ASRA Pain Medicine Update

If you are like me, you may find yourself at the end of your workday thinking, “I wonder what tomorrow will bring?” We are practicing medicine in uncertain times. As anesthesiologists and leaders, our mental and physical wellbeing has never been more vital than in recent months. The safety of those in our midst, our patients, our team members, and our families, directly depends on our ability to take care of ourselves.

Remember to stop and take your own “wellness” pulse and at the end of each day, give yourself grace. You deserve it.

Prior to the COVID-19 pandemic, data demonstrated that nearly 50% of anesthesiologists reported professional burnout with work stressors and lack of work control as major factors impeding their personal wellbeing.^[1,2] We are all aware of the added pressure placed on us as physicians to not only care for our patients, but also to care for own health. Many of us find ourselves struggling to remove mental stressors such as changing clinical information, financial challenges, and new work roles with limited time available to decompress. My hope is to give you some real-life resiliency metrics, aka wellbeing tips, to improve your own health, and avoid another “list” you should feel pressed to find time to achieve.

The COVID19 pandemic has brought several tests to our wellbeing, specifically to those of us leading healthcare teams working on the front lines.

• Information is coming at us at alarming rates and causing mental fatigue. As a cardiac anesthesiologist and a mother of four, the number of emails I have received due to “life” changes from COVID-19 is exponential. Whether it is instructions on homeschooling or activities, or new information from hospital leadership, we are drinking information from a fire hose. The mental capacity for us to store information has had to substantially increase at a fast rate. Rapidly changing patient therapies and clinical pathways, access to personal protective equipment, and constant information sharing has left most of us information overloaded at the end of our workdays. One of the best ways to mentally give your brain a rest is to schedule breaks throughout your day where you unplug. Take 5-10 minutes and walk outside. Set boundaries around your phone/email/computer and give yourself a curfew, at minimum 30 minutes before bed, where you stop engaging or reading online. This will allow you to prepare your mind for sleep and give your brain a solid night’s rest.
• The psychological toll of being a healthcare worker right now is real. We must recognize the new stress our jobs may be creating and take extra time to prevent mental and physical fatigue. Early studies of healthcare workers on the front lines in Wuhan during the initial COVID-19 outbreak suggested that the psychological toll of taking care of COVID-19 patients is real, with higher risks of depression, anxiety, insomnia, and distress reported in those caring for these patients.^[3] One of the best things to combat these psychological stressors is to routinely be aware of your mood and to have social support. Even if you have one friend at work you can confide and check in with, this will significantly help you cope with the ongoing stress we are facing. I like to give myself a “gratitude check” twice each day before I get out of my car at work and at home. I check my mood before entering my environment and take a quick minute to name three things I am grateful for. Try it, it works.
• Home may not be the escape it once was from the busy status of our clinical practices. We know that physicians who are resilient cite strong family and social support systems throughout the longevity of their career. For most of us, we depend on our home life as being predictable and a safety net for us to decompress at the end of our long days. Currently, our home life has been upended. We may find ourselves homeschooling our children, suddenly having college-age children back in our homes or supporting our elderly parents in ways we have not prior to the pandemic. Our partners may be working from home and we may find ourselves struggling to keep up with domestic demands we once had help with. A tip: find a place in your home you can claim as your own. Set boundaries to your family members and tell them that when you are in this space, you need a moment (or several) to decompress. We know that routine time alone, even brief, is associated with mental wellbeing. I like to call it “space and grace”; space to decompress and grace to accomplish less than what I feel I should.
• What we can control, and what we can accomplish in a day, has changed. Many of us find ourselves taking on new roles, learning new pathways and protocols, and adopting new workflow scenarios that are constantly changing. At the same time, the way we teach our trainees, deliver education, administratively manage changes and conduct research have all been disrupted. Yet our work requirements, from safety to education, have not diminished. We find ourselves able to accomplish much less than what we did prior, and thus our measure of professional achievement or success may be less. This is an interesting conundrum: we find ourselves working harder, but “producing” less. We may not be producing as much educational content, research outcomes, or scholarly activity. The pressure on us to achieve has not dissipated. As such, it is important as leaders we recognize this important challenge and change our messaging. Our teammates and colleagues should be rewarded for the quality and safety work they are doing.
  
  Let me tell you what has worked for me (a recovering over-achiever and perfectionist): In the morning, I give myself 3 simple things to accomplish that are within my control. Sometimes they are:
  1. Taking great care of my patients
  2. Asking the members of my OR team how they are doing
  3. Having a meal with my family
     
     Notice these are not ‘finishing a manuscript’ or ‘writing a research protocol’. Give yourself three things to accomplish – that you can control. It is enough.

My hope is that we will come out of 2020 more resilient, more capable, and more compassionate as anesthesiologists. I see how anesthesiologists are leading so many initiatives during the COVID-19 pandemic, and our immense capacity to be incredible leaders and innovators is evident in every institution. Remember to stop and take your own “wellness” pulse and at the end of each day, give yourself grace. You deserve it.

References

1. Shanafelt T, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012;172:1377–85. doi: 10.1001/archinternmed.2012.3199.
2. Shanafelt T, Hasan O, Dyrbye L, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 2015;90:1600–13. doi: 10.1016/j.mayocp.2015.08.023.
3. Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3:e203976. doi: 10.1001/jamanetworkopen.2020.3976.