Toughness Not the Antidote to Pandemic PTSD

John Whyte, MD, MPH; Diana Hendel, PharmD

Disclosures

December 15, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

  • Healthcare professionals dealing with COVID-19 have faced relentless case numbers, death rates higher than they are used to, and fears for their families about their own safety. This experience has crossed from normal types of stress into traumatic stress.

  • Resilience and the ability to compartmentalize often serve healthcare workers and their patients well. However, emotions that can harm both the body and the mind must be dealt with.

  • The healthcare system often does not create a culture that encourages healthcare workers to seek counseling or other support.

  • Leaders can play an important role by encouraging the use of support programs. Also, listening to healthcare workers' stories without trying to "fix" people or give a pep talk is important for the healing process.

  • Silver linings in the pandemic include the camaraderie among healthcare workers, the improved logistics of pandemic response, and the support the public is showing them.

This transcript has been edited for clarity.

John Whyte, MD, MPH: Welcome, everyone. You're watching Coronavirus in Context. I'm Dr John Whyte, chief medical officer at WebMD.

COVID-19 has impacted all of our lives, and it's hit health professionals pretty hard. We've been watching the videos of the emergency rooms and hospitals being overwhelmed. So, what's the impact on health professionals, and how do we help them through this?

To help provide some insight, I've asked on Diana Hendel. She's the [co-]author of a new book called Why Cope When You Can Heal?: How Healthcare Heroes of COVID-19 Can Recover from PTSD. Diana, thanks for joining me.

Diana Hendel, PharmD: It's really a pleasure. Thanks for having me.

Whyte: Healthcare workers see a lot of trauma on a daily basis. In the emergency room, you see patients with gunshot wounds, wounds from car crashes, and who have had heart attacks and strokes. Why is COVID-19 so different?

Hendel: You raise such an important point. Healthcare workers and professionals are, by nature, among the strongest, toughest, most resilient, grittiest people that any of us would ever encounter. Their measure of emotional and mental toughness is unparalleled. They are accustomed to seeing accidents and traumas. What's different about COVID is that it's day in and day out, month after month — now approaching a year.

The amount of death, anguish, hardship, and loss is enormous. It is far beyond what they've experienced day in and day out in the past. Because the pandemic continues on — its severity, the risk for their own lives, and the impact on their own families — this has really crossed from the normal stress that they encounter into traumatic stress for them.

Whyte: Let's talk about that impact. There's the impact on the individual person — the nurse, the pharmacist, the doctor ─ but there's also the impact on the healthcare system. Can you help explain what's going on there?

Hendel: So much has been written about the impact of trauma on individuals, but very little has been published about the impact on an organization, a community, a group, or on a collective. Collectively, that is what we're experiencing at all those levels. When organizations are traumatized, often people come together in wonderful ways — the camaraderie, the bonding that can occur, the esprit de corps as they rally around a particular event.

As events go on, and depending upon the nature of the event, sometimes blame and finger-pointing arise: Who caused it? Who didn't do enough to prevent it? Guilt arises often, and we see this in organizations: Did I do enough to save my patient? Should I have done something different? Am I protecting my loved ones at home?

Sometimes, depending upon the nature of the trauma, shame can enter an organization. Sometimes the organization itself wonders about the reputation that the community will hold. So, certainly with the COVID pandemic, all those things are in play ─ both the impact on individuals and on the organizations themselves.

Whyte: For physicians, isn't there an attitude of, "Get over it, you can deal with it, don't let your emotions get in the way"? That's historically been the approach in training. Is that doing damage?

Hendel: Well, I look at it as a "both/and." I think that resilience, toughness, and that ability to compartmentalize and put it aside for the moment really serve people well — and they certainly serve our patients well when we're able to do that. But I consider it a "both/and," that we also need to make room for the emotional toll and impact. We often put that aside and just keep going. Until we deal with how the emotions impact our bodies and our minds, that continues to build up.

To your point, it can cause long-standing harm. It can result in unresolved feelings and have an unhealthy impact on physicians and clinicians. So, it's very much a "both/and." I wouldn't say to discard the resilience and toughness, but I would say to add a practice of being able to navigate and process the emotions.

Whyte: As you know, WebMD also runs Medscape. We've seen that burnout was an issue pre-COVID.

You ran a large health system for many years. Some people will argue that health systems have created more stress. The culture doesn't create an environment where one can say they're not okay or they're having challenges. We've heard from Dr Esther Choo, who talked about seeking help from a mental health professional, and whether you then have to disclose that on your medical licensing. That can create challenges.

