COVID-19 Chapter 17: Frontline Mental Health

pandemic response. I was in West Africa during the twenty fourteen of Bowl outbreak whereas the medical director of an ebola treatment unit, and after that I was part of a US government initiative helping to develop a clinical trial capacity for therapeutics in the event of a high consequence

pathogen outbreak. I've also worked in numerous disaster zones in the aftermath of natural disasters, and I feel like all of that background really has helped prepare me to work during this public health crisis for facing here in the United States and in the world because of the COVID nineteen pandemic, and this has been a really challenging year. Sometimes I forget that it's only been a year and a half because it feels like it's been ten years.

And there are days when I am walking into the hospital that I'm exhausted and I feel empty, and I don't want to hear the word COVID anymore. And I think that sometimes I hear people use the word hero and it makes me cringe because I don't feel like we are heroes.

to affect our healthcare workers. I feel like I have some insight because when I returned back from West Africa after the Abola outbreak.

On top of the fact that this pandemic has been drawn out for so long, and I feel like every time we see another surge, it's just another layer of exhaustion that people feel, and I hear it from my colleagues. I hear it from my friends who are just really tired, and I'm starting to see it as well. I see personality changes in people that I never even used to hear a crossword from. I've seen people who are older thinking about retiring or stepping back, and this will affect

our entire profession. I think for myself, some of the things that I worry about is when I came back from West Africa, I noticed that I had somewhat of a more disconnected feeling, and I noticed that I have that now. It's not so much that I don't care about my patients or I don't care about people, but there's definitely some sort of detachment, and I think that part of that is to protect myself, and I think other people do that too, as a way to protect themselves.

And I think we should all be cognizant of that because this has been a very difficult time for all of us in the healthcare field. We don't just have the same structures as everybody else, but then we also have the increased demands of trying to care for our patients. And since this has been going on for over a year now, it's felt like a marathon, and it's a marathon that for some of us we don't see ending

anytime soon. We need support just like everybody else. And I hope that people who are out there listening to my story and everybody else's story remembers that, and hopefully as we see this small light at the end of the tunnel with our vaccines, which are wonderful, we can all remember that and remember that we need to come together as we try to end the coronavirus pandemic. Thank you.

patients could get. I wanted to share specifically Mikes experience with two patients. I think they're both good representations of what COVID can do to people and what we've been seeing at the bedside. You know, patient number one. She was my mother's age, in her fifties, and I had started my shift with her on two leaders nasal canula, which is basically just bare minimum boxygen requirement. And I ended my shift calling your family to let them know

it did not look good. She had progressively worsened throughout the day with her work of breathing getting worse and worse, and she was she entered that third stage of COVID that we all so dread, and she went in to car to pulmonary arrest four times after we had intibated her, and then she arrested four more times in the ICU.

we know that there's nothing more we can do. And I'm really tired. I'm so tired of COVID. I have spent time as an ICR nurse. I'm no stranger to death. Bad bad flu seasons in the past have of course been devastating, but you get used to saving thirty, forty, fifty,

even sixteen seventy year olds. You know, it's a It was a well established expectation that for that age group, that for the most part, barring complications, patients with respiratory illnesses have a good chance of making recovery with you know, careful, with the right care and you know ventilator management.

how unpredictable this thing seemed to be. In April, I got a phone call that I was being reassigned to a makeshift COVID floor that had been refashioned from an outpatient surgical center. The first thing I arrived to start my shift, I saw a giant truck outside the building. It reminded me of the truck to see around New York when they were filming a movie. I was later told that this was the refrigerated truck to hold the

dead bodies that were outpacing the hospital morgue. Every shift began that way, walking past that truck like a symbol of what felt like the futility of trying to save the people who were dying. Working on the floor was a type of nursing that I hadn't trained for and that I never planned on doing. Most of the patients where I worked had do not resuscitate and do not intobate orders, so I was there to provide them comfort

care as they died. The image of these people gasping for air as I slowly slipped away, as an image I can't erase from my mind, and I think it will hold onto my whole life. I spent twelve hour shifts in this windowless floor and layer upon layer of protective gear. I saw patients die, and I saw other patients have emotional breakdowns from being sequestered from their families.

