Avoiding burnout: A physician shares self-compassion strategies for provider wellness

By Dr. Rishikesh S. Chavan, pediatric oncologist and medical director of the blood and bone marrow transplant program at the Hyundai Cancer Institute at CHOC Children’s

Navigating the COVID-19 pandemic and a rapidly evolving medical landscape has put added pressure and stress on the healthcare workers braving the front lines. This is why it’s more important than ever to recognize signs of burnout in yourself and your colleagues, and essential that we as physicians practice self-compassion.

As physicians juggle their position as a healthcare provider, possibly the head of their household, and many other roles, it can be almost unnatural for physicians to think of themselves and their own needs.

But as the saying goes, you cannot pour from an empty cup. Physicians can’t do their best to care for patients and their own children at home unless they’re supporting their own comfort. I liken it to the safety instructions on an airplane – put your oxygen mask on before assisting others.

Self-compassion tactics

To avoid self-sabotage or self-destructive tendencies, one needs to feel a deep sense of love and acceptance of themselves. That’s why practicing self-compassion is so important. Here are some ways to get started:    

  • Make your own checklist Similar to a checklist one uses at the end of a shift to transition cases, make a personal one to end or begin your day. Everyone’s checklist will look different. We each classify different habits or rituals as essential. Do you need your morning coffee to function best? If you have exercised are you then your best self? For your checklist, consider elements such as:
    1. Acknowledge something that was difficult during your shift. After the feelings come up, let them go.
    2. Name three things that went well.
    3. Did you notice anyone else have a particularly hard shift? Check on them.
    4. Check in with yourself. Are you OK?
    5. Rest and recharge.
  • Relax – Identify your strategy for relaxation to help you take your mind away from the daily grind. Be aware of self-compassion versus self-indulgence. For example, watching an episode of your favorite TV show is one thing but binge watching an entire season is another. For several people, activities like bike riding, working in the garden, reading a book, practicing a musical instrument, or taking a yoga class may help establish a state of flow and provide an opportunity to go deeper.
  • Meditate – By definition, meditation means to focus on something. As you gently have a subtle focus on your heart, you can be a silent observer of your thoughts without reacting to them. An assumption that you are not your thoughts allows you to ignore intrusive thoughts and achieve a sense of peace. Sitting quietly with a guided meditation via apps such as Heartfulness, Headspace or Calm may help you get started. Studies have shown that peace and tranquility rank among the most common feelings people report after meditating, in whatever modality suits them.
  • Check in with your colleagues –Not only should we check in with ourselves, but we should check on our colleagues as well. If you see signs of burnout in a colleague, gently bring them into a conversation, or bring them a cup of coffee, and ask, “Is everything OK? Is there something that you want to talk about? Can I help you with anything?”

Interventions for physician burnout

A 2017 JAMA study found that the strongest evidence for effectiveness in combating physician burnout was organization-directed interventions, but the study noted such programs were rare. Most interventions for physician burnout put the onus back on the physician, with a focus on incentivizing physicians to participate. More effective intervention models are engrained across an entire hospital or healthcare system.

In January 2018, CHOC convened a Physician Wellness Subcommittee, composed of a group of physicians dedicated to help CHOC continue to be proactive and supportive of physicians. Its mission is “To promote physician wellness to benefit ourselves and others.”

Additionally, at CHOC, the spiritual care team offers regular “Tea for the Soul” sessions where chaplains are available to clinicians and provide a compassionate, non-anxious, non-judgmental presence to help them cope with added stressors.

CHOC leadership has taken other steps to provide additional support for its physicians and staff, recognizing the additional stressors placed upon CHOC staff during COVID-19. CHOC’s on-site daycare was set up within 72 hours, giving clinicians peace of mind that their children are safe and happy while they work. Recognizing that shopping for groceries and sundries might be challenging for staff, CHOC has set up in-house shopping resources, as well as a grab-and-go meal program and farmers market.

What referring providers should know about safety at CHOC during COVID-19

At CHOC Children’s, we know you want to provide your patients the very best care every day, especially during these uncertain times. CHOC has been in close contact with local, state and federal authorities to stay up to date with the latest outbreak information and ensure we’re following the best practices to limit the spread of COVID-19.

For the safety of our patients and families, here are just a few of the following procedures and measures currently in place:

  • Developed workflows to triage patients presenting with possible symptoms and best practices for treating suspected cases.
  • Increased screening at all CHOC entrances. All visitors, patients, physicians and staff members are screened for COVID-19 symptoms.
  • Everyone is required to wear a mask at all CHOC locations. For those who don’t have masks, we will provide our donated cloth masks at screening.
  • Visitor guidelines have been strengthened to help protect our patients, families, physicians and staff. For full details, please see our visitor guidelines.
  • Clinical areas are cleaned multiple times per day, in addition to the medical grade sanitization we have always provided. We will continue to thoroughly sanitize to the most rigorous standards.
  • We have established an Incident Command Center composed of a multidisciplinary team of leaders. The Command Center centralizes operational decisions, and coordinates CHOC’s response with local authorities and neighboring facilities.

