Helping Health Care Professionals Recover From PTSD

[THEME MUSIC] Welcome, everyone. You're watching Coronavirus in Context. I'm Dr. John Whyte, chief medical officer at WebMD. COVID-19 has impacted all of our lives, and it's really hit health professionals pretty hard. . We've been watching the videos of the emergency rooms and hospitals being overwhelmed. So what's the impact on health professionals? And how do we help them through this? To help provide some insight, I've asked Diana Hendel. She's the author of a new book called Why Cope When You Can Heal? How Health Care Heroes of COVID-19 Can Recover from PTSD. Diana, thanks for joining me.

Oh, Dr. Whyte, it's really a pleasure. Thanks for having me.

Let's start off with, health care workers see a lot of trauma on a daily basis. In the emergency room, you see gunshot wounds, car crashes. We deal with people who have had heart attacks and strokes. Why is COVID-19 so different?

You raise such an important point. Health care workers and professionals are, by nature, amongst the strongest, toughest, most resilient, grittiest people that any of us would ever encounter. Their measure of emotional and mental toughness is unparalleled. And they are accustomed to seeing accidents and traumas. What's different about COVID is that it's day in and day out, month after month-- now, year-- approaching a year.

And the amount of death and anguish and hardship and loss is enormous. It is far beyond what they've experienced day in and day out in the past. And so because it keeps going on, because of the severity, because of the risk for their own lives, because of the impact on their own families, this is really crossed, from the normal stress that they encounter, really into traumatic stress for them.

And let's talk about that impact. There's the impact on the individual person-- the nurse, the pharmacist, the doctor. But there's also the impact on the health care system. Can you help explain what's going on there?

Yeah. So much has been written about the impact of trauma on individuals, but very little has been published about the impact on an organization, on a community, on a group, on a collective. And that is what we're experiencing at all those levels, collectively. And so organizations, when they're traumatized, often people come together in just wonderful ways-- the camaraderie, the bonding that can occur, the esprit de corps as they rally around a particular event.

But what also settles in as events go on, and depending upon the nature of the event, sometimes blame and finger pointing arises. Who caused it? Who didn't do enough to prevent it? Guilt arises often. And we see this in organizations. Did I do enough to save my patient? Should I have done something different? Am I protecting my loved ones at home? And then, sometimes, depending upon the nature of the trauma, shame can enter an organization. Sometimes the organization itself wonders about the reputation that the community will hold. So certainly with COVID and the COVID pandemic, all those things are in play, both the impact on individuals and on the organizations themselves.

For physicians, isn't there an attitude of, get over it, you can deal with it, don't let your emotions get in the way? That's historically been the approach in training. Is that doing damage?

Well, I look at it as a both/and. I think that resilience and that toughness and that ability to compartmentalize and put it aside for the moment really serves people very well-- and certainly serves our patients well when we're able to do that. But I consider it both/and, that we need to make room also for the emotional toll and the emotional impact. And often, we just put that aside and just keep going.

And I think until we deal with how the emotions impact our bodies and our minds, that continues to build up. And so, to your point, it can cause long-standing harm. It can result in unresolved feelings that result in unhealthy impact for physicians and all clinicians. So it's very much a both/and. And I wouldn't say to discard the resilience and the toughness, but I would say, add a practice of being able to navigate and process the emotions.

As you know, WebMD also runs Medscape. And we've seen that burnout was an issue pre-COVID. You ran a health system, a pretty large one, for many years. And some people will argue that health systems have created more stress. The culture doesn't create an environment where one can say they're not OK or they're having challenges.

We've heard from Dr. Choo, who talked about, if you go seek help from a mental health professional, do you then have to disclose that on your medical licensing? And that can create challenges. And in your book, you talk about that PTSD is not inevitable, and you provide some solutions. So I want to hear about those solutions, and I'd love to hear about how you think about it now [LAUGHS] versus how you thought about it a few years back when you were in charge of a system.

Yeah, both when I was in charge of the system-- I grew up with a health care organization. I was a former CEO of two hospitals in Long Beach, California. But I'm also a clinician by background, clinical pharmacist by training. And so I know very much what it is to serve at the bedside, serve on the front lines. And to your point, our culture of, just get over it, just move on, we're tough, we're resilient, does contribute to the stigma of addressing mental health challenges-- and particularly PTSD.

