Physician Health

How pandemic’s toll adds up to “moral injury” for physicians

Jennifer Lubell , Contributing News Writer

Pulmonologist Reggie Mason, MD, knows all about the effects of physician burnout during COVID-19. He lost a brother to the disease and saw its inequitable impact on African Americans in his home state of Georgia.

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“Physicians are human too, and our training sets us up to be hypervigilant,” said Dr. Mason, a physician lead for total health and inculturation with the Southeast Permanente Medical Group in Georgia.

The pandemic intensified that hypervigilance, which can be exhausting, he said.

Dr. Mason joined two other physician leaders for the an episode of the “Permanente Medicine Podcast” to talk about the importance of physician self-care during COVID-19. While the public has gone back to somewhat normal lives, many front-line physicians continue to balance previous responsibilities with ongoing demands of the COVID-19 response, said podcast host Chris Grant, chief operating officer of The Permanente Federation.

All eight Permanente Medical Groups, as part of the integrated health system Kaiser Permanente, implemented a vaccine mandate this summer. The Southeast Permanente Medical Group is a member of the AMA Health System Program.

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All three guests spoke of the relentless onslaught of the virus, and the physical and mental impact on doctors.

“The fundamental distrust in science and government made the last 18 months particularly exhausting in the health care field,” said Dawn Clark, MD, ob-gyn and chief wellness officer for the Southern California Permanente Medical Group.

Physicians have suffered “moral injury” from seeing so many people dying alone while dealing with limited treatment options, said Dr. Clark.

“It’s so important to know that physicians have emotions, have mental health problems just like anyone else,” said Ashley Zucker, MD, psychiatrist for the Southern California Permanente Medical Group and chief of psychiatry for Kaiser Permanente San Bernardino. A silver lining to the pandemic is that it has decreased the stigma of mental illness, she added.

Learn about the health systems that are stepping up as COVID-19 strains doctors, among them the Southern California Permanente Medical Group in Pasadena.

Permanente Medical Groups and their wellness leaders have launched several well-being initiatives throughout the pandemic, making mental health resources more available to physicians.

At Dr. Clark’s medical group, a 55-word story challenge encouraged people to share their experiences with COVID. “We collected so many more stories than we expected,” she said. Ongoing peer support programs and town halls enable physicians to talk about their experiences with grief, inspiration and post-traumatic stress.

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The Southeast Permanente Medical Group seeks to boost resiliency through narrative medicine sessions. This seizes on the idea that physicians and other health professionals are whole people, giving them the safety and space to talk about painful subjects, said Dr. Mason.

Read about how to get doctors to check in on their own well-being amid COVID-19.

Taking breaks, getting exercise, and eating well are small but critical steps, said Dr. Zucker, a self-professed Peloton addict. Practicing gratitude and setting boundaries at work, are also important.

Sleep is a “super critical ingredient that takes us in the direction of joy,” said Dr. Mason. Lacking the energy to care for yourself, or your patients—“that’s very demoralizing. So, let’s focus on the physical first. Sleep is a big part of that.”

Discover four well-being initiatives to tackle the pandemic’s heightened stress.

Physicians are often hesitant to ask for help. Dr. Clark recalled that asking for help was seen as a sign of weakness during her training.

“That’s been ingrained in our medical culture and it’s absolutely wrong. We need to continue these conversations but decrease that stigma,” she said.

The AMA offers resources to help physicians manage their own mental health and well-being during the COVID-19 pandemic and provides practical strategies for health system leadership to consider in support of their physicians and care teams during COVID-19.