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Recognizing the signs of burnout
Sustaining your well-being and preventing burnout
Building resilience
Coping with psychological distress

Recognizing the signs of burnout

As a result of COVID-19, many physicians and other health professionals are experiencing physical isolation, a surge in care demands, equipment challenges, and the ongoing risk of infection. These factors can all lead to increasing stress levels.

When stress builds up it can lead to feelings of extreme exhaustion and being overwhelmed, also known as burnout.

Here are some signs you may be experiencing burnout: 

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  • having feelings of sadness, depression, failure, helplessness or apathy
  • becoming easily frustrated
  • blaming others, or feeling generally irritable
  • feeling disassociated, indifferent or apathetic 
  • isolating or disconnecting from others
  • practising poor self-care 
  • feeling tired, exhausted or overwhelmed
  • using negative coping strategies

Sustaining your wellness and preventing burnout

Many workplace and environmental factors are beyond your control. The good news is there are healthy habits and professional skills you can use to counter stress and anxiety.

Here are some practical steps to help you monitor and support your own well-being:

Check in with yourself:

  • Gauge where your mood is on the self-assessment tool.


    What is my colour right now?
    Graphic adapted from Road to Mental Readiness, Canadian Armed Forces © October 2017 Drs. Kerri Ritchie & Caroline Gérin-Lajoie, The Ottawa Hospital

     

  • Ask yourself what you can do to keep your spirits up, recharge or move toward the green color.

  • Listen to your own feelings. Know the signs indicating you’re stressed out and when they appear, you need to act.
  • Monitor yourself over time for symptoms of depression or stress disorder and seek support if these symptoms become overwhelming.

Read more: A clinician’s guide: managing COVID-19 stress and anxiety

Care for yourself:

Considering the pandemic could play out for months, physicians need to implement personal strategies to deal with fatigue, stress and uncertainty. 

Here are some suggestions:

  • Meet your basic needs – eat, drink and sleep regularly. Avoid negative coping strategies such as excessive intake of caffeine, sugar, alcohol or drugs.
  • Take control of the pace of your life. Use transitions throughout your day to be mindful and reflect on your feelings:
    • Transitions within your workday. These happen hundreds of times during your shift, moments when you can ask yourself: Am I distracted or anxious? Do I need a mental break? Taking that pause can reduce your stress, so you have more bandwidth for the task at hand.
    • Transition from work to home. The commute home is a great opportunity to process your day. Talk to your family about how they can support your transition mentally and emotionally. Do you want to vent about your day when you arrive home, or be left alone for 15 minutes? Having those conversations can help your long-term recovery.
    • Transition from home to work. Get ahead of the anxious thoughts. Imprint to your subconscious: What do I want to feel today? What do I need to bring that would be helpful to my team? What am I scared of? And can I do something with those feelings right now?

Read more: “Talk to your fears”: strategies to manage stress during the COVID-19 pandemic

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Use tactical breathing to focus, gain control and manage stress. Here’s how to do it:

  1. Visualizing each number as you count, breathe in slowly for a count of four;
  2. Pause and hold your breath for a count of four;
  3. Exhale slowly for a count of four;
  4. Repeat three to five times.

Read more: A clinician’s guide: managing COVID-19 stress and anxiety

Stay connected:

Social distancing does not mean cutting yourself off from friends, family and colleagues. If you can’t meet face-to-face, pick up the phone for a chat, videoconference or even a text. 

Peer support is a strategy that can be helpful in dealing with adverse events, like COVID-19. At work, consider “buddying up” with someone you trust for check-ins and informal chats. 

Here’s how buddy check-ins work:

  • Choose someone you know well and with whom you can be open about what you’re going through.
  • Identify a way to connect, either in person, by phone or by text. This type of connection can be mutually beneficial – it can also serve as a reminder to practise self-awareness (a self-check-in) and to take care of yourself.
  • Arrange to connect on a daily basis and try to stick to the schedule.

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Use the HELP acronym as guidance for your chat:

  • Ask: “How are you doing?”
  • Be Empathic and understanding.
  • Listen without judgement and state your concerns.
  • Plan next steps: encourage them to seek formal support and/or ask what you can do to help.

 Source: Resident Doctors of Canada’s Resiliency curriculum


Building resilience

At home:

Children of all ages are now familiar with COVID-19. Their daily routines have been disrupted — school, sports activities, time with friends and vacations. Many are also aware their physician parents may be at greater risk of contracting the virus.

Here are some tips on how to reduce their anxiety:

  • Talk to them about the root cause of their anxiety – it might be different than you expect.
  • Assure them you will do everything possible to keep your family safe and explain the precautions you’re taking.
  • Be conscious of the discussions you’re having in their presence.
  • Make sure you’re as engaged as possible with them when at home.
  • Help them establish a routine that includes fairly consistent wake up, schoolwork, play and family times.

