Coronavirus in Context: Coronavirus has significantly amplified clinician burnout

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You're watching Coronavirus in Context. I'm Dr. John Whyte, chief medical officer at WebMD. Today, I'm joined by Dr. Esther Choo, professor of emergency medicine at Oregon Health and Sciences University. Dr. Choo, thanks for joining us again.

Thanks for having me on.

And congratulations. I think, when we spoke to you last, you were not yet full professor. Is that right?

That's right. Thank you.

Well, congratulations. You helped shed light on what was happening on the front lines, especially in terms of shortages of PPE, as well as burnout. Tell us what's happening now on the front lines. What are you seeing?

Yeah, I think I have things, um, that are both hopeful, but also very discouraging. I mean, in many ways, this has been a groundhog day kind of, uh, era, where I wake up and I think, are we in March? Are we in April? Um, because here we are in July, I mean, moving fast through July, and a lot of the same issues are there. Um, and certainly we've done a lot of work, but, uh, but there are also really concerning shortages in the resources that we need.

For example, um, we've distributed through, uh, the organization I'm involved with, Get Us PPE, more than 2 million units of PPE around the country. We have requests pouring in, especially from the hardest hit areas right now, like Arizona, Florida, and Texas, and we've only been able to meet about 10% of the need there. So that represents a-- a lot of work and a lot of successful, um, distribution of PPE. At the same time, we are constantly overwhelmed with a huge need that's out there, um, particularly for smaller health facilities.

Why do you think it's the case? Is it an issue of manufacturing, that companies just can't make it quick enough? Is it poor coordination, you know, at the federal and state level, in terms of getting it to people who need it? It seems like we made some progress in terms of front line responders, and now we're-- we're heading back, as you point out, to areas of shortages. So how can we fix it?

Yeah, it's a little bit of everything, as you say. I mean, it's everything from failing to mobilize the supply chain, um, from, uh, underestimating the amount of need and the sustained need-- I think back in February and March, we didn't imagine that we would still be here in mid-summer, um, with rates going up, um, and hospitals in crisis now, and heading into crisis. Um, as we reopened, um, there was a need for PPE in many locations and businesses that were not hospitals, and we failed to estimate how much PPE we need.

As we go into the fall, there's gonna be a huge PPE need in schools in order to protect teachers, um, so that they can continue to be safe as they-- um, as we reopen schools in many areas. And so I think just all along the need has marched ahead of, um, of a fairly fixed supply chain, although, again, we're doing as best as we can to-- to stimulate the supply chain and to create an inflow of materials as we have them.

Well, what can listeners do? Could they donate? Could they, you know, help in-- in some ways in their communities? If people are listening and want to do something, what do you advise them?

There are so many ways to help. I mean, certainly organizations like mine, um, we're not the only one, but we are accepting donations. We're at getusppe.org. Um, and we put as much of that money, uh, directly in the hands of, uh, health care organizations, um, and, uh, and helping them boost their supplies as possible. Um, I think it's also important to not get issue fatigue here.

I think there were so many people advocating for, um, for increased supplies, talking to their elected officials, um, and really advocating for mobilization of federal and state and local resources so that we could continue to support health care organizations in-- in acquiring PPE. I think people got tired, um, which is so understandable, because we are tired of advocating for it. Um, but I think we need to understand, as long as this, um, surge continues, we need to be, uh, just as energetic as the virus in advocating, um, that resources get-- get dedicated to this, because it's an important part of the containment effort.

Let's talk about burnout, especially in terms of mental health. We had talked before about, you know, many front line responders were really experiencing some type of PTSD. Are other services and resources available now, more so than there was before, in terms of addressing this mental health burden?

Well, I think there are a lot of really wonderful efforts to create, uh, online free, accessible, uh, counseling resources for health care workers who are in-- uh, really at the front lines of this, and experience-- experiencing all kinds of, um, stress, anxiety, PTSD and burnout. Um, but I want to be clear that, um, these kind of crisis resources are kind of bandaids on top of what has been a little bit of a mental health crisis in health care before we had it in the pandemic.