I think most people that become a nurse do so so they can help comfort and heal people, and for so many of us, we didn't feel like we were able to do either for our patients, and that, more than anything, has broken in our spirits. Eventually, when the surge lifted, I got to go back to the er, where a new normal has set in of wearing protective gear for entire shifts, always concerned that any patient could

be carrying this virus. I'd say at least half the staff has gotten COVID and many are dealing with long haul symptoms such as brain fog and shortness of breath. I was able to get my vaccine on the second day it was available in the United States, and although I was nervous and had my concerns, I had seen the devastation and the long term effects of COVID enough that I was willing to take the chance. I thought it would give me some sort of peace of mind

to be vaccinated. But work is still full of anxiety and fear due to the variants. So many patients who are now testing positive admidst taking vacations or going to large underground parties in New York. And there's nothing that frustrates us of healthcare workers more. For a brief time, the world was clapping for us, and everyone seemed to tire of that and tire of trying to stop this

thing from spreading and mutating. I've started attending therapy for my sleep issues and have been told I have pta SD From the last year of work, I'm haunted by the faces of people I watched die, but I also try to remember the rare, beautiful moments of the last year.

I had one patient who wanted to watch baseball last spring, and I had to explain to him that the sport had been canceled for the season, so instead I pulled up an old Mets game on the iPad and sat with him for a couple of minutes to watch it. He told me he wished he could buy me a hot dog. A year later and baseball is happening again, but he is dead. I, like so many people, desperately want this thing to be over, but part of me doesn't know if I see an end date anytime in the future.

and anxiety that a lot of us are feeling. With this episode, we wanted to revisit the mental health impacts that this pandemic is having, but on a very specific group of people, frontline healthcare workers.

been a really difficult road to say the least. Providers have been dealing with overloaded hospitals, a lack of adequate personal protective equipment, in watching patients die alone without family or friends there for comfort. And we've heard a lot of this healthcare heroes narrative in the media, but healthcare workers are human beings, not superheroes. And this year has put an incredible amount of stress on the healthcare system and on our providers as individuals.

long term the mental health of frontline healthcare workers. But also we wanted to take a broader view to examine what kinds of structural issues in the healthcare system contribute to the problem to begin with.

Sciences University in Brooklyn, New York. His newest book, titled Becoming a Doctor's Doctor, is a memoir of his journey, and he joins us in this episode to answer so many of our questions about the underlying issues that contribute to mental health struggles and healthcare providers, as well as how the COVID nineteen pandemic has exacerbated these This interview was recorded on March twenty ninth, twenty twenty one, and we also wanted to mention that there were some sirens

that went off a few times while we recorded, so you may hear those in the background, so just keep that in mind, and we will let him introduce himself right after this break.

I've written extensively on that, and I'm excited about my most recent book, which is called Becoming a Doctor's Doctor. Mmoir excellent.

would say, perhaps covered up. The stigma associated with any kind of perceived flaw or whatever you might call that in medicine back in those days was so profound. So we didn't hear anything from the dean's office. I'm the one who made the announcement to my classmates. We didn't attend his funeral, we didn't send flowers, And I thought over the years, how different this would be a Bill were killed in a motivatal accident night of cancer or something.

And I think that that got me thinking about the stigma associated with psychiatric illness and medical students and physicians. And then fast forward a few years when I was in training that in psychiatry in the early seventies, I saw my first physician patient on Christmas Day, nineteen seventy, the pseudonymus for doctor Monroe. And that's how I started

my book. I actually about my memoir because I really wanted to capture how captivated I was really by his story looking after him and his family, And through the rest of my training, which is four years, I got to actually look after some other members of doctors' families, so that by the time I graduated and opened up my halftime private practice, I felt I had a little bit of a leg up. I wasn't quite as intimidated about looking after my peers or whatever as maybe some

of my colleagues were. So that's kind of how it all got started.

But then it can get worse though too, and you touched on that aeron that sometimes individuals then wonder is this burnout or perhaps have I fallen into a depression something like that. Now there is the illness of depression, things like that. So the systemic factors are felt to be the things that are really driving this, and physicians themselves. So in other words, you could take the healthiest doctor and he or she is going to succumb at some point with a system that is so demanding of them.

