Cast & Curious

Tag: mental health

  • Turning Quarantine into Quality Time

    Most healthcare workers and facilities were caught unaware by the corona virus pandemic. Orthopedic surgeons who answer ER calls for acute extremity trauma weren’t exempted from this onslaught. After a short stint at the pandemic frontline, I was back lining COVID-19 front liners with hospital’s emergency incident command (HEIC) group. After about a week with HEICS, a friend told me I was on the verge of collapsing. I made it through another week, just in time for another pull out for yet another task. I thought I was out of the frying pan.

    An article in JAMA Internal Medicine predicted a pandemic of behavioral problems and mental illness in the general population as a consequence of COVID-19. Health workers are already experiencing burnout and “moral injury” even prior to this pandemic. Moral injury “describes the mental, emotional, and spiritual distress people feel after perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations” says Dr. Williams. The uncertainties of COVID-19 fight all the more add to this burnout and moral injury. Little has been discussed about the health workers own mental health.

    There are myriad of reasons why many health workers does not verbalize anxiety while frontlining. Front liners are very busy saving others, often to the point of self neglect. Personally, anxiety was at its during the mandatory 2 weeks post front lining quarantine. Doing nothing while on isolation could wreak havoc on mental health if left unaddressed. For example, I had bouts of the “interns’ syndrome”- diagnosing myself to have contracted COVID-19 based on clinical symptoms of the disease. I also had sleepless nights thinking about the “what if” scenarios if I contracted the disease. Yet I survived the isolation days thanks to a network of social support (including social media) that worked from a distance, and these four essential “steps” I learned from the writings of Adam Grant, a Wharton professor. Here are those essential steps:

    Labelling. The same JAMA Int Med article predicts a substantial increase of mental health issues during and probably after pandemic. Problem is, not many in this generation have prior pandemic experience. Even with health workers who deal with a lot of stress may find this pandemic-related anxiety, on a different level. Most psychologists and psychiatrists would just call it “anxiety” but I don’t think I had this level of anxiety before. I will call it “Post Front lining Stress Disorder” just to highlight the elevated anxiety level . Not totally a very scientific way of labelling but yeah, I am very anxious post front lining.

    T1. Are you dealing with pandemic related mental health issues as a health worker ? How did you came to terms with this?

    Reframing. I’m not exactly an introvert, but I’m comfortable being alone. I read books, hike mountains, travel places and photographed landscapes on my own. The enhanced community quarantine however is prohibitive to some of these activities. So I reassessed my isolation, tried to understand and looked for “productive” opportunities in each of these perspectives. The fear of dying alone doing nothing is I’m afraid what inspired me to reframe my isolation.

    T2. What or who was your inspiration for “reframing” your isolation?

    Distraction. The most insane part of the isolation ordeal for me is distraction . I tried cooking, vlogs, zoomongering and social destalking- unfollowing apocalyptic people and news online. I’m pretty surprised about the things I can and can’t do while in isolation. What’s more important was the act of trying to distract myself from a sordid state of self isolation. Just a warning that although “distraction” may alleviate misery on the short term, some “distractions” like alcohol or drugs have destructive effect on people.

    T3. Whats the funniest distraction you did while quarantined or isolated?

    Amelioration. There was a point in my distracted state that I realized, distraction isn’t enough. I have to protect my (and the people I love) health. I have to help protect my work and colleagues and my embattled nation. I have to learn, do or produce something relevant to this COVID-19 pandemic. I learned HEICS ala “The Matrix” in 2 weeks time. But thats another story.

    T4. What was the most productive thing you’ve done while isolated or quarantined?

    Join #HealthXPh twitter chat on April 18 at 9PM Manila Time as we suggest ways of turning quarantine into quality time. Note the following guide questions and append #HealthXPh to all your tweets!

    • T1. Are you dealing with pandemic related mental health issues as a health worker ? How did you came to terms with this?
    • T2. What or who was your inspiration for “reframing” your isolation?
    • T3. Whats the funniest distraction you did while quarantined or isolated?
    • T4. What was the most productive thing you’ve done while isolated or quarantined?

    See you all!

    Image by Freepik

  • The Pursuit of Happiness in Healthcare Workplace

    “Mam, where’s our patient?!” As the OR nurse calmly enumerated a litany of reasons why our patient isn’t yet on the table as scheduled, I’m welling up with frustration. “Excuse me” I said. I silently went back to the empty OR dressing room. I threw a one-two punch -high kick in the air, closed my eyes, took a deep breath and sat momentarily. Grabbing my hospital coat, I went to the patients room, talked to the patient and tried fixing whatever I could, so the patient can have the procedure on a later time. I did that with all the warm smile I could muster. Deep inside? I was screaming for reason. “Am I still happy doing all these, despite the challenges?”

    The news and internet is teaming with bleak stories of healthcare workers worsening mental health, burnout and job satisfaction. WHO recently updated its definition of burnout:

    Burn-out is a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions: (1) feelings of energy depletion or exhaustion; (2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and (3) reduced professional efficacy. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.

    WHO, 2019

    Evidence points to a staggering 1 in 2 healthcare workers has had or is experiencing burnout. Yes thats 50% of health workers! Burnout evidently affects health professional mental status and is tied to job satisfaction according to recent studies.

    T1. Have you experienced or is experiencing burnout in the healthcare workplace? Please describe.

    Don’t get me wrong. I’m not turning a blind eye to the systemic problems besetting the health care industry. The causes of health workers burnout are multifactorial and systemic.

    Work system factors of the systems model of clinician burnout and
    professional well-being.

