Underprotected Clinicians: 'We Are Tired of Advocating'

John Whyte, MD, MPH; Esther Choo, MD, MPH


July 24, 2020

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  • There is a shortage of personal protective equipment (PPE) in hard-hit states like Arizona, Florida, and Texas. It has been difficult to fulfill their PPE requests because of supply chain issues and underestimating the sustained PPE need.

  • As schools reopen this fall, there will be an increased need for PPE to protect teachers and staff.

  • Healthcare worker burnout, stress, anxiety, and PTSD have increased substantially during the pandemic.

  • Our society stigmatizes clinicians who admit that they have mental health issues, and they can be penalized professionally for seeking help.

  • Clinicians need mental health services that are widespread, easily accessible, and confidential.

This transcript has been edited for clarity.

John Whyte, MD, MPH: You're watching Coronavirus in Context. I'm Dr John Whyte, chief medical officer at WebMD. Today I'm joined by Dr Esther Choo, professor of emergency medicine at Oregon Health and Science University Medical Center in Lake Oswego, Oregon. Dr Choo, thanks for joining us again.

Esther Choo, MD, MPH: Thanks for having me on.

Whyte: You helped shed light on what was happening on the front lines, especially in terms of shortages of PPE as well as burnout. What's happening now on the front lines?

Choo: I have seen things that are hopeful but also very discouraging. In many ways this has been a Groundhog Day era, where I wake up and think, Are we in March? April? Because here we are in July, and many of the same issues are present.

Certainly, we've done a lot of work, but there are concerning shortages in the resources that we need. For example, through the organization I'm involved with, GetUsPPE.org, we've distributed more than 2 million units of PPE around the country. We have requests pouring in from the hardest-hit areas right now (eg, Arizona, Florida, and Texas), and we've only been able to meet about 10% of the need there. So that represents a lot of work and a lot of successful distribution of PPE. At the same time, we are constantly overwhelmed with a huge need that's out there, particularly for smaller health facilities.

Whyte: Why do you think it's the case? Is it an issue of manufacturing, that companies just can't make PPE quick enough? Is it poor coordination at the federal and state levels in terms of getting it to people who need it? It seems like we made some progress in terms of providing PPE to frontline responders. As you point out, we're now heading back to areas experiencing shortages. How can we fix it?

Choo: It's everything from failing to mobilize the supply chain, from underestimating the amount of need — and the sustained need. Back in February and March, we didn't imagine that we would still be here in mid-summer with rates going up and hospitals either in crisis now or heading into one.

As we reopened, there was a need for PPE in many locations and businesses that were not hospitals, and we failed to estimate how much PPE we need. As we go into the fall, there's going to be a huge PPE need in schools in order to protect and keep teachers safe as we reopen the schools in many areas.

The need has marched ahead of a fairly fixed supply chain. Although, again, we're doing as best as we can to stimulate the supply chain and to create an inflow of materials as we have them.

Whyte: What can listeners do? Could they donate? Could they help in some ways in their communities?

Choo: There are so many ways to help. Organizations like mine (GetUsPPE.org) and others are accepting donations. We put as much of that money directly in the hands of healthcare organizations, helping them boost their supplies as much as possible.

It's important to not get "issue fatigue" here. There were so many people advocating for increased supplies ─ talking to elected officials, advocating for mobilization of federal, state, and local resources ─ so we continue to support healthcare organizations in acquiring PPE.

People got tired, which is understandable, as we are tired of advocating for it. As long as this surge continues, we need to be as energetic as the virus in advocating that resources be dedicated to this, because it's an important part of the containment effort.

Whyte: Let's talk about burnout, especially in terms of mental health. We've talked before about how many frontline responders are experiencing some type of posttraumatic stress disorder (PTSD). Are there more services and resources available in addressing this mental health burden?

Choo: There are a lot of wonderful efforts to create online, free, accessible counseling resources for healthcare workers on the front lines and who are experiencing stress, anxiety, PTSD, and burnout.

But I want to be clear that these kinds of crisis resources are Band-Aids on top of what has been a mental health crisis in healthcare before we had a pandemic. Yes, we're in an unprecedented time in terms of the sustained stress that this pandemic has brought, but we're in this environment where it's shameful to admit that you have mental health problems or that you need help from a therapist.

It is actually scary to try to seek medical care, because you can be penalized professionally. Medical boards will ask whether you've sought mental health care in a way that doubles down on that fear and stigma. And there can be real professional consequences. We've seen this.

We need to change the culture in healthcare around having mental health problems. This should be viewed as a very normal part of our very tough practices. We should try to make our healthcare environments more humane to begin with so that it's not as harrowing to have a career in medicine. We should view seeking care as an expected and normal part of a healthcare provider's professional life.

Whyte: What are some of the resources that people could use right now?

Choo: My own hospital does a great job of this. We have a confidential counseling service for healthcare workers; you can walk in any day of the week and receive 100% confidential and free care. I can leave a shift and walk into that office. They make themselves as accessible as possible.

Because it's so confidential, I don't have to be afraid to walk in there. When they see that there is a bad event in a department or something happens on social media, they do outreach and say, "Hi. It looks like you're going through a tough time. I just want you to know that these hours are open to you."

They're very proactive in providing support, and that is what we need right now. We need to acknowledge a couple of things. First of all, this is a difficult time like no other. It's layered on an already tough practice. We need to make resources so available that you cannot avoid them, which is how I honestly feel like it is at my institution.

We need to lower the bar of accessibility in every single way — in how many steps you need to go through to reach that resource. Lower the bar on cost. Lower the bar on any punitive or stigmatizing attitudes toward that care. We need that now more than ever. When the pandemic's over, we need to completely reset how we approach these issues to begin with.

Whyte: When do you think the pandemic will be over?

Choo: I think this is going to be a long year. That's all that I will say in terms of a school year because I have school-age kids. In my household, we are planning to not expect normality for a full calendar school year. Even if we get a vaccine in the early part of 2021, I am very concerned, based on what we've seen, that we can scale up our manufacturing and our distribution chains in a way that is efficient and equitable. I don't think that we will reap the benefit of that for quite some time. I'm uncomfortably settled into a nonnormal life right now.

Whyte: You started off the interview by saying you're hopeful. What are you hopeful about?

Choo: I'm really impressed by our community of healthcare workers and scientists. I sit here, day after day, and watch people leave their regular jobs ─ their very exhausting, taxing, and physically draining jobs. Then they sit down and they do advocacy work so that we can get the science out. I've never seen so many healthcare workers out there using their voices to educate the public, contributing to projects, so that we can do things like distribute PPE and educate our community.

These people are volunteering with their school systems to try to make the best and safest plan so that kids can return to school in some capacity. They're volunteering in workplaces and trying to figure out how we can transform physical spaces so that people can be at work in some capacity. They're joining conversations at the local, state, and national levels. Our people are showing up in droves day after day. This has become a 24/7 project, fighting the pandemic and working with people at every level in every sector to try to get through this.

I don't know about you, but I have felt just tremendously inspired by the work that people are doing on their own time to just get our country through this. It gives me hope every single day even as so many things are devastating about this virus.

Whyte: Dr Choo, thank you for all that you are doing and for being a leader, a mentor, and an inspiration to a lot of people.

Choo: Thank you, Dr Whyte. I really appreciate it.

Whyte: And thank you for watching Coronavirus in Context.

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