And some of the things that you hear about so much of the electronic health records, for instance, or the increasing corporatization of medicine so that there's less less time with the patient having gathered so many things on the computer and having to do so much work that feels like deureaucracy. And there are a number of other factors that doctors describe. It varies a little bit on the branch of medicine, and so that can really make doctors

feel demoralized. And you know, when we look at the definition of burnout, it really it's got to do with a loss of agency and control over your life. Or doctors on a treadmill and they describe this kind of exhaustion, an erosion of their spirit. Those are the terms that they'll often use. They'll talk about depersonalization, for instance, that sort of numbness or detachment from their patients in each other, like a loss of compassion, and that's very, very bothersome.

And at the end of the day, the other thing that they described is a sense of futility even though they really are helping people, that's not necessarily they don't really feel gratified that they're experiencing that. So that's the big systemic piece. But the one thing I never want to be left out is what we bring to the table ourselves as individuals. So in other words, we could be going through just stuff on our own personal life,

having to deal with who we are as individuals. Are particular vulnerabilities, whether or not we've suffered from anything past in terms of health challenges, or there could be things going on in our family, and Aaron, I think you were kind of trying to get at maybe whether or not there are particular things that we might be prone to in medicine, because there has been quite a lot of research on this. It's mixed, but it's generally felt

that especially during training, medical school and residency. And beyond that, our rates of depression are a little bit higher than age matched cohorts in other professional schools, for instance. So there's that piece. The second is also we don't know so much about anxiety disorders because I think that they've been underdiagnosed in the past. For instance, PTSD, which we're hearing about so much since the COVID nineteen pandemic, we're hearing about it before that, I would say only in

the last maybe five seven eight years. Before that, I think it was not being picked up or not being talked about, because it's probably always been there at some level. And so, but the other one that that we're most concerned about is suicide and physicians, and that was the substance of the book I did just before the memoir, called Why Physicians Die by Suicide? Lessons learned from their

families and others who cared. And that's my postvention research, interviewing family members and friends and colleagues of doctors who have ended their lives. And what we found is that the research varies, but it's been felt though for one

doctor a day dies by suicide in this country. We don't know whether those rates are growing up or going down, or just how acrive were But even if it's that or something like that that's very serious, there tends to be a gender difference that the risk of suicide and women doctors compared to women in general is much higher than it is for male doctors as compared to men

in general, for instance, those kinds of things. So I think I'm getting back to your question that even before COVID nineteen, you know, we're a group of human beings, you know, with some pre existing vulnerability, and that's that's the so called humanness that I'm trying to communicate in my memoir.

little box to get your medical license. So what does this stigma look like and how, in your opinion, does it contribute to the high rate of mental health issues in healthcare workers.

That this is not something that is generally accepted that easily in society, as you mentioned, especially in the house of medicine and the culture of medicine. So there's all of that piece where we beat ourselves up and delay going for help, the external stigma, and you touched on really the most profound example is when we're judged or

discriminated against external life. And the two areas that I think that's most manifest has been with regard to our application for medical licensure or their renewal, as well as credential applications for hospital privileges, medical center privileges, and things like that. Where this is problematic, then it's twofold. Doctors get frightened that, oh my god, if I go see

a psychiatrist, or it's some help. I'm going to have to report this when I go to get a medical license or when I renew my license, so they avoid going, they don't get treatment, and doctors should be able to get the same kind of care that they so selflessly give to others. So with regard to licensure, that varies tremendously from state to state. I happen to practice in

New York. We're one of I think about twelve states where no questions are asked at all of us when we apply for a medical license, No health questions, nothing, And contrasts that with some states which will remain unnamed, where the questions are draconium, so they violate the Americans with disabilities. That good news, though, is that this has been looked at very strategically and carefully over the last

five years. The last two to three years, there's been a recommended template for what's called the Federation of State Medical Boards that if you feel you do have to ask a question about a physician's health, this is what we would recommend to a doctor. Are you currently suffering from any illness that is affecting your ability to practice

safe and competent medicine? If so, phrase explain. So there's three things about that that we feel are you know, for those states that feel that they need to ask that are acceptable. The first one is that currently so this is just about a current illness. The second one, because it's current, it's about possible impairment as opposed to

just having an illness. The third part that we like in my field asy chuntry, is that doesn't partition off psychiatric illness and substance use disorders from say general medical conditions like diabetes, high blood pressure, multiple sclerosis, something like that. So that's kind of where that sits. In More and more state licenses are modernizing their questions or perhaps moving to not asking any questions at all.