I mean, yes, we're in-- in an unprecedented time in terms of stress, and this, um, sustained stress that this pandemic has been, um, but we're in this environment where, um, it's shameful to admit that you have mental health problems or that you need help from a therapist. Um, it is actually scary to try to, um, seek medical care because you can be penalized professionally. Uh, medical boards will ask whether or not you've, um, sought mental health care in a way that, um, that kind of doubles down on that fear and stigma.

Um, and there can be real professional consequences. We've seen this. We need to change the culture in health care around having mental health problems. This should be viewed as a very normal part of our very tough practices. We should try to make our health care environments more humane to begin with so that it's not as harrowing to have a career in medicine. Um, but we certainly should view seeking care as, uh, an expected and normal part of a health care provider's, you know, professional life.

What are some of the resources that people could really use right now?

You know, my own hospital I think does a great job of this. We have a confidential service, a counseling service for health care workers, um, where you can, uh, walk in any day of the week and get, um, literally 100% confidential and free care. Um, I can leave a shift and walk into that, um, office. Um, they make themselves as accessible as possible. And, um, and because it's so confidential, I don't have to be afraid to walk in there. Um, we, um-- and they also do outreach.

I mean, when they see that there are, you know, events, things like, uh, you know, a bad event in a-- in a department, or something that happens on social media, they do outreach and say, hi, it looks like you're going through a tough time, I just want that you know these hours are open to you. And they're very proactive in providing, um, support for that. And I think that is what we need right now. We need to, um, acknowledge a couple of things.

First of all, that this is a tough time like no other. It's tough layered on an already tough practice. And I think we need to make resources so available you can almost not avoid them, um, which is how I honestly feel like it is at my institution, and lower the bar of accessibility in every single way. Um, in how many steps you need to go to to, um, to reach that resources, um, lower the bar on cost, lower the bar on any punitive, um, or stigmatizing, um, attitudes towards that care. Uh, I think we need that now more than ever. And then when the pandemic's over, we need to completely reset how we, uh, approach these issues to begin with.

When do you think the pandemic will be over?

Oh, boy. I think this is going to be a long year, is all that I will say. I think of it in terms of a school year because I have school-aged kids. And I am personally, um, in my household, we are planning to not expect normality for a full calendar school year, because even if we get vaccine in the early part of 2021, I am very concerned, based on what we've seen, that we can scale up our manufacturing and our distribution chains in a way that is efficient and equitable. So I don't think that we will reap the benefit of that for quite some time. So I'm, uh, uncomfortably setted-- settled in to, um, a non-normal life right now.

You started off the interview by saying you're hopeful. What else are you hopeful about?

Well, I'm really impressed by our community of health care workers and scientists. I mean, I sit here day after day and watch people leave their regular jobs. They're very exhausting, taxing, emotionally and physically draining jobs-- I mean, just what we've been talking about-- um, they leave their jobs, and then they sit down and they do advocacy work so that we can get the science out. Um, I've never seen so many health care workers out there using their voices to educate the public, um, contributing to projects so we can do things like distribute PPE, um, educate our communities.

People are volunteering with their school systems to try to make the best and safest plan, um, so that kids can return to school in some capacity. They're volunteering in workplaces to try to figure out how we can transform physical spaces so that people can be at work in some capacity. Um, they're joining conversations, um, at the local level, the state level, the national level. I mean, our people are showing up in droves day after day after day.

Um, this has become a 24/7 project, is really fighting the pandemic and working with, um, you know, with people at every level in every sector to try to get through this. Um, I-- I don't know about you, but I have felt just tremendously inspired, um, by the work that people are doing, uh, on their own time to just, um, get our country through this. It gives me hope every single day, even as, um, so many things are devastating about this virus.

Well, Dr. Choo, thank you for all that you are doing, and-- and for being a leader, a mentor, an inspiration to a lot of people.

Thank you, Dr. Whyte. I really appreciate it.

And thank you for watching Coronavirus in Context.