The COVID-19 pandemic has placed a tremendous burden on physicians and other health professionals. It is a burden that is cognitive, physical and emotional. One way to address this ongoing burden is through a peer support program, which can positively impact and shape the culture of medicine during the pandemic and moving forward.
“Peer support is an organizational approach and an individual approach to being there for each other,” Jo Shapiro, MD, FACS, an associate professor of otolaryngology-head and neck surgery at Harvard Medical School in Boston, said in an AMA webinar. “When we think about our organizations and when we think about the way we practice medicine, we need to remind ourselves that the culture of medicine is very strong.”
“Much of the culture is wonderful, like the fact that we're healers and we put our patients first. That is beautiful, and no one will ever take that from us, but there is a dark side to this,” said Dr. Shapiro. “The culture has in some ways let us down over the years. It’s been increasing our workload without actually increasing the support to front-line clinicians, and it’s minimized the emotional and physical well-being of physicians and other health care providers”
Asking the question, “How are we expected to sustain our work if we don’t address these challenges to our well-being?” Dr. Shapiro emphasized the importance of peer support. By implementing peer support in a health system or physician practice, it can help doctors and other health professionals open up about what is causing them stress.
Here are six fundamental elements for how to use peer support to provide guidance during a pandemic and beyond.
Peer support should be proactive, without waiting for peers to show signs of stress. It is important to put the invitation “out there in a way that is destigmatizing,” said Dr. Shapiro. “We’re checking in on you and offering peer support because that’s what we do.”
“This is a routine part of what we do now, so the invitation needs to be given in that way,” she said. “It’s not like we’re just calling people who we know are really not handling things well.”
“If you’ve ever been supported by anybody and that person is really giving their full caring attention to you in and of itself, that feels incredibly wonderful,” said Dr. Shapiro. “That is the basis of peer support. Being able to do that."
Once a peer support conversation has begun, it is important to practice empathic listening. This is because it shows that someone is “really hearing what the peer is going through,” she said.
“Then, based on whatever they say, reflecting with the peer about what they’re feeling, what they’re experiencing and reflecting in terms of normalizing their emotions, because you won’t be surprised to hear that most of the things that people say, many of us have experienced,” said Dr. Shapiro.
The other part of reflecting is to validate and say, “It’s totally understandable that given what you just told me you were asked to do or you had to witness, that you would feel that way. That really makes sense.”
“And then sharing your experience when it’s relevant,” said Dr. Shapiro. “There’s this tension between you don’t want to overshare because you’re really there to support the peer, but sometimes if you’ve had a similar experience or had some kind of way to connect with the peer, it is perfectly appropriate to share to a degree.”
When helping a peer, it is important to practice reframing. This allows the peer to put their emotions in context.
It also helps them to weave their emotions into “the positive part of what they do,” said Dr. Shapiro. “The tricky part of this is you don’t want to minimize their emotions, but you do want to help them see all the good that they’re doing.”
Reframing is extremely important and while it can be difficult to do at times, it is key to guiding peer support.
“It’s helpful to encourage learning and teaching so people are learning and growing every day, pandemic or not,” said Dr. Shapiro. “But especially now where there’s so much new information.”
“I’m encouraging people to share what they’ve learned and helping their colleagues not just get through this, but actually take better care of patients,” she said. “That feels good for us anytime something is learned and shared.”
Encouraging learning and teaching benefits not only the individual, but the group as well. It allows the team to move through a problem together.
A key part of peer support is helping the peer reconnect to any positive coping mechanisms that they have used in the past so they can use these strategies in their current circumstances. Identifying these can help the peer work through emotions or problems blocking their path.
“Interestingly or paradoxically, we often find that the coping mechanisms that the peer uses normally they’ve stopped using during this especially stressful time,” said Dr. Shapiro. “There should be a gentle help for the peer to realize that this is such an important time to care for themselves.
It is also a time for peers to “use their support systems, rely on their friends and family, and their colleagues to help them through,” she said. “We all need support. We all deserve support.”
Connecting physicians and other health professionals to appropriate resources as needed is also vital to the success of a peer support program. “Sometimes peer support is absolutely not enough,” said Dr. Shapiro. “We know health care providers, especially physicians, do not usually access mental health or other kinds of support.”
“One of the wonderful aspects of peer support is offering those resources to any of our peers,” she said, adding that it can help to emphasize that sometimes a particular circumstance or environment at the moment is causing them to be especially stressed, and they may want further support
In that case, "you are—as a peer supporter—happy to connect them with someone who can help them further,” said Dr. Shapiro.
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.
The peer supporter should close with an expression of appreciation for the work the peer does and for sharing their thoughts with you. “Because of the pandemic, peer support actually helps us reconnect and gives us back this feeling of solidarity,” said Dr. Shapiro. “We're in this together, and it's really important for us to remind ourselves that we are.”
“There's a lot we can do and are doing for each other,” she said, adding that “this is a very positive way of thinking about how we can support each other.”
The AMA is offering a free survey to help health care organizations monitor the impact COVID-19 has on their workforce during this pandemic. The survey can be used to track trends in stress levels, identify specific drivers of stress, and develop supportive infrastructures based on these drivers. Organizations that use the survey will receive free-of-charge support from the AMA in launching the surveys and access to data through an easy-to-use reporting dashboard.