Why Healthcare Workers Need More Than the COVID Vaccine
Don't let the excitement overshadow the need for mental health treatment.
Posted Dec 23, 2020
Christmas came a week early this year for frontline workers with the Pfizer and Moderna vaccines rollout. Busy hospitals enjoyed a red-carpet moment as photojournalists caught the excitement of mass vaccination around the country.
The energy in these auditoriums was palpable; a victory of science that offers more than immunity as a shot signals the end is in sight. The pandemic, the quadruple whammy of trauma, grief, fatigue, and moral injuries, may be coming to an end.
The cost of being present and caring for patients during this pandemic is called compassion fatigue. This strain, sometimes characterized by emotional withdrawal, is the mental and physical exhaustion of feeling someone else's pain.
Symptoms of compassion fatigue
Physical symptoms of compassion fatigue are similar to burnout and may include fatigue, sleep disturbance, compromised immunity, headaches, stomach aches, and emotional distress. These can result in increased alcohol intake (and other drugs), anger and irritability, strained personal relationships, absenteeism, attrition, avoidance of patients, or compromised care.
Healthcare workers traditionally gather around food at breaks to vent or grieve with patient families. These outlets are gone due to visitor restrictions and social distancing. Many are still distancing themselves from their own families to prevent transmitting the virus to loved ones.
Trauma is the next crisis
Vaccination selfies are a stark contrast to Dr. Colleen Smith's photos early in the pandemic, showing a refrigerated trailer backed up to Elmhurst Hospital in Queens as a makeshift morgue. Healthcare workers will not be able to unsee COVID-19.
Before this crisis, multiple sources, including Medscape's National Physician Burnout, Depression & Suicide Report, note physician burnout at alarming rates (greater than 40 percent). The numbers are undoubtedly worse now, and health care workers will have little time to process their experience before getting back to business as usual in strained hospital systems.
Why healthcare providers will need mental health care
COVID-19 is particularly damaging to clinician wellness because the response rocks the core beliefs of the profession. Doctors are trained to treat patients, not to decide who will and won't get ventilators.
Doctors and nurses can rationalize that these are imperfect times, but they don't have a switch to turn off what makes them talented caregivers—their drive for perfection. Health care demands it and continuously reminds them there is little room for error.
Licensed providers can't accept this is the best they can do and tune out years of perfecting complex medical decision-making and delicate procedures. It's devaluing when they cannot provide the care they trained for; it's dehumanizing to place themselves and their families at risk.
Perfectionism is a hurdle
When the clinical demands settle, an administrator or well-meaning colleague will say, "I think you should see somebody." That is when the perfectionism that kept them alive and caring for patients during the pandemic may keep many providers from seeking mental health care.
To survive in this intense stress, providers have had to compartmentalize feelings to absorb the workload. For many, the wall will crumble when the crisis subsides, and they'll feel broken. Getting over that they are capable healers but can't fix themselves is a big mental hurdle in seeking care.
The system discourages help-seeking behavior
Doctors and nurses who move beyond the unique form of the stigma and seek counseling may find it difficult to access care. Even large health systems struggle to recruit and retain enough psychiatrists. The pool is even smaller when you search for providers to treat professionals with the trauma-informed care and confidentiality they have earned.
The lucky ones who find mental health care might live with a new fear—that their treatment will interfere with their ability to practice. Credentialing applications, state medical boards, and malpractice carriers often ask antiquated and illegal questions.
"Have you ever seen a psychiatrist?" has nothing to do with current functioning or ability to care for patients. Listing a simple antidepressant medication on a pre-employment physical shouldn't trigger a cascade of paperwork to prove a licensed professional is not a danger to patient care. These questions do not encourage help-seeking behavior or make patients safer.
The COVID vaccine offers exhausted frontline workers protection and the promise of relief. Science wins—for a moment. But as social media explodes with pictures of Rosie the Riveters posing in scrubs, think about the other care they deserve.
Hopefully, frontline workers will not throw away their shot to change healthcare culture to support self-care and mental health treatment as much as it values vaccination.