    I am for systemic solutions and we need it yesterday, or maybe five years ago. But while our health leaders are drafting solutions, we’re left to cope with burnout and find happiness in an adverse workplace. By that I mean, finding happiness on a personal level, cherry picking “tips and tricks” to cope with burnout, perform above par at and still appreciate the career we so love doing. It’s not unusual nowadays to be approached by a colleague asking “How do you find happiness in this shit hole of a workplace?!” Cynical, but a very positive way of looking for happiness in the chaotic sea of workplace challenges.

    T2. How do you find happiness in your healthcare workplace? Please elaborate.

    Systemic solution are often innovative to induce radical changes in the health care industry. The US National Academy of Medicine came up with a systems framework for addressing health professionals mental well being. I’m hopeful our health leaders will get their acts together and come up solutions to this problem. These solution need to trickle down to the grass root health workers fast. By fast, I mean five years ago. In the meantime, we’re left to cope with burnout and find happiness in the workplace. If these personal “tip and trick” miraculously worked for us, we happily share it to our colleagues and sometimes with our bosses or managers.

    T3. What workplace happiness would you share to a colleague or even to your boss and managers?

    Join #HealthXPh tweet chat this Saturday 9PM Manila time as we discuss coping with health professions burnout by finding happiness in what we do. This should guide you through the discussions:

    • T1. As a health professional/student, have you experienced or is experiencing burnout in the workplace? How did you cope up with it?
    • T2. As a health professional/ student, how do you find happiness in your workplace?
    • T3. What workplace happiness would you share to a colleague or even to you boss and managers?

    See you all on Saturday!

    References:

    National Academies of Sciences, Engineering, and Medicine. 2019. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: The National Academies Press. https://doi.org/10.17226/25521.

    Shanafelt TD , Balch CM ,  Bechamps GJ , et al . 2009. Burnout and career satisfaction among American surgeons. Ann Surg 2009;250:107 15. doi:10.1097/SLA.0b013e3181ac4dfd

    Rosales, Rheajane & Labrague, Leodoro & Rosales, Gilbey. (2013). Nurses’ Job satisfaction and Burnout : Is there a Connection?. International Journal of Advanced Nursing Studies. 2. 10.14419/ijans.v2i1.583.

    Jabonete, Fritz Gerald & Dayrit, Aubrey. (2018). Reported Work-related Stressors among Staff Nurses in Metro Manila, Philippines.

    #HCLDR. (2019, December 5). Reconnecting To Joy in Work [Blog post]. Retrieved from https://hcldr.wordpress.com/2019/12/05/reconnecting-to-joy-in-work/

    Credit: Image by Halcyon Marine Healthcare Systems from Pixabay

  • Mental Good: How healthcare professionals balance career and personal lives

    “To go beyond is as wrong as to fall short.”- Confucius

    About a month ago a colleague committed suicide just a day after her hospital duty . She was working 72 hours straight without sleep for weeks, but not even her family had an inkling she was about to take her own life.  Two days ago I talked to another friend who is disappointed with his medical career because of the so many challenges he is going through. He is beat up. Today, I talked to another healthcare professional and the same “tone of disillusionment”  is palpable as tears well in the corner of her eyes.

    “This is not what I signed up for medicine”  was the bottom line for this three healthcare professional.

    Disappointment, frustration or simply “burnt out”  is a well known but rarely verbalised, “not so secret” secret among colleagues in the healthcare profession. In fact, it is so common in the medical profession we’ve considered this part of the “normal challenges” of our career path and we expect every physician to survive it. Of course the sad reality is that not everyone survive this challenge.

    Some of them end up dead.

    While the cases of suicide among healthcare professionals maybe small and sporadic (an outlier) what surprises us the most is that nobody seem to have an inkling that physician or healthcare professional A is depressed and suicidal until he or she is actually dead or dying.  Are healthcare professionals good at hiding depression and frustrations or have the general public gotten used to the notion that healers ought to endure superhuman problems and heal themselves?

    The devil is in the small details.

    Most of the telltale signs of depression are what we see as “normal” in the day to day existence of a healthcare professional. Seventy Two hours straight duty? That’s normal. Most even brag about it. Felt bullied by a senior? “Oh thats just normal. That’s needed for you to harden up.” Sometimes, our health system exerts tons of pressure upon a healthcare professional, yet it doesn’t provide an outlet for overcoming stress, deprivation and disillusionment.

    When colleagues on rare occasions do come to me seeking advise on what to do with their career and personal life, I am tempted to answer drawing from my own experience. How do you balance professional and personal life really? I realized though that my experience might be an outlier too and would not be applicable to anyone else even if we thread the same career path.

    So i bring these dilemma for discussion here on our tweet chat.

    T1. As a healthcare professional, how do you balance professional and personal lives? Where do you draw the line of caring for others without harming your personal lives?

    I have seen obviously sick or sleep deprived physicians tending to patients, a dangerous situation for both patient and professional.  Where do you draw the line here?  If you are a patient, what would you suggest to your healthcare professional knowing he is sick or is sleep deprived?

    T2. What counsel would you give to a disillusioned, depressed colleague who seeks your advise,  besides seeking professional help? 

    We always give advise to disillusioned or depressed colleague but we rarely knew or had the chance to follow up if they really did.  What other advise can you give?

    T3. Can you give an example of the “lowest low” in your medical career and how were you able to overcome it?

    Join us this Saturday, May 20, 2017 9:00PM Manila time as we bring balancing life, depression and medical career into the discussions of health in the Philippines!