Physicians and the psychological trauma of COVID-19 [PODCAST]

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“As COVID-19 devastates America and the world, I hope that fundamental change to our health care system results from its horrific exposé. Without COVID-19, the pressures placed on physicians are already immense. In the age of COVID-19, these pressures are proving to be insurmountable. Being a physician is difficult, but it does not have to be deadly. Physicians deserve proper stigma- and repercussion-free mental health care as much as they deserve proper personal protective equipment. By definition, a hero is the offspring of a god and a mortal; if we physicians are to be known as heroes, we deserve to have our human mental health care needs met.​”

Sarah Bridge is an emergency medicine resident.

She shares her story and discusses her KevinMD article, “Physicians and the psychological trauma of COVID-19.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Sarah Bridge. She’s an emergency medicine resident, and she wrote the KevinMD article “Physicians and the psychological trauma of COVID-19.” Sarah, welcome to the show.

Sarah Bridge: Thank you. Thanks for having me.

Kevin Pho: So we’ll get into your article in a little bit, but first off, tell me your story and your journey to where you are today.

Sarah Bridge: Well, I took sort of a meandering path. I grew up in Salt Lake City, Utah, then went out to undergrad in California at UC Santa Barbara, spent seven fabulous years living by the beach, and I worked in a hospital there, Santa Barbara Cottage Hospital, as a scribe. I was actually an environmental studies major, but then I kind of made my way into medicine and really loved working as an emergency department scribe.

I came back to Utah for medical school. While I was a medical student, I spent a year working abroad, and then there wasn’t anything that I liked more than EM. So I matched into residency at the University of Virginia, and I’m coming up on my third year.

Kevin Pho: All right. And how has the pandemic affected you and your residency?

Sarah Bridge: How much time do we have? It’s been definitely pretty crazy. I think it’s changed things in a ton of ways. It’s been definitely very hard on us EM people, and I think my program has done a really good job at trying to keep us all safe and sane during this whole thing. But it’s pretty different. I think it’s been different for everybody across the country, but a lot of things have changed.

Kevin Pho: Now, let’s get into your KevinMD article, “Physicians and the psychological trauma of COVID-19.” And you start your story with the tragic article of Dr. Lorna Breen, who is the emergency medicine physician in New York City who tragically committed suicide. Now, how did her story affect you and your colleagues?

Sarah Bridge: Well, I mean, it was very horrible and shocking, and it was very traumatizing, kind of, to everybody, I think. I actually came upon the article, read in The New York Times, and that was kind of what spurred me to write about this. I had been interested in physician wellness and mental health for a long time, and I think especially in light of COVID, that’s become an even more important issue.

I had some friends that had written some articles that were really important and interesting, and I think, especially in the world of emergency medicine, more people have been reading stuff that physicians in general and EM physicians are writing. And so I had been journaling some things and kicking around some ideas for an article, and then I finally just sort of thought, OK, this is the time to put something together and bring to light, I think, a really important issue in physicians.

Kevin Pho: And what are some of the specific issues that you’re seeing among your colleagues during the pandemic?

Sarah Bridge: So I think that it’s not just during the pandemic. I think that these problems with physician wellness and psychiatric issues and substance abuse and that kind of stuff have been going on since doctors have been practicing. I think that being a physician is a really stressful job. All jobs are stressful, but I think that there are a lot of challenges that physicians face. And I think, like I said, people have been struggling for a long time with things, and I think there’s a lot of stigmatization within the medical community.

I think a lot of people don’t seek mental health or substance abuse help when they need to. I think a lot of people are afraid to. And I think that the stresses that COVID has brought upon the medical community are just making all of those things worse. Those are some of the things that I have been thinking about, and I think it’s definitely coming to light more now.

Kevin Pho: And if you’re a frontline clinician, or for that matter any clinician, and if you’re feeling overwhelmed by the stress, not only from the pandemic but from the day-to-day activities of your job, what are some solutions? What are some next steps that you can suggest?

Sarah Bridge: So I’ve been thinking about this a lot, because I think one of the difficult things, especially in light of the pandemic, is that, at least for me, where I derive a lot of my wellness and a lot of my resilience and ability to handle the stresses of residency is from my peers and being able to kind of be socially close, right? Like Wednesday conferences, getting to see everybody, or hanging out outside of work, or commiserating. And that’s been really tough with the social distancing and everything being kind of online and Zoom. Like, we still have Zoom conferences and this and that.