And you've touched on sort of the bigger picture of what some of these issues at the root are, But can you talk about where these bigger picture problems originate and how each step of medical training and beyond contributes to the problem.

applicants to medical school are making up their list. Sometimes the bottom line is they say, I want to go to a school that really does seem to be a place that cares about its students for four years, not just that we're going to get a first rate education, but that indeed this feels like a big home or something for four years. Or they found the other medical

students friendly, a little less competitive with each other. So when you have a culture that starts with the dean who's setting a tone or an example for the entire medical school, that makes a huge difference than all the

associate games. Okay, then you've got pure wellness groups where the second year medical students reach out to the first year medical students, where you've got free services, mental health counseling services for your students, where there's stuff that just sort of builds in on the website, where you've got people like me who have a possession of being ombits person because because mistreatment is not on you know, it's

tough enough going through four years of medical school. You don't need to be experiencing this treatment at the hands of a resident or a professor or something like that. So when you can create all of that, I like to believe that that guarantee is like more of a

safe passage. And even if there's a tragedy in the medical school, for instance, say where or if a medical student dies by suicide, we now have national basically a toolkit that I was instrumental in consulting on through the American Foundation for Suicide Prevention that walks you through what you do on day one, day two, with regard to the other students, to the professors, to the family, to the media, all that sort of stuff all meant to

reduce copycat suicide or things like that. So it's making a whole change in the culture of medical education. And then then after medical fill it's kind of the same thing through residency training, which should be anywhere from for to six years. Again making sure that you don't like the health of your trainings, offering services for instance seven days a week perhaps or in the evening because of

the long hours that they work. They reduced duty hours per week again built in services, changing the whole culture having to do with microaggressions and micro inequities that women's students have faced, that LGBTQ students have faced, that Asian and black and other minority of a matteral students have faced.

she wasn't. On the other hand, I visit countries or I receive now I get on conference calls with physicians from various parts of the world that are really open to learning some of the advances that we have here. For instance, in the United States, they wouldn't necessarily want our system because it's a confusing system with all the

insurance coming for instance. And I spent the bulk of my practice years in Canada, where we have a universal healthcare system, but we weren't without our problems as well in terms of with physician health. The one piece though, that I can sort of speak clearly about it so proudly of, was that I could see I could treat a medical student, I could treat a physician or the

family member without ever having to worry about insurance. I think one thing that is universal, though, is this increasing perception that people in medicine for too long have been sort of treated as workhorses, and you know, they're used to hard work, and seat of just pile more work on them. We think what we're seeing is that that's not work right.

personal vulnerabilities that you know we've been talking about. The Other thing that I'm excited about is that we have more and more role models through self disclose in both scientific and lay journals that they've suffered from depression, alcoholism,

an eating disorder for instance, something like that. And we've got more resources for doctors tovarious state physician health programs very a little bit from state to state, but largely though right there to certainly really help physicians in their hour of need and then to offer sort of follow up in advocacy, and that's very important. There's less sexism and abusive teaching, but yet we still have a me too movement in the house of medicine as well. Dudy

hours or less. There are dedicated rest breaks, sleep breaks, Strategic napping, for instance, is something that's that. It's called areas that need more work. We've talked about the licensing and credential applications. Far too many doctors you're still leading

their very unbalanced lives. This is now getting to the personal piece where there I feel it's altruistic, but they are working way too hard and they're not building in enough time in their life for exercise, for nutrition, for just quote unquote, taking time to smell the roses, for relationships for kids for now. You know, I never mean that in a judgmental way, because there are some individuals in medicine and say, look, I'm not interested in relationships.

