I would like to report that Covid is behind us, but we all know firsthand that is not true. The B-2 variant which is 10 to 50 times more infectious than the B-1 variant has replaced the B-1 variant. The sewer water viral count confirms the rampant spread through communities, peaking higher than previously experienced. While infection with the recent B-1 and B-2 variants may not be as lethal as previous variants, it is still resulting in a high death rate. These variants do not lead to as many intensive care admissions, but infection with either still results in non-intensive care hospital care for many patients. This requirement for hospitalization contributes to the stress on our emergency departments and the number of available hospital beds. When there is this need for admissions related to Covid, other non-Covid cases get delayed. This results in further stress to the providers as you struggle to do your work in less-than-optimal conditions and do your best to remain civil while navigating an increasingly difficult practice environment with an unhappy and frustrated public. Can we do more to protect our patients, staff, families, and ourselves?
We need to continue to be brutally honest with patients and the public about what it will take to curb Covid. Physicians are in a unique position to have these conversations about risk with patients. We need to continue to speak openly and remind people about the simple and effective ways that work. We need to reinforce that masking, physical distancing and avoiding large gatherings have proven to work to decrease transmission. Please continue to provide information about the importance of vaccination and let us see if we can further improve the uptake of boosters. It is a bit puzzling that we have an acceptable uptake for our first and second vaccinations, yet we have the second-lowest rate in Canada for the uptake of boosters. How can we combat complacency?
My family consists mostly of health care providers. After remaining Covid-free over the past two years we have recently experienced a 50 % Covid infection rate. One family member contracted Covid at a non-health-work-related job site. While the rest of those who contracted Covid have all worked with Covid positive patients, none of them contracted Covid through their work. All have contracted Covid through social contacts and as a direct result of relaxing the use of masking and physical distancing. Keep reminding everyone that masking, physical distancing, avoiding large groups and vaccinations do work to reduce the transmission of Covid. Also remind those who choose not to be vaccinated to protect others by masking, practicing physical distancing and avoiding large gatherings.
Physician health has always been a priority for the College; now even more. Even prior to the pandemic, an increasing number of physicians were experiencing burnout. Physicians expressed dissatisfaction with aspects of their work, and the lack of work-life harmony. This has intensified since the pandemic. There has been a constant need to provide care despite the fact physicians are experiencing fatigue and are desperate for a break. We talk about burnout as if it is something that others experience, but not us. Providing safe care requires providers to be healthy. In an emergency we reference putting on our own oxygen masks first, but how many of us do that? We talk about it but are we vigilant in doing so? It is the only way to remain healthy and available to provide care.
We also talk about self care, but what does that mean? Our Saskatchewan Physician Health Program Director, Ms. Brenda Senger, has a wonderful definition of self care. Self care does not mean "me first" it means "me too". Too many times we witness physicians giving and giving and giving and then hitting a wall – burned out and withdrawing and at times walking away. We appreciate that physicians “stretch” that extra bit to provide care and take that extra shift because their colleague has a more urgent need to go home, however, it should be an exception, not the norm. Our work environment has also contributed to working in overdrive. While accessing patient related information electronically has resulted in positive benefits in caring for patients, it has also had a negative impact on providers in that it is harder to completely disconnect from work when the information flows in continuously.
Covid has only intensified my concern about physician wellness. Physicians like other healthcare workers have experienced potentially traumatic events during the pandemic that has resulted in significant distress. While the public displays of gratitude during the initial stages of Covid helped the providers cope with the burden of illness during the pandemic, the public is now frustrated with the healthcare system and at times this frustration results in less than civil actions towards providers. Those on the frontline during the pandemic have experienced unrelenting workloads. Experiencing traumatic events in addition to the workload raises a concern about the development of anxiety, depression, post traumatic stress disorder, compassion fatigue, moral injury, traumatic grief, and burnout.
In the Saskatchewan Health Authority (SHA) Townhalls, the Saskatchewan Physician Health Program staff provided wellness presentations on identifying and coping with burnout, compassion fatigue and moral injury along with other relevant topics. These are available on the SHA website and are excellent resources. The staff at the Saskatchewan Physician Health Program are willing and ready to help you and your colleagues: contact Brenda Senger, Director of Physician Support Programs (306-657-4553), or Jessica Richardson, Clinical Coordinator in Regina (306-359-2750).
Another impressive set of resources is the Canadian Medical Association’s Pandemic Wellness Toolkit. On this site you will find the following resources:
- Support for physicians experiencing harassment.
- A Wellness Support Line that offers free confidential counselling.
- A Wellness Connection that offers free, virtual peer support sessions.
- A Physician Wellness Hub. This provides wellness tools and resources for physicians, learners, leaders, and educators to create change in the culture of medicine.
- Connect with Peers.
- Support your Team.
“Check Your Vitals” is a tool that is a modified form of the Canadian Armed Forces tool that helps you assess how you are feeling and provides recommended actions. It is an excellent tool to judge whether you are in a “healthy, reacting, injured or ill state.” The Canadian Armed Forces developed this tool to assist the members of the force to manage their stress and anxiety during high stress times (combat), to allow them to focus. This is the same for physicians; we must focus when the stress is the highest. Please check the tool out and use it to keep an eye on yourself. Even the most experienced and resilient of physicians can feel overwhelmed, stressed, and anxious. These tools will help you determine whether you should be reaching out for help. Be open to seeking help for yourself, and help those who reach out to you to find the help they need.
This summer I hope you will find time to rejuvenate. You may not be able to take as long a holiday as you desire but plan short breaks that allow you to decompress and get out in nature and the sunshine with your loved ones. Even shorter days and an extended weekend help. Work with your colleagues to make sure you can find time off. Dr. Mamta Gautam, a well-known psychiatrist who works in Physician Wellness, recommends planning your next holiday as you finish your current one. It is good advice. Knowing when your next break is planned will help you to focus and get through your work week, especially if it is a tough one.
Be kind to yourself, take the time to get healthy and stay healthy. Remember the “me too” in self care advocates for you to be healthy so you can continue to care for all the others in your life who rely on you as a physician and a family member.