SafeHaven Program Confidentially Supports Physician Mental Health

[MUSIC PLAYING] Welcome, everyone. I'm Dr. John Whyte, Chief Medical Officer at WebMD. And you're watching Coronavirus in Context.

We've been talking a lot about burnout. And we know burnout has been a problem pre-COVID. Medscape recently put out a report about how widespread burnout is.

But we also have to address solutions, and what are some innovative ways to provide care and get people the help that they need. So to help provide some insights, I've asked Dr. Teresa Babineau. She is associate professor of Family Medicine at the University of Virginia.

And J. Corey Feist. He is the CEO of the UVA Physician Group. Thanks for joining me.

Thank you for having us.

Thank you, John.

I want to start off with something that you both have talked about. And, Terri, I'll give it to you first, is this idea that for too long, suffering burnout, PTSD, challenges with wellness has been a secret. And the medical community has made it such, partly because of our training. Is it really not getting any better?

I think it is starting to get better, as even in the beginnings of medical school, we are starting to speak about these kinds of issues. People who go into medicine and to become health care providers, they tend to be very other-centered. And so because of that, everything that they are doing is centered on another person. So that is starting to change as we are starting to discuss these kinds of issues, and also bringing more and more humanism into medicine.

Is it more acceptable now to say you need help?

It's getting there. It's still very difficult, I think. When you go through the rigors of medical education and you spend 20 hours out of a day studying, and it's a very competitive thing, and it's very difficult to get a residency, so you become kind of in a competitive realm.

And because of that, you don't want to show any chink in the armor. But it's starting to change. And as we become more team-centered, it's also starting to change because you're relying on other members of your team.

Corey, you've talked about this concept of repetitive trauma. September 11 was a horrible event. But for many people in ER settings, hospital settings, it was a single point in time. You pointed out this is like running into a burning building every single day for over a year. Talk to us about how that impacts the physicians that you're working with.

It's a great question, John. As you and I previously discussed, I think we've got, really, two things happening in this country right now. We've certainly got burnout, which you were talking about with Terri. But we have this second repetitive trauma.

What I hear from the front lines across Virginia and across the country right now, from all health care providers, physicians and nurses, is that they're very tired. And they're also taking on the burden of being the proxy for the families of the death and dying. And they're seeing a volume of death and dying that they have not seen before.

And as you all previously stated, these individuals were humans before they received the accolade hero recently. And because of that, I think we need to recognize the toll, the traumatic toll this is taking, and bring resources to bear to support those individuals. And what we know about trauma is that many times, the symptoms of the trauma or the manifestation of the trauma isn't really-- doesn't really come out until down the line.

So even though our COVID numbers are looking a little better, our vaccine numbers are looking better, the manifestations and the harm of this trauma is going to be long lasting. And hospitals and health systems need to come together to support the well-being of their workforce. And this is going to be an important component of that work.

You've been a proponent of saying, we need to change the conversation. So I'll ask you both, how do we change the conversation?

I think that's a spectacular question because it's going to take a long time. One of the ways that we change the conversation is we make the conversation necessary and important. And we start from the very beginning.

So even before, when we're admitting students into health care provider schools and into professional schools, we start discussing how important the humanness that they bring to that is. And it needs to stay that way. It really has to be that we have to understand that, indeed, they are human. And they are going to mess things up occasionally.

It is rare. [CHUCKLES] And the whole thing is, is the heart that these folks bring to taking care of others is huge. But sometimes there are going to be mistakes. Sometimes you're going to have to wait a little bit in order to get a result, or in order to have that conversation that you might need, while still expecting the best from health care providers.

And the way that that can be done is, like I said before, we band into teams. So we rely on each other. We use that expertise that each individual provider brings, be they nurse, nursing assistant who's there at the bedside all the time, the physician, the specialists, the subspecialists.

Today was a perfect example. I got an email from a subspecialist who sent that to four other physicians in the care of one particular patient. And so you didn't feel like you were out there on your own. So I think those are some of the ways that we can start to change things. And then the law is another way.

