There are no heroes in this war
Health care professionals need more support
The death by suicide of Dr. Lorna Breen, the medical director of the emergency department at NewYorkPresbyterian Allen Hospital in New York City, is just the beginning of yet another health care crisis.
The COVID-19 pandemic has turned hospitals into battlegrounds and doctors into soldiers. The lack of adequate personal protective gear, the fear of infecting our own families, the shortage of ventilators, the moral distress of having to choose resource allocation and more have all created anxiety and concern among health care professionals. It is likely this crisis will lead to further attrition of the health care workforce and afflict those on the front lines with lasting trauma.
While much has been made on television and social media about the respect being shown to health care professionals across the world, many of those same professionals are being targeted by violence. In Mexico, bleach was thrown at a doctor. In India, a physician was barred from her own apartment complex for fear of her infecting others. A nurse in Chicago was attacked on a bus, again by people concerned about their risk of acquiring the infection from her.
Health care professionals have been vocal on social media and directly to the media about their concerns regarding lack of PPE. Many hospitals have sent out warnings to staff about speaking to the media or sharing any of their communications with the public. As a result, some staff are being punished by hospital administrators or even fired for speaking up about lack of PPE. Dr. Samantha Houston, a hospitalist in Mississippi, was fired by Baptist Memorial Hospital-North for speaking publicly about lack of adequate PPE and for protecting nursing staff.
COVID-19 has added a tremendous amount of stress to the pre-existing level of burnout among health care professionals. Physician burnout was already a public health crisis that affected almost half of physicians in the U.S., according to a recent Medscape survey. It is well established that physicians who are suffering from burnout are twice as likely to commit serious medical errors. In 2019, the World Health Organization expanded the definition of burnout from a state of exhaustion to a “syndrome resulting from chronic workplace stress.” And that was before the pandemic struck.
To get a gauge of how the COVID-19 pandemic has impacted burnout in the industry, we surveyed health care professionals in mid-April without any regional limitations. The survey assessed perceived support from the health care system, concerns regarding PPE availability, impact of the COVID-19 pandemic on productivity and potential job loss, anxiety about spreading illness to immediate family members and psychosocial resources at work and at home.
Out of the 553 responses we received, concern about spreading infection in their households was the most signifcant stressor according to 85% of respondents. Almost 60% of the physicians felt the pressure of loss of productivity. Nearly 50% of all respondents reported inadequate PPEs despite the fact that our survey was not limited to hot spot regions. Fifty percent of the respondents felt inadequate emotional support and resources from leadership in handling work-related issues.
The only silver lining to note was the level of support felt from families and friends, which is a reflection of human adaptability during adverse conditions. Over 80% of all respondents felt they had emotional support from their families and friends despite social distancing.
But the fact remains, we are screaming for help beyond our walls.
Many of our colleagues are getting sick and dying like wounded soldiers on this battlefield. We do not yet have definitive data regarding how many health care professionals’ lives have been lost in this pandemic. Data from Italy has shown that 20% of responding health care workers were infected, with death rates still unknown. In the U.S., over 9,300 have been infected and at least 27 have died. There surely will be more to come.
In March, Congress passed the Family First Coronavirus Response Act (FFCRA). This provided two weeks of paid leave to workers exposed to or infected by COVID-19, but this same legislation also stipulated that health care professionals may be excluded from paid sick leave. Many institutions have clearly stated that even if we are exposed to the coronavirus, we must come to work unless we have symptoms. This has grave potential to expose patients and colleagues to the virus.
Our ask is simple. Holding administrators, insurance companies, hospital systems and politicians accountable during these tough times is vital to fix our already broken health care system. There is no health care professional who is doing the job to be called a “hero.” We are simply doing our jobs.
But while doing our jobs, we deserve the fundamental right to be protected from getting infected. We have safety standards that have been ignored from the onset of this pandemic. Health care professionals need to have the right to sick leave, particularly when acquired as a hazard of their work. Additionally, addressing and treating mental and emotional well-being of the health care professionals who are dealing with the impact of this pandemic need to be a priority. Help should be made freely available for those who need it.
As health care professionals, we will continue to care for our patients with utmost empathy. We took an oath to care for the sick, and so you will find us coming to work, as we always have, regardless of the conditions. We want to serve our patients. But we also do not want our jobs to kill us.
We do not want to be martyrs at the end.
Dr. Kamala Tamirisa is a cardiac electrophysiologist in Dallas, Texas. Dr. Ritu Thamman is an assistant professor of medicine at the University of Pittsburgh. Dr. Martha Gulati is a professor of medicine and the chief of cardiology at the University of Arizona.