Read more: For physician parents: helping children understand risks and reduce fears

At work:

The SARS outbreak in Toronto in 2003 had enduring psychological effects for health care workers and hospital staff. COVID-19 threatens to do the same.

Fostering a more resilient work environment is essential in helping physicians cope with the unpredictability of the pandemic. 

Here are a few things you can do now to support your staff:

  • Educate yourself to recognize the signs of stress and trauma – feeling anxious, stressed, scared, guilty or helpless. 
  • If you’re new to this, consider taking a mental health first aid course — it can increase awareness, help decrease stigma and identify appropriate language to use.
  • Guide physicians to any resources they need to encourage them to take care of themselves.
  • Carve out a regular time for team meetings. Encourage colleagues to express their concerns and ask how you can better support them. 
  • Establish regular peer consultation, mentorship and collegial support.
  • Make a conscious effort to bring a positive attitude to the workplace and practise empathy, understanding and civility – it might just be contagious!

Read more: How leaders can support team resilience in a pandemic


Coping with psychological distress

Despite efforts to build resilience to cope with the stress of the pandemic, many frontline workers will still experience acute anxiety and other emotional distress when faced with an adverse situation.

Becoming aware of your self-talk and challenging your negative thoughts will help you maintain your focus and improve your performance.

Follow these six steps to challenge your negative self-talk after a stressful experience:

  • Reflect on the situation (who, what, when, where, why).
  • Identify the emotions you experienced.
  • What negative thoughts were running through your head?
  • What evidence supports your automatic thoughts?
  • What evidence does not support your automatic thoughts?
  • Can you come up with a more balanced, alternative thought?

Source: Resident Doctors of Canada’s Resiliency curriculum    

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Moral distress:

Physicians can often experience moral distress – a feeling of doing the wrong thing or having very little power to change a situation. In the context of COVID-19, physicians might be forced to make difficult decisions about who receives which level of care, depending on the allocation of resources.

The ‘moral residue’ is the feeling that remains after the situation that triggered the distress has ended. If not dealt with, the level of moral distress experienced may increase with similar encounters.

Though it’s often not possible to eliminate situations causing moral distress, there are ways to mitigate its emotional impact at three different levels:

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The individual physician:

  • Check in with yourself to gauge your level of distress (see What is my colour right now?) and take steps to care for yourself.
  • Share your feelings (of distress, guilt) with people you trust, perhaps members of your health team.
  • If you’re having increased difficulty functioning, reach out to your family physician, an employee assistance program or your provincial physician health program.

Tapping into your “choice points”

Life is full of choice points – a point in time where you have to decide what your behaviour is going to be. When you notice you are in a distressing situation, tapping into your choice points can be helpful.

For example:

I don’t feel I have the resources to provide the best care to my patient

  1. Notice the difficult feeling or thought – e.g. moral distress, anger, anxiety
  2. Ask yourself: What are the risks/benefits of the possible decisions? What systems are available to support me?
  3. Take action: Reach out for system and/or personal support. Find one small thing you can do to take care of yourself.

Source: Gillian Potter, Psychology Resident, Dr. Kerri Ritchie, C.Psych. Dr. Caroline Gerin Lajoie, MD, FRCPC, The Ottawa Hospital

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The health team or department:

  • Hold debrief meetings on a regular basis, particularly when morally charged situations occur.
  • Build team cohesion by having clear and timely communication and shared decision-making, so that everyone feels included and validated.
  • Encourage team members to support each other and ensure no one isolates themselves. 
  • Consider creating a buddy system (see ‘Stay connected’).

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The health organization or system:

  • Be honest and transparent about the situation that could be causing the moral distress. For example, if there are resource constraints.
  • Create triage teams that would allow for the separation of the clinical and resource allocation decisions. 
  • Let physicians know you have their backs, and they aren’t alone in having to make these difficult and emotional decisions.
  • Create guides to advertise wellness supports, encourage peer support and give staff opportunities to practise self-care.

    For more information:
    Moral Distress and COVID-19: How to recognize and cope with it (CMPA podcast)
    COVID-19 and Moral Distress

    Last updated May 22, 2020

    Online psychological and peer supports for physicians and frontline workers during COVID-19

    Canada-wide:

    Free online crisis training for essential workers during COVID-19 (Mental Health Commission of Canada)

    Free one-on-one psychological services for health care providers (Canadian Psychological Association)

    Daily Zoom call for peer support for physicians w/ Dr. Mamta Gautam (invitation via Twitter)

    COVID-19 women physicians’ emotional well-being Facebook page

    Check with your provincial physician health program, many of which offer 24/7 counselling and peer support programs

    Ontario only:

    MD-led virtual chats during COVID-19 (OMA)

    Weekly psychological support groups for health care providers (de Souza Institute)

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