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Nisha Mehta, MD's, phone has been ringing with calls from tearful and shaken physicians who are distressed and unsettled about their work and home situation and don't know what to do.
What's more, many frontline physicians are living apart from family to protect them from infection. "So many physicians have called me crying.... They can't even come home and get a hug," Mehta said. "What I'm hearing from a lot of people who are in New York and New Jersey is not just that they go to work all day and it's this exhausting process throughout the entire day, not only physically but also emotionally."
Physician burnout has held a steady spotlight since long before the COVID-19 crisis began, Mehta said. "The reason for that is multifold, but in part, it's hard for physicians to find an appropriate way to be able to process a lot of the emotions related to their work," she said. "A lot of that brews below the surface, but COVID-19 has really brought many of these issues above that surface."
Frustrated that governments weren't doing enough to support healthcare workers during the pandemic, Nisha Mehta, MD, a radiologist in Charlotte, North Carolina, decided there needed to be change. On April 4, Mehta and two physician colleagues submitted to Congress the COVID-19 Pandemic Physician Protection Act (CPPPA), which requests, among other provisions, ensurance of mental health coverage for healthcare workers. An accompanying petition on change.org had received nearly 300,000 signatures as of May 29.
Don't Suffer in Silence
A career in medicine comes with immense stress in the best of times, she notes, and managing a pandemic in an already strained system has taken those challenges to newer heights. "We need better support structures at baseline for physician mental health," said Mehta. "That's something we've always been lacking because it's been against the culture of medicine for so long to say, 'I'm having a hard time.' "
If you're hurting, the first thing to recognize is that you are not alone in facing these challenges. This is true with respect not only to medical care but also to all of the family, financial, and business concerns physicians are currently facing. "Having all of those things hanging over your head is a lot. We've got to find ways to help each other out," Mehta said.
Where to Find Support
Fortunately, the medical community has created several pathways to help its own. Types of resources for COVID-19 frontliners run the gamut from crisis hotlines to smartphone apps to virtual counseling, often for free or at discounted rates for healthcare workers.
The following list represents a cross-section of opportunities for caregivers to receive care for themselves.
Physician Support Line (PLS) . This free and confidential hotline was launched on March 30 by Mona Masood, DO, a Philadelphia-area psychiatrist and moderator of a Facebook forum called the COVID-19 Physicians Group. The PLS is run by more than 600 volunteer psychiatrists who take calls from US physicians 7 days a week from 8:00 AM to 3:00 AM, with no appointment necessary. The number is 1 (888)-409-0141.
For the Frontlines. This 24/7 help line provides free crisis counseling for frontline workers. They can text FRONTLINE to 741741 in the United States (support is also available for residents of Canada, Ireland, and the United Kingdom).
Resources From Professional Groups
Action Collaborative on Clinician Well-Being and Resilience. Created by the National Academy of Medicine in 2017, the Action Collaborative comprises more than 60 organizations committed to reversing trends in clinician burnout. In response to the pandemic, the group has compiled a list of strategies and resources to support the health and well-being of clinicians who are providing healthcare during the COVID-19 outbreak.
American Medical Association (AMA). The AMA has created a resource center dedicated to providing care for caregivers during the COVID-19 pandemic. The website includes specific guidance for managing mental health during the pandemic.
American College of Physicians (ACP). The professional society of internal medicine physicians has created a comprehensive guide for physicians specific to COVID-19, with a section dedicated to clinician well-being that includes information about hotlines, counseling services, grief support, and more.
American Hospital Association (AHA). The AHA's website now includes regularly updated resources for healthcare clinicians and staff, as well as a special section dedicated to protecting and enabling healthcare workers in the midst of the pandemic.
Virtual Psychological Counseling
Not unlike the way telemedicine has allowed some physicians to keep seeing their patients, many modalities enable participation in therapy through video, chat, phone call, or any combination thereof. Look for a service that is convenient, flexible, and HIPAA compliant.
Traditional in-office mental health therapy has quickly moved to telemedicine. Many if not most insurers that cover counseling visits are paying for telepsychiatry or telecounseling. If you don't know of an appropriate therapist, check the American Psychiatric Association or its state chapters; the American Psychological Association; or look for a licensed mental health counselor.
Because financial constraints are a potential barrier to therapy, Project Parachute, in cooperation with Eleos Health, has organized a cadre of therapists willing to provide pro bono online therapy for healthcare workers. The amount of free therapy provided to qualified frontliners is up to the individual therapists. Discuss these parameters with your therapists up front.
Similar services are offered from companies such as Talkspace and BetterHelp on a subscription basis. These services are typically less expensive than in-person sessions. Ask about discounts for healthcare workers. Talkspace, for example, announced in March, "Effective immediately, healthcare workers across the country can get access to a free month of our...online therapy that includes unlimited text, video, and audio messaging with a licensed therapist."
Online Support Groups and Social Media
For more on-demand peer support, look for groups such as the COR Sharing Circle for Healthcare Workers on Facebook. The site's search engine can point users to plenty of other groups, many of which are closed (meaning posts are visible to members only).
Mehta hosts her own Facebook group called Physician Community. "I would like to think (and genuinely feel) that we've been doing a great job of supporting each other there with daily threads on challenges, treatments, pick-me-ups, vent posts, advocacy, and more," she said.
For anyone in need, PeerRxMed is a free, peer-to-peer program for physicians and other healthcare workers that is designed to provide support, connection, encouragement, resources, and skill-building to optimize well-being.
For those craving spiritual comfort during this crisis, a number of churches have begun offering that experience virtually, too. First Unitarian Church of Worcester, Massachusetts, for example, offers weekly services via YouTube. Similar online programming is being offered from all sorts of organizations across denominations.
For DIY or on-the-spot coping support, apps can help physicians get through the day. Apps and websites that offer guided meditations and other relaxation tools include Headspace, Calm, and Insight Timer. Before downloading, look for special discounts and promotions for healthcare workers.
Additionally, COVID Coach is a free, secure app designed by the US Department of Veterans Affairs that includes tools to help you cope with stress and stay well, safe, healthy, and connected. It also offers advice on navigating parenting, care giving, and working from home while social distancing, quarantined, or sheltering in place.
For practicing daily gratitude, Delightful Journal is a free app that offers journaling prompts, themes, reminders, and unlimited private space to record one's thoughts.
Adopt a Ritual
Although self-care for physicians is more crucial now than ever, it can look different for every individual. Along the same lines as keeping a journal, wellness experts often recommend beginning a "gratitude practice" to help provide solace and perspective.
Tweak and personalize these activities to suit your own needs, but be sure to use them even when you're feeling well, said Mohana Karlekar, MD, FACP, FAAHPM, medical director of palliative care and assistant professor in the Department of General Internal Medicine and Public Health at Vanderbilt University Medical Center.
One exercise she recommends is known as Three Good Things. "Every day, at the end of the day, think about three good things that have happened," she explained. "You can always find the joys. And the joys don't have to be enormous. There is joy — there is hope — in everything," Karlekar said.
Debra A. Shute is a freelance writer in Marblehead, Massachusetts
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Cite this: COVID-19: Where Doctors Can Get Help for Emotional Distress - Medscape - Jun 01, 2020.