I just love my work. And that's fine. But I said, but at least, also, if you're going to keep doing it, then at least take some trips by yourself or something, you know, go to a yoga class or something, you know, things like that, just so you can protect your individual health.

There's still too many doctors. Even with COVID nineteen going on, and how we've normalized all of the stress associated with being on the front lines steal so many doctors who kind of just suck it out or they it's that sort of macho rigor or something that is still very much a part of medicine. I mean, it's commendable a well nobile, but it should never ever feel like a weakness. If you go for mental health care, you don't feel weak.

If you start to have blood in your yarn, I mean, it's scary, or if you notice a lump in your grass, that's scary too, but you go and get help. And I would like to see more physicians have primary care doctors.

Too many don't. And one final thing I'd like to say is that I would like to see more psychiatrists who are kind of sort of dedicating at least part of the week to look after their colleagues, you know, if they're if they're so inclined because there's a you know, there's some science to it, and there's things that you need to do, and that person officing you is a fellow physician as opposed to perhaps you know, an attorney, are a realtor, teacher, or something like that, just because

you're in the same field. You're both in that a sun that sort of thing. So those are the kinds of things that with that. Then I think that that doctor patient gets a higher level of care when the doctor looking after or him is comfortable looking after the doctors. So I do a lot of teaching in that whole around in my day to day work.

There are some differences though, because one thing is that there isn't the same degree of stigma associated with patients with COVID nineteen, although at the very beginning though, there were some patients who someone fel stigmatized that they got it and somebody else didn't, and people, of course were afraid of them. We knew less about the virus than now, much like HIV at the beginning, but even doctors who

looked after patients with AIDS were stigmatized. So you know, there and other than that, there are also lots of differences put the really calls to the four physicians, and so I've seen doctors through the COVID pandemic because my colleague that I doctor, fis We started support groups at University Hospital Brooklyn, our teaching hospital. This is our first year anniversary of starting weekly support groups for hospitalists and for emergency docs. Then we had groups for residents, for

medical students, all for the nurses like that too. I remember a couple of physicians saying that I was kind of burned out before the pandemic, but I don't feel it now. Even though this is very scary work and we're not exactly sure what we're doing because we're still learning about this virus, I do feel that I'm doing what I was trained to do to look after critically ill people. Now again, that's in the face of concerns about PPE and all of the the masking and gowning

and gloving and that depersonalization that you feel. And this is of course when relatives who are outside the hospital and they've got dying loved wins in the hospital, and the healthcare professionals having to comunicate by way of FaceTime with them, and oh, when I think back on all of that, it was just unbelievable. So that called to the fore those so many things in health professionals themselves.

And now is when I think people are more concerned about the long term effects of this, which perhaps we could come to. The one thing though, if there's any silver lining to all of this, I have heard people say that there's been a more humanistic interpersonal space development.

I've heard doctors talk openly about feelings that you would never expect that they would talk about before that they're talking with their trainees about what they're feeling in their heart, for instance, the sorrow of their feeling and the fear that they're having. Things like that where they're dropping at least some of that intellectual jargon medicales that we use in our health centers just to be human with each other.

So I think there has been more of that sort of community of care, so that in a way is a good thing.

And yet especially in the media, this narrative of the healthcare heroes seems to be perpetuated, seems to be constantly put forth, you know, putting a rosy spin on this pandemic or on the actions of healthcare workers during the pandemic, which in some ways maybe allows us, as people who are not directly involved on the front lines, to sort of ignore or you know, look through rose colored glasses

at this excess stress, at the lack of ppe. And so can you just talk a little bit about how damaging this healthcare hero's narrative can be?

if people love partying. No masks on things like that or and I'm not going to get political, but the fact that it's become political is also so traffic that you know, we have to follow the science. And I know that sounds like a hackney phrase, but it is essential until we really are clearly, you know, really out

of the woods. So that's where sometimes the healthcare professors will say, like, yeah, it's nice to be called a hero, but you know, do something yourself in terms of prevention so that we're not we're not having to be in this kind of heroic job. The other thing, too, is that I really like this when these healthcare workers just say, you know, I don't like being called a hero. I just it just it doesn't it doesn't feel right. I'm a doctor, I've trained to do this work, but I'm

not a hero. So what I've always said to them, I said, look, just try to say thank you. That what it is is that people are just so touched and honored by the work that you're doing and putting yourselves at risk for others. And I said, and that's really because they do see you as heroic, even if you don't feel that yourself. I said, you are doing extremely important work. Then of course they say, yeah, but most of my but most of my patients have died.

