Tara Kiran is a family physician at the St. Michael’s Hospital Academic Family Health Team and the Fidani Chair of Improvement and Innovation at the University of Toronto.
Everywhere around me, I see signs of physician burnout.
Clinical volumes are rising. Patients who had deferred care are coming in now with important concerns. We see the impact of COVID-19 on some of those left most vulnerable and hold the space as they share their struggles.
We are trying to keep up with rapidly changing COVID-19 guidance but the onslaught of communication is exhausting and oftentimes confusing.
We see case counts rising in many jurisdictions and are frustrated by the slow, ineffective government response. We are in leadership roles and are frustrated that our voices still aren’t heard. We know flu season is around the counter and we worry because there is no clear plan about how to deal with the deluge of people with upper respiratory symptoms that we know will soon be flooding our clinics and emergency departments.
We worry about our incomes and the viability of our practices. Outpatient volumes were low for so long and we worry what the second wave will mean for our offices and our OR times.
We are doing all this while carrying weight inside the home.
We’ve been looking after kids at home for months. They are finally back to school but the ever-changing logistics have been crazy-making and we worry not just about their safety but also their learning and development. We are also caregivers for older loved ones whose health deteriorates further the longer this pandemic goes on.
Work and home have never been more demanding.
We’re told to
- “Find time for a walk”
- “Practice gratitude”
All good strategies to build self-resilience.
But the issue is not self-resilience.
Our system is strained and our force of will can’t keep it together.
I wonder how our generation would do fighting in trenches in Europe in 20 below. Hmmm…
You are right , Tara, about the tremendous strain felt at every level from the personal to the system. Everyone is feeling it. We have no choice as medical leaders but to guide our docs and learners through these rough and uncharted waters. Each of us has our own way of managing this extreme stress. This makes me think we should discuss this at Exec and share how we are all doing and our strategies for managing this.
This reminded me of a great piece by a paediatrician in Flint Michigan who argued that we place far too much emphasis on resilience in individuals, especially disadvantaged children, and not enough on resilience in communities: https://www.nytimes.com/2020/05/12/opinion/sunday/flint-inequality-race-coronavirus.html
My sense is that doctors, perhaps especially those who provide primary care, may place too much pressure on themselves to be models of resilience.
It’s hard to argue with the tremendous systems level factors that are causing physician burnout, moral injury, and secondary trauma. I would just add that resilience (individual as well as community) is necessary, but not sufficient. Yes we need resilience, and yes it can be grown and strengthened and developed. But resilience by itself is also not enough – AND we also need systems transformation in order to sustain our health care workers and the health of our society.