If I could add to that, John, I think there's some-- there are a couple of important additions. First of all, like any change or behavior change initiative that starts by modeling behavior, that behavior has to be modeled from the top down and the bottom up, across all health care organizations. Note, now that's a behavior change. It doesn't cost this country a nickel to do that. That's just about checking in on each other and making sure that people recognize that their well-being is important not just to the hospital executives who are responsible for bringing resources, but to each other as peers and colleagues.

And I would say that from a longitudinal perspective, or a long-term perspective, what we want to do is also start these conversations as early as possible. I've now been asked to have speaking engagements with students as early as high school who are considering going to be premed, and then colleges for premed students. We have to recognize that to normalize this conversation, first of all, we have to have it, but we have to have it early and often.

Clinicians will say, though, sure, they're concerned about their personal health. But they're concerned about their professional reputation, their ability to work. The aspects of licensure will often ask them questions that they're concerned that if they seek help that they'll be penalized.

So, Terri, I want to ask you about a program SafeHaven. You're the volunteer chief medical officer of that program. Tell our audience what SafeHaven does.

Well, SafeHaven is really a, I believe, an innovative program that adds to other programs that are available in many health care workplaces. SafeHaven began with a change in the law in the state of Virginia that now is being replicated in multiple other states. And with that change, the Medical Society of Virginia advocated, and was signed into law last year, that if a physician recognizes that they need not only mental health care but maybe even just some coaching, maybe they need a little bit of help in how to more effectively see patients, or time constraints that they are found under, that they can seek that help without any retribution to themselves.

Now the one caveat is, of course, if the physician is deemed to be either a threat to themselves or to a patient, then those protections are no longer in evidence. And the normal way that those kinds of things are reported to the board of medicine happen. But if, for instance, a physician, especially in the midst of the COVID pandemic, finds that they are really under so much pressure-- they have young children at home, they can't see their patients fast enough, they have older parents that they're concerned about bringing the disease home to-- and they feel that they have no one to reach out to, it used to be that many physicians felt, and physician assistants felt, that if they did that, they would end up harming their license or losing their ability to earn a living as a physician. And for most of them, the biggest thing was they would lose the ability to see patients.

So if you go into a program such as SafeHaven, that is run by the Medical Society of Virginia, you no longer have to have that concern. Those things cannot be found by your employer. In addition, it is a program that is run-- that is outside of your workplace, so that if you have those concerns that maybe you're concerned about your workplace bringing some kind of action against you, you don't have that concern any longer.

And as you said, it's being duplicated in other states around the country. Corey, what have you found that has been the response to the SafeHaven program?

There's been great support for this. I mean, I think if you start from the perspective of the stigma associated with getting mental health support is pervasive. And there are many layers to it. The licensure is one of those.

Credentialing and privileging applications, medical malpractice forms, insurance credentialing forms-- there are so many layers across the health care industry. This is an excellent starting point. And the physicians and others are very supportive. But it's also-- there are also-- there's a degree of trepidation because this has been so reinforced. And so I think we as a medical society and a health care community need to launch a significant education campaign as to what is real and what is not.

And the last thing I would say that's the hardest part about this work is because every state is different, whereas a physician may be working in a state that has favorable laws today, they may think about going to a different state tomorrow, which has less favorable laws. And so that still may be an impediment to getting help. So we really need to make this change, offer programs like SafeHaven across the country.

I was speaking with the American Medical Association just this morning. And they were talking about this program as a model that they're trying to help us replicate. So it's a great program. And it's one that we really need to scale and advertise so that we can help make a real long-lasting impact.

Corey, you're also the co-founder of a foundation, the Dr. Lorna Breen Heroes Foundation, in honor of your sister. Can you share with us her story?

Sure. Dr. Lorna Breen was an incredible academic physician at Columbia, and lived her whole life for the dream of being an emergency room doctor in New York. She studied at Cornell undergrad, got her medical degree from the Medical College of Virginia, did her training at Long Island Jewish Hospital, and was double-boarded in emergency medicine and internal medicine, and was the medical director for NewYork-Presbyterian's Allen Hospital in the northern part of Manhattan for over a decade.