I said, But that doesn't mean, though, that you didn't do something. You were there with them, you showed up, you held their hand, because their actual loved ones can't do that, they're outside outside the hospital. I mean, it's very granular. These are the basic, you know, the basic covenant of the health professional patient relationship.

The other, though, is probably broader, and that has to do with grieving, and sometimes I think when we can articulate that for an individual who's feeling something but they're

not sure what to call it, they are grieving. And if they're not actually grieving the physical loss, say of a family member or a friend to COVID or something else, it's one of the other losses that they've had the loss of, well, maybe attending their niece's first communion or their nephew barmits or uh an in person funeral for instance,

or a wedding, things like that. That's all forms of grieving what we once had, you know, that type of thing and preparing for the quote unquote new normal as these things evolve through a lot of loss and this isolation of course that we've all had to live with people in relationships that's been really different. Sure, there's a set of problems there, you know, too much time with

each other. You know, we've heard of an uptick and domestic violence in dysfunctional families because the kids are remote learning, and you know all of that stuff we're hearing about physician moms and what they're all dealing with. They're trying to run a practice at the same time as you know, homeschooling, their kids are hybrid schooling or not having available childcare

as they once had. So that's that's all in that kind of all of the laws that even probably many of us aren't even exactly sure really what that is right now, but it'll unfold. And again, I'm always try to be positive though. I really follow things like post traumatic growth and my experience with that was long before COVID nineteen. That's through my brief at work the families who have lost someone to suicide, and yes, they look

back and say, this has been a complete nightmare. But now if I have been my seventh year since losing my son, I'm seeing a bit of a silver lining to his premature death. I know that I'm a better person. I'm kinder and we're giving. I've got more emotional intelligence, I'm wiser, you know, I'm more gracious toward families who who do have a son graduating from university and I don't people just so amazing and so full. I think of a strength and grace and dignity and courage and love.

you in some ways. I've always told the spouses and partners of doctors, especially that you have as much right to a whole range of feelings. That your work, whatever it might be, is just as important. It's defined differently. It may not get the sort of kudos or something

that people in the health professions got. That you're doing whatever you're doing, it all counts in the same degree, and so and so I think to just kind of stuff it and to try to always be strong and comforting and cairing you can get burned out or something, and also resentful. The other thing, of course, is always tell people that your bottom line is you're trying to protect family life, and for some of you it may

also include spirituality or religion. Not always, but there's gone to be other archetypes of family rituals that will that will work.

most importantly, how can we begin to change things? What are the changes that we should make at the medical school level or at the hospital level, or what role do other physicians have to play in terms of providing or helping to provide this emotional or mental health support for other physicians or healthcare workers.

still still human beings. And so I've always felt that health professionals are They're used to hard work, but the fatigue if they feel after a twelve hour shift it's been a good day, is a different kind of fatigue than they feel if it's been twelve hours but half of it's been a nightmare or something where they just feel that this is such a dysfunctional place. I'm working that kind of thing. I mean, they need to feel valued. It's not always just so much from patients or their

family members or something, but from the system itself. And again that's into all of these, all of the stakeholders, the CEOs of hospital systems. But yet when and if people feel that, it gives, it gives more meaning for purpose in your work, and you get through these these tougher days because you feel that there is you know, just lit of an ethos here and because without that that we know from the work for instance, it's coming

out of Stanford led by doctor Tate channan Felt. He's always writing about making the business case for burnout prevention and he's done it in spades. That if if the CEOs don't get on top of this, there's just so much money because of attrition and turnover a staff. People just don't stay. They can loss of life for instance, long term visibility that your workers going because they're ill. Listen to a humane model for a healthy workplace. There's a strong business model for that.