So I think trying to stay connected with each other and supportive of each other through these hard times is really important, even if it’s difficult right now. I think, too, that accessing some of the mental health things that are available, like free counseling services provided by the hospital, at least that’s what they have at UVA, or program directors or other faculty in the program that can kind of help facilitate that or promote that, I think taking advantage of that and not feeling like you’re weak or shameful for doing so, and just encouraging that, I think is really, really important right now. And I’ve definitely seen that happening more, which has made me really happy, and I think it needs to continue happening.

Kevin Pho: So what’s something that you know now that you wish you knew back before the pandemic started about six months ago?

Sarah Bridge: Ooh, that there would be a pandemic? I don’t know. I think that, relating to the article that I wrote, I think that with medical education, at least, something that I didn’t really anticipate is that it can be very socially isolating. I think that physicians on the whole tend to be gregarious people and outgoing and like interacting with people. And I think that the residency hours are really tough, and I think that it’s hard to sometimes not feel alone in this process, even if you have friends and family around. I think it can be tough.

I didn’t realize how difficult it would be to kind of compartmentalize what’s going on at work, especially with what I’m seeing now coming through the emergency department, and my personal life and my own social life. I think that’s harder than I thought it would be, and I kind of wish that I’d known that before. I think that it’s hard to have balance, and I think that you really have to work at that to keep yourself sane and happy. And I think that I sort of knew that this would be hard, but, you know, kind of how isolating the process can be. And just making sure that all of my social circles were sort of good before I started would be good. Not that they weren’t, but you know what I’m trying to say.

Kevin Pho: So one of the things that you mentioned was that mental health issues among the physician profession have always been stigmatized, and doctors don’t want to appear, quote unquote, “weak,” and this has been going on for years now. Now, how have things been going now, especially with the pandemic, and more articles are written about the mental health of physicians? Is the situation as it relates to the mental health of clinicians better now than it was, say, one, two, three, or four years ago?

Sarah Bridge: You know, I think that it is, and I hope so. I think that, on one hand, definitely, I see this within my colleagues. More people are, we’re not as happy, right? It’s hard dealing with all this stuff, especially in the hospital, and all the pressures that are put on us. I think the morale is down. I think it’s been very difficult for physicians and health care workers in general dealing with this.

On the other hand, I think the minute that the pandemic started, I was getting more and more emails saying, “Free counseling services, please come use this, we’re here for you at UVA.” Or even when I was rotating at a small community hospital in Northern Virginia, in the bathroom there would be something posted that said, “If you need confidential help with mental health issues or substance abuse, you can call this number.”

And I think in that way it is improving. I think that hopefully this will be a time that it becomes destigmatized, and people are going to say, “Yeah, this is really hard. I am struggling. Let’s all help each other.” So I think in that way it is improving, and I hope to see it continue in that direction. I really do.

Kevin Pho: We’re talking to Sarah Bridge. She’s an emergency medicine resident, and she wrote the KevinMD article “Physicians and the psychological trauma of COVID-19.” Sarah, what is your number one tip that you could share with your fellow frontline clinicians?

Sarah Bridge: I think that the most important thing for us to do right now is support each other. I think that as people get tired, and as people get down, and morale is low, it can be easy to kind of slip into this negative thought process about the people around you. And I just think that we really, as physicians, need to band together and support each other in this really difficult time as much as we can.

I think you were a resident at one point. You know how it goes. And I think when people get tired and upset and frustrated, they can take it out on each other, you know, that you needed that, this, or neurosurgery is being mean, or whatever. And I just really think it’s important, especially now, that we need to be there for each other as much as we can and supportive of each other as physicians and all health care workers. So that would be my main tip.

And then, on top of that, just building as many of your healthy coping mechanisms as you can, trying to stay social and use humor and whatever you can to keep your morale up during this really hard time, is super important.

Kevin Pho: Sarah, thank you so much for sharing your insight, and thank you for your time and for being on the show.

Sarah Bridge: Great. Thank you so much for having me. It’s a real pleasure.

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