May 17, 2021

Kimberly A. Brown, MD, FAST, FAASLD Kimberly A. Brown, MD, FAST, FAASLD

In recognition of Mental Health Awareness Month in May, AASLD News spoke with Kimberly A. Brown, MD, FAST, FAASLD, and Ryan M. Kwok, MD, two moderators from the recent AASLD webinar Mental Health & Burnout During the Pandemic: Name It, Frame It and Tame It, now available for on-demand viewing as part of the COVID-19 and the Liver series.

Both physicians offer insights into recognizing and dealing with burnout among health care professionals.

“People need to recognize it in themselves and they need to recognize it in their coworkers,” said Dr. Brown, chief of gastroenterology and hepatology at Henry Ford Hospital. “We’re all vulnerable, and in order to be good caregivers, we have to deal with it and get ourselves healthy.”

The 2021 theme for Mental Health Awareness Month is: You Are Not Alone.

“We need to see each other, be checking in on each other, assessing how things are,” said Dr. Kwok, associate program director for the Gastroenterology/Hepatology Fellowship program in the National Capital Consortium and associate professor of medicine at the Uniformed Services University.

Ryan M. Kwok, MD Ryan M. Kwok, MD

How has the COVID-19 pandemic impacted mental health among healthcare providers?

Dr. Brown: It’s impacted mental health in several ways. The first is the burden of work we’ve had. Many physicians were asked to perform tasks they might not have been prepared to perform, which was an added stressor as we tried to meet the demands of patients.

Second was the change in technology, trying to respond very quickly to how to take care of patients when you couldn’t physically see them.

Third has been the burden we have in terms of not feeling we could provide the experience we wanted to for our patients—either patients not being able to access us or patients becoming very ill and not wanting to come to the hospital or being restricted from coming due to COVID.

And then there was a fourth consideration, which is the personal and family fear. This wasn’t just something that was happening to our patients. It was something that was happening to us, our colleagues, and our families. There was a lot of fear at the very beginning that we would potentially take the virus from the hospital setting back to our homes and our children.

Dr. Kwok: Nurses seem to be among those hit the hardest by this, as well as younger healthcare workers. It disproportionately affects us because we are right there on the front lines—the physicians, nurses, technicians, other allied health professionals. If you’re on the floor, if you’re running a clinic where you’re screening patients, these are the providers that really are at the leading edge of this fight.

What are some of the signs of burnout?

Dr. Brown: Some individuals will withdraw. They may not engage with others, their personalities may change. Somebody who seemed capable of taking on a task might become frustrated or angry very easily.

There’s a lot of things that clue you in that somebody’s becoming disengaged, like a change in the way they react to situations—more anger, more frustration, more apathy. It can be a variety of different responses to the same situation, but it’s different than they have expressed before.

Is there a hesitancy among physicians to admit they have hit a point of burnout?

Dr. Brown: I do think physicians in particular are less willing to acknowledge shortcomings. They are used to being the leaders, the motivators, the people who are the best in the room. And to recognize that maybe they have something keeping them from doing their best, I think, is difficult for people to recognize in themselves. So oftentimes we have to help each other by recognizing it in others.

What are some options physicians have for combating burnout—in themselves or a colleague?

Dr. Kwok: First and foremost, just being an open and willing listener. Even in the midst of a busy clinical day, if a colleague stops you and they’re in a place where they’ve put that trust on the line to say, “Hey, I'm going to take a chance and share this with a colleague,” pause to set aside what you’re doing. That’s the sign where a colleague is really in a difficult spot and we have to take the time to be that listening ear. If you get the sense that they’re in a place where it’s out of your skill set or comfort level, try to connect them with resources in a way that’s appropriate and sensitive. But if there’s concern for self-harm or for harm to others, we need to act on that and get professional intervention.

With the vaccine rollout, it seems there is an “end in sight” for the pandemic, but what do you think the long-term effects of this “event” on healthcare providers might be?

Dr. Brown: I think many providers have essentially PTSD from what happened at the very beginning. No one was really prepared, and we were trying to make changes on the fly. Every time there’s been a surge in COVID-19 cases, all of those feelings come back again. Hopefully, we’re moving to a point where we won’t have any more of those surges, but you just never know.

Dr. Kwok: A year’s worth of stress and anxiety. That’s going to be a weight on the collective psyche that will bear itself out for a long time to come—hidden injuries that will endure and not maybe manifest themselves here in the near term, but maybe later on. I just hope we are able to recognize them and address them in meaningful ways without too much fallout.

Dr. Brown: There have been people who have moved jobs, because that’s often a response to stress. There have been people who have retired early, and they won’t be coming back.

We need to recognize physician burnout was a problem prior to the pandemic. There were issues that were accentuated during the pandemic that we need to deal with—how we can help physicians and other health care providers do their job in a way that doesn’t deplete them.

Dr. Kwok: The pandemic will probably drive people out of the practice, which is really difficult in a time when, as hepatologists specifically, we have data to say we need more hepatologists, not less. I think there is a segment of the population who is saying, “I’ve evaluated things in the light of the pandemic, for good or for bad, and I'm moving onto something else.”

As we gain some optimism for vaccines and what hope they offer, this is still incredibly difficult. I still don full PPE (personal protective equipment) every time I go into the endoscopy suite, I still review all the COVID tests, and I still am cognizant of these things at all times. It’s a weight that we’re all carrying, and acknowledging that it’s still ongoing is really important. We’re not back to “normal” or prepandemic phases, and this is something that we’re going to continue to have to deal with.

Additional Resources

AASLD has compiled a list of resources available for download for healthcare professionals to learn more about how to prevent, recognize, and address burnout. This toolkit includes links to podcasts, webinars, guides, self-assessments, and more.