Burnout

Key Self-Care Strategies for Clinicians Amidst COVID-19

Interview with Dr. Marcus Shaker on ways medical workers can prevent burnout.

Posted Jul 06, 2020

Marcus Shaker, Used with permission
Source: Marcus Shaker, Used with permission

Everyone needs to practice self-care as a way to ensure their well-being longterm. This is even more true for clinicians and medical staff on responding to COVID-19. Here are some evidence-informed strategies to do self-care and prevent burnout.

Marcus S. Shaker, MD, MSc, FAAP, FAAAAI, FACAAI is a Pediatric Allergist and Clinical Immunologist at the Children’s Hospital at Dartmouth-Hitchcock, and an Associate Professor of Pediatrics, Medicine, and Community and Family Medicine at the Dartmouth Geisel School of Medicine in Hanover New Hampshire. His research involves the evaluation of health and economic outcomes of common allergy practices and how to optimize high-value care for patients with allergies and asthma.

JA: How did you first get interested in this topic?

MS: Actually, that’s a funny story. About nine months ago I was at a national allergy meeting. It was a Saturday evening and I was heading back to my room to try to squeeze in a few more hours of work. On my way to my hotel, I was intercepted by a colleague who insisted I change my plans immediately and join him and several other allergists for a night of Texas barbeque and line-dancing. Well, this group of dancers included some really fantastic individuals from the wellness group of the American Academy of Allergy, Asthma, and Immunology. We had some wonderful Texas hospitality at the “Rustic” and formed lasting friendships. When the pandemic was upon us, several of us connected to provide important guidance on clinician wellness.

JA: What was the focus of your study?

MS: “Physician heal thyself” is a common proverb, but it still is largely overlooked by healthcare providers and the general public that many clinicians struggle with a lack of fulfillment, depression, and burnout. The best definition of burnout may be “an erosion of the soul caused by a deterioration of one’s values, dignity, and spirit” (Maslach and Leiter, 1997). Burnout can be insidious, and everyone is at risk, especially when dealing with heightened stress during the pandemic. It is important to address because burnout can increase the risk of medical errors, divorce, substance abuse, and even suicide. If you feel like you have symptoms of burnout, depression, or suicidal thoughts, it is important to talk to your healthcare provider (even if you are one).

JA:  What did you discover in your study?

MS: Classic signs of burnout are exhaustion, lack of personal accomplishment, and depersonalization. Before the pandemic, burnout rates among US physicians were around 46 percent, and those rates may be even higher now. Especially early in the pandemic when a shortage of personal protective equipment was occurring nationally, stresses upon medical providers were pronounced. Tensions escalated as anxiety about personal health and safety increased while dealing with the uncertainties of a new and evolving global pandemic. While the warmer months and acclimation to the “new normal” has blunted the edge of these stressors, clinicians and health care systems must still be vigilant to recognize early symptoms of burnout.

JA: Is there anything that surprised you in your findings, or that you weren't fully expecting?

MS: Somewhat surprisingly, an attitude of gratitude can be a really important component of preventing burnout. While any one behavior may not make you immune to burnout, counting blessings rather than burdens can really help. Acknowledging fears and resentments, practicing forgiveness, and sharing worries with trusted friends can be very helpful (and you don’t even have to be line-dancing in Texas to do it). Incorporating mindfulness practices can be helpful to nurture the eight dimensions of wellness—emotional, spiritual, intellectual, social, physical, environmental, financial, and occupational.

JA: How might readers apply what you found to their lives during COVID-19?

MS: Social media can be a “double-edged sword” in times like these. There are billions of active users accessing social media platforms across the world, and it becomes more important than ever to have valid and well-vetted sources of information. Pandemic guidance has been rapidly changing in recent months, and with uncertainty looming, batting the coronavirus “infodemic” is important for everyone, especially healthcare providers. It is really critical to creating time and space for mindfulness, especially during the pandemic. Some tips include turning off social media notifications so that your device doesn’t rule your life. Scheduling time to interact with social media and recognizing when you are developing unhealthy habits with your screen can also be helpful. Similarly, it is important to find the balance between staying informed about COVID-19 recommendations and becoming overwhelmed by a barrage of worrisome news.

JA: How can readers use what you found to help others amidst this pandemic?

MS: In medicine, as in all areas of life, if you give all you have and hold nothing back, you can quickly find yourself lonely, empty, and disconnected. But we are not alone. We each need friends to successfully captain the ship of our own lives. The feelings clinicians have may are unique to healthcare providers, but everyone needs to pay attention to their own mental, physical, and spiritual health. We ignore the domains of wellness to our own peril. But there are some simple tools available at our fingertips to improve wellness. You can start by simply searching the App Store for mindfulness, gratitude, or wellness. Together we can each stand by the good and make it better.

JA: What are you currently working on that you might like to share about?

MS: I am currently working on several projects including reflections on wellness, national allergy practice parameters, and studies to maximize value in the care of patients with allergic and immunologic diseases. Much of this work relates to understanding how patients’ values and preferences can be communicated with healthcare providers to provide the right care, at the right time, every time.

References

Extended bio:

Dr. Marcus S. Shaker is Co-Chair of the American Academy of Allergy, Asthma, and Immunology (AAAAI)/American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force on Practice Parameters and serves as an Editorial Board member for the Journal of Allergy and Clinical Immunology In Practice, the Annals of Allergy, Asthma, and Immunology, and the Journal of Food Allergy.

Bansal, P., Bingemann, T. A., Greenhawt, M., Mosnaim, G., Nanda, A., Oppenheimer, J., Sharma, H., Stukus, D., & Shaker, M. (2020). Clinician Wellness During the COVID-19 Pandemic: Extraordinary Times and Unusual Challenges for the Allergist/Immunologist. The Journal of Allergy and Clinical Immunology: In Practice, 8(6), 1781-1790.e3. https://doi.org/10.1016/j.jaip.2020.04.001

Maslach, C. & Leiter, M. (1997). The truth about burnout: How organizations cause personal stress and what to do about it. San Francisco, CA: Jossey-Bass.

If you’re thinking about suicide, help is available—the national suicide prevention hotline is a phone call away: 1-800-273-8255.