Lorna was at the pinnacle of her career. She was, in this last year, going back and getting her MBA from Cornell's MBA/MS program in health care administration. And she was at the top of her game.

She was an amazing sister, family member, sister-in-law, the crazy aunt to eight nieces and nephews. In this last year, she made national news because of her death. In a very short period of time, Lorna contracted COVID while treating patients in Manhattan, attempted to run the medical-- serve in her role as medical director remotely while trying to recover from COVID in the heat of the pandemic, at the height of the pandemic in March.

Went back to the workforce as soon as she was afebrile for about 48 hours. And was so overwhelmed with the death and dying, coupled with 12- to 24-hour shifts days in and day out, that she became suicidal, which is just baffling for a human who had never had one scintilla of mental health history. And so my wife Jennifer, after receiving a call from Lorna after she'd been back on service about four or five days, got Lorna out of New York City, and got her an inpatient admission to the University of Virginia, where she spent about 11 days. Tragically, she took her own life about five days after that.

And the conversation that we're having is, in part, inspired by her real desire to take care of the well-being of her colleagues. She was published on well-being and well-being in emergency room operations just a year ago, November. And she cared deeply about her colleagues as much as she did about her patients.

And so we believe that this is an extension of her work, to take this well-being conversation to the national scope, as well as every single state, trying to change the laws, because I will say, there were three big contributors to her death. The first was contracting COVID. The second was the trauma associated with seeing the death and dying, and not being able to do anything about it. But then the third was the stigma about asking for help.

And then finally getting help, formal help, was literally the nail on the coffin. And it's a tragic ending to a really, really unfortunate story. And I would just end by saying that my wife Jennifer and I are doing this work not for one individual here. We're doing this, as I said, as an extension of Lorna's caring for her health care community, and our caring, so that we can prevent future similar cases to Lorna.

And tragically, we know that the number of suicides by physicians in this country before the pandemic was more than 1 physician a day, 400 a year. And so we're going to do everything in our power to make that number zero by sharing this story, and sharing best practices, and working with Dr. Terri and others to shine a light on this issue and make change.

It is tragic. And I'm sorry for your loss. And I want to thank you for sharing your sister-in-law's, Dr. Lorna Breen's, story.

Terri, are you optimistic that we're going to get to where we need to be? We've had bumps all along the road. Where can people go for help right now?

Well, I really am optimistic, John. I think that there are multiple wonderful programs that health care entities have. The University of Virginia-- I'm privileged to work with theirs, as well as working with the Medical Society of Virginia-- is phenomenal. Sometimes, as we start to change the culture, I think that probably more providers will find their way to those places and gain that trust.

I'm also optimistic because of what people like Corey and Jennifer are doing and talking about. It used to be that we would try to hide from the tragedy of Lorna's life. And that's just horrible because her life was not a tragedy. Her life was just an incredible gift.

And so as we start to change that look and discuss this openly, I am optimistic. And as we become better at it, the other thing is, is I honestly believe we become better physicians because then we can accept where our patients are along there. And they find us to be more approachable because we are-- you have that fine line of sharing.

As you know as a physician, you have that fine line of sharing yourself. And our ability to listen to their stories and to understand, I think that will make us better. As Osler said, if you want to know the diagnosis, ask the patient.

And in this particular case, I really think that is true. If you want to know the diagnosis, ask the doctor. However, we have to make it so the doctor thinks that they can share that.

Well, it's hard to argue with Osler. So with that, I want to thank you both for sharing your insights, for sharing your own stories, and working, as we said, to change that conversation around burnout and trauma. Thank you both.

Thank you for having me, John.

Thank you so much for opening the conversation as well.

And if you have questions about burnout or anything COVID related, send us a note. You can email me at [email protected] as well as post on our social media properties. Thanks for watching.

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