We experienced a very traumatic workplace shooting while I was CEO. And after a number of years, it became apparent to me that I personally-- I individually had PTSD. And it was really quite a conflict. I was willing to get help, but I wasn't willing to come out with that. It was really clear that, in our culture, being a CEO and having PTSD was a sign of weakness.

And I knew I had gone through lots of adversity, lots of very tough situations, traumatic situations. So I knew I was tough, and I thought toughness and busyness was the antidote. And I discovered it wasn't. And so I did get more help and more intensive help. And I did fully recover. And now, I am helping organizations and individuals and leaders address the traumatic stress that they may experience in their organizations.

And you talk in the book about individual things that people can do, but also the fact that systems have to change as well, in terms of allowing people to ask for help, checking on people, in terms of how they're doing-- not putting all the burden on the part of a health professional. What are some examples that you talk about and ways that we can help address this? So as you point out, that PTSD is not inevitable.

Well, to your point, health care organizations have been really stepping up to establish employee assistance programs, to make it known that psychological, spiritual care is available for employees. Offering peer to peer counseling is really important. But the more that leaders come out and encourage it and model it, that will be something that really opens the floodgates. Because again, people can be tough and be affected. And so the more that leaders model that and encourage people to seek advice, counsel, support, help as needed.

I think the key thing that people can do, both coworkers, employers, and all of us who work in support of health care professionals, is to listen to them-- to listen to their stories without trying to fix them, without jumping in with a pep talk, without jumping in with a, well, you'll get over it. Those are easy things to say, and we all, when we're faced with someone who is struggling, often say those things. And in my experience in working with thousands of others, being able to listen, bear witness if you will, to their story without jumping into fix, is really key to helping them heal. And it's not easy to do. It's uncomfortable to hear somebody else's pain. But it's perhaps the most supportive and loving thing we can do, is to simply listen to them.

Do you think there's any silver lining from the impact that COVID has had, in terms of how we deliver care, how we practice as clinicians?

I think there are many silver linings. I think, to that point of the camaraderie, the esprit de corps, the rallying to support one another, that is abundant. And we see that every day. Individuals and organizations that can capitalize on that-- I think that carries health care organizations forward. I also think that, logistically, there is a lot of work that's been done in response to this pandemic to shore up a lot of our logistic responses and to improve those. And so as we do after action reviews, as we do the look back, I think there's a lot of improvement that we can incorporate. So I think those are some of the things that will really be served as silver linings for the health care industry.

You talk about how communication is key, and we haven't always been the best in terms of communicating internally to our colleagues, as well as externally to the broader community. Do you think that will improve over time? We've seen that in challenges with PPE and explaining what's going on there. Why is it so hard for health systems to communicate effectively?

Well, I think there are a lot of challenges, logistically, to communicate. But I think, also, what happens is, sometimes there's a hesitancy to come out until we know all the answers. And in my experience, coming out with communication as soon as possible, saying what we do know, admitting what we don't yet know and how we're going to find out, establishing regular, frequent touch points, establishing call centers so people with questions can know that there's a central repository for their concerns-- all of those things in the immediate aftermath of an event, or as a pandemic unfolds, are critically important.

I think many times, when there's a void, when there isn't a lot of communication, of course people fill those voids with narratives that are often not particularly healthy. And so our ability to speak to that void and ensure that there aren't voids created, our ability to address elephants in the room and address rumors very forthright is really important. So those are some of the elements-- that I am seeing tremendous improvement in communication. By virtue of the virtual world that has happened, I think people have really stepped up and improved their communication game tremendously. And I'm seeing that. And I know that that will last into the future.

Well, Diana, your new book, Why Cope When You Can Heal? How Health Care Heroes of COVID-19 Can Recover From PTSD is available now. I want to thank you for providing your insights and helping us think through, how do we help those that are in need right now and how do we help improve the system?

Well, thank you Dr. Whyte-- really an honor and privilege to be on your show.

And I want to thank our viewers for watching. If you have a question about COVID-19, please feel free to send it our way. We may answer it on the air. You can send it to [email protected]. Or you can follow us on social-- on Twitter and Instagram at @WebMD and send us a message there. Thanks for watching.

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