Physician wellness after COVID-19: Steps to getting back to normalcy

The COVID-19 pandemic has taken a toll on mental health with 42% of Americans reporting depression or anxiety symptoms in December 2020, compared with just 11% the previous year.¹ Physicians and other health care workers may be at higher risk for psychological distress as they not only cope with their own feelings but also respond to the emotional needs of their patients. Results from a survey of health care workers showed that 93% reported stress, 86% had anxiety, 76% reported exhaustion and burnout, and 75% felt overwhelmed. Caregivers also reported significant problems with insomnia, appetite changes, and physical symptoms like headaches and stomach pains.²

Although individuals may not be experiencing the same stressors they faced at the beginning of the pandemic—anxiety over personal safety and the health of family members due to a lack of personal protective equipment, financial insecurity, and “lockdown” isolation—new challenges constantly crop up. Over the last year, individuals have been forced to develop new lifestyles, learn to work virtually, experience having kids at home, and avoid in-person social activities with friends and family.

Throughout this phase, physicians have been exposed to another challenge—public skepticism of COVID-19. Whether it is a debate about masking or vaccines, if COVID-19 is even “real,” doctors must navigate a world in which acceptance of scientific authority is no longer a given. This is particularly difficult for physicians who are working on the front line, exposed to the harsh realities of the disease.

Now that COVID-19 vaccines have ramped up, individuals find themselves in a third stage—a tentative pivot toward pseudonormality. They are starting to engage in activities with others while wondering—is it really over? Are we really “safe”?

Fortunately, we can take steps to improve our mental well-being as we continue to navigate the (hopefully) postpandemic world.

Having negative emotions is normal

According to psychologist Steven Cohen, PsyD, coauthor of a book on physician wellness, physicians must learn to acknowledge their feelings nonjudgmentally. “Emotional reactions occur automatically,” he says. “They are neither good nor bad—they just ‘are.’” He says that although we cannot control these feelings, we can control how we choose to think about them.

Pay attention to your emotions

“The worst thing that we can do is to try to suppress or ignore negative feelings and emotions,” says Cohen. This doesn’t mean that we have to dwell on distressing feelings. But we do need to learn to identify these emotions and give them a label. We can do this by saying, for example, “I feel angry that my patient refused to believe that COVID-19 is real,” or “I feel overwhelmed and exhausted with seeing so many sick patients.”

“While it may feel uncomfortable to acknowledge these feelings, push through the discomfort,” says Cohen. This is where emotional growth takes place. He also advises physicians to take it a step further by asking themselves if anything more might be triggering their feelings. This includes such comments as, “When patients don’t believe in COVID-19, it means they don’t believe in science which means they don’t believe in me as a doctor,” or, “There are so many sick people. It feels like there will never be an end to this disease.”

Challenge your beliefs

Ask yourself if any truth or evidence supports your negative thoughts. For example, if you find yourself thinking, “This disease will never end,” evaluate the thought logically. Do you know for a fact that the disease will never end? Consider that all pandemics eventually do end, and life gets back to normal. Critically analyze negative thoughts that you have in this manner.

Practice cognitive reframing

No one wants to feel angry, worried, or stressed. We want to feel calm, in control, and at peace. Visualize how you want to feel, and ask yourself how you can achieve that goal. One step is to practice deliberate cognitive reframing in which you consider alternate explanations for your beliefs, then choose to think more positively.

For example, if you become angry at a patient who calls COVID-19 a “hoax” and find yourself thinking that they don’t trust you as a doctor, make the decision to choose an alternate belief. Consider, “Right now, this patient is in denial because it is too emotionally painful for them to accept that COVID-19 is real, but it doesn’t mean they don’t trust me as a doctor. After all, they came to the office to see me. It is very likely that with patience, I will be able to help them see things differently.” If you would like to learn more about how to practice cognitive reframing, online resources are available, or you can make an appointment with a mental health professional for one-on-one practice.

Practice mindfulness daily

Cohen is a strong advocate of mindful meditation practice. “Even brief sessions of mindfulness activities— 5 minutes daily for 6 to 8 weeks—improve mental health,” he says. The key is structure and consistency. “Make a schedule and stick to it,” says Cohen. He prefers to practice mindfulness in the morning before he starts seeing patients. Consider using an app such as Headspace, Calm, or Insight Timer, or just set a timer for 5 minutes and focus on your breathing.

“Allow yourself to feel the discomfort of wanting to check the timer or quit early, and resist the urge, drawing your attention back to your breathing— this is where your growth occurs,” says Cohen. The key is to practice every day, ideally at a set time that is conducive to being alone and quiet.

Another way of practicing mindfulness is going outdoors and paying attention to nature, even just in your backyard. Try yoga or other exercise and note how your body feels during these activities.

Engage in in-person communication

It’s time. We have been isolated for over a year, and most health care workers have been vaccinated for COVID-19. At this point, we have developed new patterns and habits that can make interacting with others difficult. We need to get out of the virtual world and start to ease ourselves back into in-person socialization and relationship-building with friends, family, and colleagues. Even if it’s as simple as talking outside in your yard with a neighbor or having coffee with a friend, start making plans to interact with others.

You are not alone, and it can improve

When we have negative emotions, we sometimes feel isolated and alone and that we are the only people who are feeling this way. Sometimes we think these feelings will never get better. Talk to a trusted friend or family member. Reach out for support from colleagues. Even better, schedule an appointment with a primary care physician, psychiatrist, or psychologist. You don’t have to wait for a crisis or emergency to call. It’s far better to talk about your feelings early before they reach a critical state. Please know you are not alone and you do not have to continue to feel this way. It can—and will—get better.

References

1. Abbot A. COVID’s mental-health toll: how scientists are tracking a surge in depression. Nature. 2021;590(7845):194-195. doi:10.1038/ d41586-021-00175-z

2. The mental health of healthcare workers in COVID-19. Mental Health America. Accessed June 8, 2021. https://mhanational.org/mental-health-healthcare-workers-covid-19