Alert Letter from the WFSA Professional Wellbeing Committee
Anesthesiologists are highly trained health professionals, prepared to deal with the full spectrum of perioperative care including major surgery, trauma, obstetrics, critically ill patients, and management of pain in all of its manifestations. As a specialty we have risen to the occasion to take on the challenges of caring for the highest risk surgical patients during the SARS epidemic and now the COVID-19 pandemic. In these circumstances, anesthesiology professionals showed great resolve, scientific and educational adaptability, and demonstrated our essential role in the delivery of care.
At the outset of the pandemic there was significant uncertainty regarding modes of transmission of the virus. Anesthesiology professionals who were called upon to intubate suspected COVID-19 patients were forced to confront the fear of potentially becoming infected and spreading the virus to co-workers or their families. In high-risk patients, the short time between hospitalization to deterioration and respiratory distress requiring mechanical ventilator support was so dramatic that it was brutal fight for every breath. These experiences were potentially psychologically harmful, for the patients and our professionals. Compounding this, the initial inadequate availability of rapid and reliable COVID-19 diagnostic testing, along with shortages of personal protective equipment (PPE) added to the stress involved in the care of these patients. It became impossible to know if what we were doing to protect ourselves and our family members was adequate. The combined result of all of these factors has been a vulnerability to numerous psychologically generated phenomena such as shared trauma, post-traumatic stress disorder, burnout, alcoholism and substance abuse, all capable of influencing our professional and personal wellbeing,.
The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of global society including mental and physical health. This reality of a “4th wave” affecting mental health may result in an increase in the incidence of psychogenic depression, burnout syndrome, drug dependence, and suicide in physicians (particularly anesthesiologists) who are involved in the medical care of these patients.
1st Wave: Immediate mortality and morbidity of COVID-19. 1st Wave Tail: Post-ICU and admission recovery for many patients.
2nd Wave: Impact of resource restrictions on non-COVID conditions – all the usual urgent things that people need immediate treatment for – acute.
3rd Wave: The impact of interrupted care of chronic conditions (people stayed home).
4th Wave: Psychic trauma, mental illness, PTSD, economic injury, burnout, and more.
The world is rightly focused on measures to suppress COVID-19 transmission and protect the most vulnerable, along with research to develop treatment drugs and a vaccine. However, the mental health impacts of COVID-19 to the healthcare professionals will be significant. There is an increasingly urgent need to understand and address these impacts through research and supportive measures for the Physicians/residents/nurses (Anesthesiologists).
Questions to be answered by anesthesiologists / residents / nurses in an introspective way in order to initiate a psychic reflection on the psychogenic reflexes generated by medical care during covid-19 pandemic.
- Thinking about the current coronavirus (COVID-19) pandemic, what, if any, concerns do you have about the impact on your mental wellbeing?
- We are keen to understand what people are doing to support their mental wellbeing during the coronavirus (COVID-19) pandemic. What, if anything, has been helping your mental wellbeing at this time?
- Is there anything that you think has been helping your mental health and wellbeing during the pandemic?
Priority concerns about the impact of the COVID-19 pandemic on mental health of the physicians / residents / nurses involved in medical support:
- Becoming mentally unwell (fatigue, Burnout, behavior of suicide, drug dependence, others)
- Difficulty accessing mental health support and services
- Changes in the family and relationships (including issues for children and young people, and older people)
- Financial support suggestions:
- Offer the staff extra money
- Offer the staff extra days-off
- Offer the staff paid holidays or at least heavily discounted holidays, in order to be able to provide this option to the staff, a committee should be formed to negotiate with bodies like banks, airlines and hotels to negotiate the reasonable way to do it.
In order to build a caring and supportive professional environment, WFSA and member societies are seeking to develop new and innovative well-being programmes which link clinician health and well being to quality and patient safety. A peer-to-peer wellbeing programme must be established in each Anesthesiology Department. This programme should focus on empathic listening, sharing experiences with peers, support and refer; such a programme should not provide diagnosis, nor therapy which we have the referred medical professional to manage. We need to develop our faculty with such peer support skills in resilience: Control, Commitment, Connections, Calm, and Care.
- Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA 2020; Apr 7. doi:10.1001/jama.2020.5893;
- Shah K, Chaudhari G, Kamrai D, et al. (April 04, 2020) How Essential Is to Focus on Physician's Health and Burnout in Coronavirus (COVID-19) Pandemic?. Cureus 12(4): e7538. doi:10.7759/cureus.7538.
Gastão F. Duval Neto (Chair of WFSA Professional Well-being Committee (PWC))
Miodrag Milenovic (Chair of WFSA Education Committee)
Bisola Onajin-Obembe (Chair of the WFSA African Regional Section)
Daniela Filipescu (WFSA council member)
Carolina Haylock-Loor (WFSA council member)
Fauzia Khan (WFSA board member)
Davy Cheng (Chair of WFSA Scientific Affairs Committee)
Ezzat Aziz (PWC member)
Stuart Brooker (PWC member)
Venkatagiri Kalandoor (PWC member)
Wichelewski Josef (PWC member)