As CHOC and other healthcare facilities adapt to the fluid environment created by the COVID-19 pandemic, and national, state and local recommendations and guidelines changing, we want you to know that we are open and have the following resources to help provide the safest care:

Telehealth appointments are available. To refer a patient, please call the Patient Access Center at 888-770-2462.

• Our 24/7 Nurse line, 1-844-GET-CHOC, is available for parents who have questions about their child’s health.

• If your patients’ families have recently lost or do not have medical insurance, they can call CHOC Children’s Family Financial Resource Center at 714-509-8600.

Please visit our website for the latest information about visiting our locations.

CHOC study shows reduced risk of emergency department COVID-19 infection

A new CHOC Children’s study that could help calm public fears about contracting COVID-19 shows that asymptomatic healthcare professionals who work in a community with a low prevalence of the disease and who undergo daily health screenings are unlikely to be carriers of the coronavirus that causes the disease.

Findings of the study, one of the first of its kind and conducted during California’s projected peak of coronavirus-related use of hospital resources, shine an encouraging light on a topic where there are currently limited data available.

CHOC’s study tested patient-facing staff at its Julia and George Argyros Emergency Department during a two-week period in April 2020, using a Polymerase chain reaction (PCR) test for COVID-19 viral RNA. Subjects were asymptomatic and had no fever, as all employees undergo daily pre-shift health and temperature screenings prior to entering the hospital. Testing found just one of 145 subjects was positive for COVID-19, and contact tracing showed that this person was not responsible for any further transmission of infection.

With these findings indicating that strict screening measures in a hospital serving a community with a lower prevalence of COVID-19 are effective in preventing the spread of the disease, the study could also offer some comfort to people who may have been reluctant to seek medical care for themselves or their children because they fear contracting COVID-19 in a healthcare setting. 

“We are encouraged by the results of the study and trust that our community will be reassured to know that the chances of acquiring COVID-19 during a visit to a pediatric emergency department can be lower than during routine activities,” said study co-investigator Dr. Terence Sanger, CHOC’s vice president of research and chief scientific officer. “We continue to urge them to seek prompt expert care for themselves and their children when the need arises.”

Hospitals nationwide have reported a significant drop in emergency department visits for major acute conditions. Patients may seek medical attention too late for adequate treatment, which could have serious, even fatal, consequences.

Preliminary data from California suggest that while healthcare workers represent 10% of all known COVID-19 cases in the state, only 18% of those cases were known to be acquired in a healthcare setting. This indicates the workers likely contacted the disease outside of the healthcare setting.

The low rate of infection in CHOC’s emergency department could be attributed to many factors, including the lower percentage of infection in the surrounding community, as well as people in the community following safety guidelines including social distancing and wearing masks.

Additionally, healthcare workers in a pediatric setting might be expected to have a lower risk of infection than those in an adult healthcare setting due to a lower rate of high-risk aerosolization procedures such as intubation in younger patients.

“We take every precaution we can to prevent the spread of COVID-19 in CHOC care settings,” said Dr. Theodore Heyming, medical director of CHOC’s emergency department and study co-investigator. “While the effects of the coronavirus continue to be devastating, this report offers a ray of hope that brave healthcare workers can continue to administer care to their patients without the added burden of putting themselves or the people they care for at further unnecessary risk.”

Also contributing to the study were Aprille Tongol, a CHOC research administrator; Jennifer MacLean, a CHOC nurse practitioner; and multiple staff from the CHOC Children’s Research Institute.

Learn more about the CHOC Children’s Research Institute.

Multisystem Inflammatory Syndrome in children (MIS-C) and COVID-19: What providers should know

While the majority of cases of COVID-19 in children result in no symptoms or mild symptoms, some hospitals have recently reported an increased  number of cases of children with a multisystemic inflammatory syndrome that shares many characteristics with Kawasaki disease, an inflammatory disease of childhood that can affect blood vessels. Once referred to as PIMS, this new syndrome has been named multisystem inflammatory syndrome in children, or MIS-C by the Centers for Disease Control.

While research on the apparent link between COVID-19 and MIS-C is limited, scientists around the country are working to learn more about the correlation. In this Q & A,  Dr. Negar Ashouri, pediatric infectious disease specialist at CHOC Children’s, shares information about MIS-C .