across the world. In this field, it can be hard sometimes to separate personal identities from our jobs as healthcare workers and physicians and healthcare workers often have really high expectations of themselves too, so burnout often stems from a

loss of agency or control. Many physicians became doctors because they wanted to help people, and our current system has them spending hours of their day dealing with bureaucracy, insurance battles, paperwork, medical charts, things that don't have anything to do with patient care. It can make their work feel exhausting and futile, and on top of that, working in healthcare can be

emotionally challenging in its own right. But one thing that's often overlooked in these conversations about burnout is that every healthcare worker is a person, an individual human that brings to the table all their own personal challenges that might

have nothing to do with their work at all. And this is of course true for everyone in every job, but we often expect that physicians and other healthcare workers are superhuman and expected to ignore or suppress these personal challenges in the face of their challenging work environment.

and it can be so difficult to overcome. Internal stigma can also be compounded by external stigma. External stigma can come in so many different forms, but essentially is the societal or workplace pressures that may make it so that someone who could benefit from mental health services, who is experiencing something like depression or anxiety or any other mental health issue, feels as though they can't seek help because

of external pressures in medicine. One of the most egregious examples of this is having to document previous or current psychiatric treatment or conditions when applying for state medical licenses

or hospital credentialing. This is something that used to be completely ubiquitous and is now fortunately changing and very state by state, but is one very strong example of a practice that really has the end result of preventing physicians and other medical professionals from seeking help or treatment because of this fear of repercussions.

and yet cases continued streaming into hospitals. Some report feeling invigorated, as though this is what they have trained for their entire careers, but others say they're overwhelmed and frustrated at being called a hero when they don't feel heroic. This pandemic may be the first time in which many healthcare workers have had to watch more of their patients pass away rather than recover, or the first time they've held up an iPad as patient after patient says goodbye to

friends and family, bearing silent witness to countless tragedies. And then if after a long shift in the ICU, they drive home to see lines outside bars or crowded sports events on the news, this can lead to a feeling

of what's the point. Moral injury can come into play yet again, this healthcare hero's narrative can in some ways allow the rest of the public to fail to acknowledge their own personal responsibility for their role in slowing or speeding up the pandemic, instead relying on these heroes to

step in and save the day. Of course, those who have fought and continue to fight so hard against this virus are incredible and we should all be extremely grateful for their efforts, But we need to be careful not to let the healthcare hero's narrative rid the rest of us of our responsibilities or make us forget or overlook that the conditions many have worked under are unacceptable.

normal that we all have to live in now. If you have someone in your life who is a healthcare worker right now, or if you are a healthcare worker yourself, recognize that this year has been a ridiculously trying one and it's okay to need help. It's okay to need support, especially right now. Essentially, It's okay to not feel okay or to not be able to take on all the extra things you maybe used to take on. It's okay

to say no and just turn everything off. Turning off and focusing on connection with each other, with our loved ones can be really helpful for your mental health, and I think this advice applies in some way to all of us. It's also a important, as doctor Meyer said, that we may someday be able to recognize growth within ourselves through this experience.

are treated. So medical training is no longer viewed as strictly the quality of education. But how well a program is going to support students and residents. Do they actually comply with new work hours regulations and restrictions. Do they have confidential counseling services? Do the students and residents and faculty actually feel supported or even happy. Also, today there are many more resources available to all of us, not

just healthcare workers. So even though the stigma isn't gone by any means, it has at least decreased in recent years. In part, we can really thank the physicians and healthcare workers that have self disclosed, that have told their stories, whether in magazines or journal articles, on social media, or even by providing a first hand account on a podcast.

So thank you again to everyone who has shared their story, not just with us, but in general, and for anyone who is struggling, whether you're a healthcare worker or a teacher, or a bartender, or a grocery store employee, or a stay at home parent or anyone at all. Right now,

know that you are not alone. And if anyone is suffering from suicidal ideation, the National Suicide Prevention Hotline phone number is eight hundred two seven three eight two five to five, and we have a link to their website as well as other mental health resources available in the US and worldwide in our show notes and also on our website.