"I Couldn't Help Anyone. I Couldn't Do Anything."
Pandemic-related burnout is real, devastating, and likely coming to your community soon
COVID-19 overtook New York City beginning in March through April and into May of this year, with a multi-faceted impact on patients (particularly from communities of color), schools, the economy, and a group particularly vulnerable to burnout - health care workers.
Physicians were known for having some of the highest rates of burnout prior to the pandemic. COVID-19 exacerbated physician burnout to degrees never before seen in New York City and surrounding areas.
An Exemplary Physician
The New York Times recently published an in-depth story on Dr. Lorna Breen, an emergency department medical director at NewYork-Presbyterian Allen Hospital located at the northern tip of Manhattan and affiliated with Columbia University Medical Center.
Dr. Breen was an exemplary physician and human being, an optimist with a magnetic personality. Raised in Danville, PA, her father was a trauma surgeon at the famed Geisinger Health System. She attended Cornell as an undergrad and then did medical school in Virginia, completed two residencies on Long Island (emergency medicine and internal medicine), and was pursuing a dual master's program at Cornell. She took up cello, snowboarding, and salsa classes, and was active in her church bible study group. She hosted a yearly rooftop party for friends and co-workers.
In the ED she was known for her compassion, composure, and organization. When chaos permeated the ED, she could be relied upon to bring order.
An Avoidable Tragedy
Dr. Breen died by suicide on April 26th.
The article describes Dr. Breen's journey from being a highly-functioning physician leader to a person unable to cope any further. Toward the end, she expressed her feelings by repeating, "I couldn’t help anyone. I couldn’t do anything. I just wanted to help people, and I couldn’t do anything.”
I can't shake my sense of how her words exemplify the third manifestation of burnout described by Maslach and Leiter - a sense of inefficacy, that what we do doesn't really matter. While not discussed as much as emotional exhaustion and cynicism, the other two manifestations of burnout, inefficacy can be more deeply felt by physicians who have dedicated their lives to caring for patients.
While we may never know specifically what contributed to Dr. Breen's suicide, there are a number of risk factors that most physicians share, and additional risks due to COVID-19 surges which are spreading across the country.
Intensity - a quality that is key to success in many specialties
Unwillingness to admit weakness - we equate weakness with failure
Expecting more of ourselves than others, a need to be superhuman
Hesitancy to express concerns about our own mental or emotional health - which can derail or end a career
An overwhelmingly chaotic workplace, as COVID flares locally hospitals, particularly EDs are full beyond capacity and unable to accept more patients
Inadequate supplies to care for patients and/or PPE to protect ourselves
The emotional burden of constantly being surrounded by disease and death at a level never-before experienced
COVID's impact on the health of infected healthcare workers, even when "recovering" from the infection, affecting the pulmonary, neurologic, cardiac, and other systems.
How can we reduce the risk of physician depression and suicide?
There are three key areas to focus on to reduce the risk:
The emotional and physical health of ourselves and our colleagues - we need to accept the fact that we are vulnerable and encourage that vulnerability with our colleagues in order to ensure we can get help early on when it can make the most difference
Our workplaces - we need to reduce the dysfunction in our clinical workplaces, reducing the demand if possible (this requires national and local leadership as well as coordination across all health systems, even those who are normally competitors) and improving workflows to eliminate waste and bureaucracy
The leadership culture in healthcare organizations - treating physicians with the respect they deserve as highly skilled knowledge workers, collaborating with them and empowering them to lead in the areas of their expertise, and letting everyone know that their leaders have their back.
You may have noticed that these are the same three domains in the professional fulfillment model from Stanford WellMD. But they must be addressed with the greater intensity that this pandemic demands.
One More Thing
Dr. Breen's family has set up a non-for-profit foundation to provide mental health support to other healthcare professionals - The Dr. Lorna Breen Heroes' Foundation. You can learn more about it and support it financially here. Please consider contributing what you can to help others.
As the pandemic continues its relentless spread across our nation, it's likely many other communities, and the healthcare providers in those communities, will have similar challenges. They will likely rise to meet the challenges in some ways, and succumb to them in others.
We can all do our part to take care of ourselves and our colleagues, eliminate any stigma associated with mental health issues, and insist our leaders do the right thing to support clinicians on the front lines.
Doing so, we can hopefully eliminate the need for any other physician to say, "I couldn’t help anyone. I couldn’t do anything. I just wanted to help people, and I couldn’t do anything.”
In these extraordinary times, we can and should do no less.