In your book, you mention that PTSD is not inevitable, and you provide some solutions. I want to hear about those solutions. I'd love to hear how you think about it now vs how you thought about it a few years back when you were in charge of a system.

Hendel: Both (when I was in charge of the system). I grew up with a healthcare organization. I was a former CEO of two hospitals in Long Beach, California, but I'm also a clinician by background ─ a clinical pharmacist by training. I know very much what it is to serve at the bedside and on the front lines. To your point, our culture of "just get over it and move on; we're tough and resilient" does contribute to the stigma of addressing mental health challenges, particularly PTSD.

We experienced a very traumatic workplace shooting while I was CEO, and after a number of years, it became apparent to me that I personally had PTSD. It was quite a conflict. I was willing to get help, but I wasn't willing to come out with that. It was really clear that, in our culture, being a CEO and having PTSD was a sign of weakness. I knew I had gone through lots of adversity and very tough and traumatic situations. I knew I was tough, and I thought toughness and busyness was the antidote, and I discovered it wasn't. I did get more intensive help and fully recovered. I am now helping organizations, individuals, and leaders address the traumatic stress that they may experience in their organizations.

Whyte: In the book, you talk about individual things that people can do, and the fact that systems have to change as well by allowing people to ask for help, checking on people to see how they're doing, and not putting all the burden on a health professional. What are some examples that you talk about and ways that we can help address this? As you point out, PTSD is not inevitable.

Hendel: To your point, healthcare organizations have been stepping up to establish employee-assistance programs and to make it known that psychological, spiritual care is available for employees. Offering peer-to-peer counseling is really important. But the more that leaders come out and encourage and model it, that will be something that really opens the floodgates. People can be tough and be affected, and more leaders model that and encourage people to seek advice, counsel, support, and help as needed.

I think the key thing that people can do (coworkers, employers, and all of us who work in support of healthcare professionals) is to listen to them and their stories without trying to fix them or jumping in with a pep talk and saying, "Well, you'll get over it." Those are easy things to say, and when we're faced with someone who is struggling, we often say those things. In my experience in working with thousands of others, being able to listen — bear witness if you will — to their story without jumping in to fix is really key to helping them heal. It's not easy to do. It's uncomfortable to hear somebody else's pain. But it's perhaps the most supportive and loving thing we can do ─ simply listen to them.

Whyte: Do you think there's any silver lining from the impact that COVID has had, in terms of how we deliver care and practice as clinicians?

Hendel: There are many silver linings. I think, to that point of the camaraderie, the esprit de corps, the rallying to support one another, that is abundant and we see that every day. Individuals and organizations that can capitalize on that — I think that carries healthcare organizations forward. Logistically, there is a lot of work that's been done in response to this pandemic to shore up our logistic responses and to improve those. As we do after-action reviews and look back, there's a lot of improvement that we can incorporate. Those are some of the things that will really serve as silver linings for the healthcare industry.

Whyte: You talk about how communication is key. We haven't always been the best in terms of communicating internally to our colleagues, as well as externally to the broader community. Do you think that will improve over time? We've seen that in challenges with PPE (personal protective equipment) and explaining what's going on there. Why is it so hard for health systems to communicate effectively?

Hendel: I think there are a lot of challenges, logistically, to communicate. What happens is sometimes there's a hesitancy to come out until we know all the answers. In my experience, coming out with communication as soon as possible, saying what we do know, admitting what we don't yet know and how we're going to find out, establishing regular, frequent touch points, establishing call centers so people with questions can know that there's a central repository for their concerns — all of those things in the immediate aftermath of an event, or as a pandemic unfolds, are critically important.

Many times, when there isn't a lot of communication, people fill those voids with narratives that are often not particularly healthy. Our ability to speak to that void and ensure that there aren't voids created, our ability to address elephants in the room and address rumors very forthright is really important. Those are some of the elements where I am seeing tremendous improvement in communication. By virtue of the virtual world that has happened, I think people have really stepped up and improved their communication game tremendously. And I'm seeing that and know it will last into the future.

Whyte: Your new book, Why Cope When You Can Heal? How Healthcare Heroes of COVID-19 Can Recover from PTSD, is available now. I want to thank you for providing your insights and helping us think through how to help those that are in need right now and how to help improve the system.

Hendel: Thank you, Dr Whyte. It's really an honor and privilege to be on your show.

Whyte: And I want to thank our viewers for watching. If you have a question about COVID-19, please feel free to send it our way. We may answer it on the air. You can send it to drjohn@webmd.net. Or you can follow us on social — on Twitter and Instagram at @WebMD ─ and send us a message there. Thanks for watching.

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