Hello, dear friends. How are you doing? I’m mourning the many troubles in our land. I’ve kept mum here on many of them; otherwise, this personal newsletter would be a running list of woes, from Ukraine to D.C., but they are on my mind. The horrific shootings in Buffalo, New York, targeting Black people and in Texas at an elementary school are the latest tragedies. I feel a great gulf of sadness and horror at such ongoing shootings, which no other country faces as we do in America. Yes, this is a health issue. Yes, it’s heartbreaking, again and again.
The 3 Field Notes this week do touch on hard health topics, including burnout and mental health, so if you are feeling like you can’t take any more serious issues on this particular day, I give you a hall pass to the birds (No. 2 + the p.s.) and a virtual hug. Take care, everyone.
1} U.S. Surgeon General’s report on burnout
Earlier this week, U.S. Surgeon General Dr. Vivek Murthy released a 76-page advisory on the crisis of burnout in our healthcare system, the stunning numbers of healthcare team members suffering and the beginnings of a mass exodus. The pandemic has exacerbated the conditions that were already terrible for healthcare workers’ health and terrible for their patients’ health.
Burnout is characterized by three things: (1) a high degree of emotional exhaustion, (2) depersonalization (i.e., cynicism), and (3) a low sense of personal accomplishment at work. Basically, you stop caring in overwhelming conditions where thriving and making a difference feel impossible. Burnout is not an individual failing but a system failing. It is product of working conditions. Even before the pandemic, a third to a half of nurses and physicians reported symptoms of burnout, as well as even more healthcare students. The pandemic has prompted increasing numbers of healthcare team members to leave medicine, which means a greater burden on those left. The advisory notes:
“Among 20,665 respondents surveyed in 2020, approximately 1 in 3 physicians, advanced practice providers (APPs), and nurses surveyed intend to reduce work hours. One in 5 physicians and 2 in 5 nurses intend to leave their practice altogether.”
We are all going to suffer greatly if we do not act now and in a major way to reverse this crisis. All of us depend on nurses, doctors, and healthcare team members in our most dire hours of health needs. They need better support. They need different working conditions.
Dr. Murthy writes:
“Today, when I visit a hospital, clinic, or health department and ask staff how they’re doing, many tell me they feel exhausted, helpless, and heartbroken. They still draw strength from their colleagues and inspiration from their patients, but in quiet whispers they also confess they don’t see how the health workforce can continue like this. Something has to change, they say.”
What Federal, State, Local and Tribal Governments Can Do
What Health Insurers and Payers Can Do
What Health Care Technology Companies Can Do
What Academic Institutions, Clinical Training Programs, and Accreditation Bodies Can Do
What Family Members, Friends, and Communities Can Do
What Health Workers Can Do
There is no one secret answer or one issue that an influx of government money would fix. The factors are much more complicated and deeply rooted at this point in the structure of the U.S. health system, in the time clinicians can see patients vs. double that amount of time that they have to spend on computer charting and other tasks; the unhealthy shifts of 18 hours or 24 hours or longer; the revenue-driven insurance system and its labyrinth demands of paperwork and authorizations; the loss of autonomy as most doctors no longer have their own practice but are an employee of a large health system; the long-standing health disparities and unequal care. (This crisis isn’t limited to America, but our stressors here are different because healthcare isn’t universally free and as it is in many countries.)
The Surgeon General is trying to turn greater attention to this crisis. As a single patient, it often feels hopeless — What can I possibly do to help? We can all help in some way, but the system has to be reshaped, too, by those who set policy, procedures, and incentives. The push from all of us can help that happen, too.
Here are three broad recommendations in the report for how individuals can help:
Learn to recognize when a health worker you know needs support.
Protect your health and the health of your family.
As a patient, be kind to health workers.
That last one might seem obvious. Of course we should be kind. But nurses, doctors, and other healthcare team members receive, unfortunately, a lot of abuse — from screams and name-calling to physical attacks. We might think, Oh, I would never do that! But we are all going to see more shortages affect our care, from wait time in the doctor’s office to delays when we are hospitalized, when we are already stressed and worried. It might be tempting to be snappy. It might feel outrageous at times. (It is outrageous to the healthcare teams, too.) But growling at a healthcare team member, who is already overworked, exhausted, and under enormous stress, won’t help anything. In fact, it’s going to make the overall situation worse.
Kindness can be the difference between a healthcare team member going home after a hard shift with relief and a memory of a patient connection vs. with anger and the vow to quit soon.
Studies show that patient connection is a buffer against burnout, a reminder to a healthcare professional of why they entered this field. As patients, we can help nurture that connection, too.
Shall we turn to something brighter, happier, and outdoors, my friends?
The birds are returning!
The quiet of winter in New York has turned into the chirping symphony of spring. Robins with their plump orange bellies have been roaming our yard lately. The music of the birds in the morning is a comfort.
Bird therapy, is that a thing? Perhaps it should be.
If you live somewhere without many feathered friends, you can visit the live Cornell Bird Feeder Web Cam, which is a favorite in our house.
Here’s a recent clip of a visit from a Baltimore Oriole:
Do you hear the birds where you live?
3} May is Mental Health Awareness Month
This is the last Field Notes in May, which is Mental Health Awareness Month. Though we will doubtless be talking about mental health during the other 11 months, too, here are a few facts, sourced from the National Suicide Prevention Lifeline By the Numbers, which has received more than 20 million calls of distress, and the National Alliance on Mental Illness, to help remind us of the scope and the need to offer help or seek help.
1 in 5 U.S. adults experience mental illness each year.
50% of all lifetime mental illness begins by age 14, and 75% by age 24.
Suicide is the second-leading cause of death among people ages 10 to 34.
Every year in America, more people die by suicide than in car accidents.
Every year in America, more people die by suicide than by homicide.
Dial 988 — Starting on July 16, the dialing 988 anywhere in America will route you to the National Suicide Prevention Lifeline. It already works in some areas now.
Finally, here’s a ridiculously silly 2-minute video from Seize the Awkward with a serious message: Reach out to people you care about.
I hope you all have a lovely week ahead with lots of connections and music by the birds.
Thank you Brianne, this was a tough post but it's so important to talk about these things. Every time I read your posts I feel a breath of fresh air. Your words are so kind and your pure intentions shine through. Something needs to change dramatically in our healthcare system. I worry about our future if something doesn't happen soon. Thank you as well for raising awareness about suicide. I love the little jingle you shared. Sometimes, simply saying hello and I'm thinking about you could make all the difference in the world. Much love
Thank you Brianne, this was a tough post but it's so important to talk about these things. Every time I read your posts I feel a breath of fresh air. Your words are so kind and your pure intentions shine through. Something needs to change dramatically in our healthcare system. I worry about our future if something doesn't happen soon. Thank you as well for raising awareness about suicide. I love the little jingle you shared. Sometimes, simply saying hello and I'm thinking about you could make all the difference in the world. Much love