. generalsurgerynews.com
Medical History: How the World Responds to Pandemics. generalsurgerynews.com
Inspiring Experiences Every Doctor Should Have in 2021. mdlinx.com