Emergency physician is an occupation that, by its nature, is extremely stressful. The coronavirus pandemic has caused that stress to grow enormously.
“It is nothing like I have ever experienced in my 17 years of practicing,” said Dr. Aisha Terry, an emergency physician and associate professor at George Washington University School of Medicine and Health Sciences. “At moments, it has been surreal and unbelievable. It has been quite taxing physically as well as emotionally.”
Emergency physicians sometimes view themselves as durable and resilient since, more than any other specialty, they often must manage situations in which every decision is a matter of life or death.
“We wear this hat that we’re lifesavers,” said Dr. Mohamed Hagahmed, an emergency physician and faculty member at the University of Texas at San Antonio. “The pandemic has shown how vulnerable we are to emotional and mental stress.”
Many emergency physicians struggle mentally and emotionally because of their careers. A 2013 study by the Mayo Clinic and the American Medical Association found that 60% of emergency physicians suffered from some kind of burnout, more so than any other specialty.
The pandemic has only worsened the problem. A survey published in the Academic Emergency Medicine asked emergency room physicians to rate the effect the pandemic had on both work and home stress levels on a scale of 1 to 7, with 1 being “not at all” and 7 being “extremely.” The median response was 5.
Many factors related to the pandemic have contributed to the worsening stress. Early on, the unknowns regarding the necessary personal protective equipment and treatment of the disease were particularly unnerving.
“There were so many uncertainties about what was going on,” said Hagahmed. “We knew we had to wear masks, but there was confusion over whether we should be wearing N95 masks all of the time. There was also confusion about what proper isolation precautions should be. We had to rely on the experiences of harder-hit areas like New York City.”
There was also a pronounced sense of helplessness because many patients could not be saved.
“We go to work to do what we got into medicine for in the first place, to manage disease, take care of patients, and save lives,” said Terry, who is also a board member of the American College of Emergency Physicians. “The virus created doubt in our ability to do that because we had never seen this kind of thing before. There were instances where our fundamental sense of purpose for being a physician had been undermined.”
Compounding that sense of helplessness was the much larger than usual number of patients whose condition could deteriorate quickly.
“For me, most of the psychological distress came from seeing folks that present acutely ill, and then they decompensate. That is, patients come in, and you can tell they are in some distress, and then all of a sudden, they crash. They lose consciousness or stop breathing,” said Hagahmed.
One reason so many patients went to the emergency room in dire condition was that they were afraid to go to the hospital for fear of contracting the virus. That caused more stress for Hagahmed.
“A lot of my patients avoided coming to the emergency department until the last minute, until they were about ready to break,” he said. “I would like the general public to know that waiting until the last minute puts patients at the highest risk for getting worse. By coming to the hospital early, a patient is more likely to have a better outcome.”
Finally, the stress of treating COVID-19 patients could often spill over into the home.
Terry noted that on days when she was around a lot of patients diagnosed with COVID-19 or around many patients who were coughing and sneezing, she worried that she was at a higher risk of infection. She didn’t want to bring the disease home with her.
“I would at times quarantine away from my husband for days on end,” said Terry. “I’ve never had to do that before, and it was mentally stressful. In the long run, it’s just not sustainable.”
As noted, many emergency physicians view themselves as lifesavers. That view, though, can make it difficult to reach out for help: Asking for help can be seen as a sign of weakness. Hagahmed suggested that more emergency physicians realizing that they are vulnerable might be a silver lining of the pandemic.
“Seeing that many lives lost and the burden of caring for that large volume of people and seeing how that affected our mental and emotional health — that made us more cognizant of our own emotional and mental vulnerability,” he said. “I’m kind of thankful for that because it not only helped us see the problem but be open about it and seek help if needed.”
Hagahmed, though, has not yet sought help for his stress.
“I have not sought any professional help, but I do need to.”