What is MIS-C?

MIS-C is a condition where different body parts – such as the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs – become inflamed. Many children with MIS-C have previously been diagnosed with COVID-19 or have been exposed to COVID-19.

Is MIS-C dangerous?

MIS-C can be serious, but most children have recovered. MIS-C, like Kawasaki disease, can be a very uncomfortable illness because it causes prolonged fever, irritation and inflammation in many tissues of the body. The main concern with MIS-C and Kawasaki disease is heart and blood vessel involvement.

Conditions that involve inflammation in the heart, such as MIS-C or Kawasaki disease, can affect the heart in different ways. They may cause the heart muscle to be irritated and inflamed, affecting the overall function of the heart.

Or, it can weaken the wall of one or more of the coronary arteries causing them to bulge or balloon out. Blood clots can form in the ballooned area and possibly block the blood flow through the coronary artery. When this happens, the heart muscle will no longer receive an adequate supply of oxygen-rich blood, and the heart muscle can be damaged.

Dr. Negar Ashouri, pediatric infectious disease specialist, CHOC Children’s

What are the symptoms of MIS-C?

Though not all children will have the same presentation, these are common symptoms:

  • A fever that won’t go away
  • Abdominal pain, diarrhea or vomiting
  • Bloodshot eyes
  • Rash or changes in skin color

Patients with the following symptoms ought to seek emergency care:

  • Trouble breathing
  • Pain or pressure in the chest that does not go away
  • New confusion
  • Inability to wake or stay awake
  • Bluish lips or face
  • Severe abdominal pain

How is MIS-C diagnosed?

In addition to exploring medical history and performing a physical exam, additional tests may include:

  • Blood tests
  • Echocardiogram 
  • Electrocardiogram
  • Chest X-ray
  • Abdominal ultrasound

How is MIS-C treated?

Kawasaki and MIS-C are best treated in the hospital by a qualified multidisciplinary group of pediatric specialists who will work to to reduce inflammation and minimize long-term heart damage. Treatment may include plasma transfusions to reduce inflammation, steroids, aspirin, antibiotics or supportive oxygen.

Is MIS-C contagious?

MIS-C is not contagious.

What are the long-term effects of MIS-C?

MIS-C is a new illness and medical professionals are actively studying it to learn more. Children who have had serious cases of MIS-C should be followed by a multidisciplinary group of specialists who will watch oversee their care.

Learn more about the infectious disease team at CHOC Children’s.

Webinar to explore roles of intelligence, innovation in pediatric aspects of COVID-19

An upcoming collaborative symposium co-hosted by the Sharon Disney Lund Medical Intelligence and Innovation Institute at CHOC Children’s (MI3), will explore how innovation and intelligence can assist pediatric healthcare in a post-COVID-19 environment.

Held May 18 from 1 to 3 p.m. PDT, the live interactive webinar will feature speakers from children’s hospitals and health systems throughout the country, including Dr. Anthony Chang, CHOC’s chief intelligence and innovation officer and medical director of MI3.

Here’s a list of speakers and their topics:

  • Srinivasan Suresh, MD, MBA, FAAP – VP, CIO, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA  — Importance of Data for AI for COVID-19
  • Dawn Wolff – Chief Strategy Officer, Children’s Mercy Hospital, Kansas City, Mo. –  Leveraging Innovation Assets in a Time of Crisis
  • Omkar Kulkarni, MPH – Chief Innovation Officer, Children’s Hospital Los Angeles – KidsX. Health – Accelerating Pediatric Digital Innovation through Collaboration
  • Leanne West – Principal Research Scientist, Georgia Tech Research Institute (GTRI), Children’s Healthcare of Atlanta Pediatric Technology Center, Atlanta, Georgia and President of ICAN, International Children’s Advisory Network   Offering the Pediatric Patient’s Perspective– Pediatric Patient Panel featuring ICAN Kids
  • Jennifer Olson SVP, System Operations & Chief Strategy Officer, Children’s Minnesota, Minneapolis, MN   Innovation: A Strategic Recovery Element of Resuming the Business of Pediatric Healthcare
  • Sherry Farrugia – COO/CSO- Children’s Healthcare of Atlanta Pediatric Technology Center –  Rapid Deployment of Innovation
  • Vasum Peiris, MD, MPH – Center for Devices and Radiological Health, Office of Strategic Partnerships and Technology Innovation, U.S. Food and Drug Administration
  • Kevin Maher, MD – Children’s Healthcare of Atlanta, Emory University – Connection between COVID-19 and Kawasaki disease.

“Pediatric Aspects of COVID-19” is co-hosted by International Society for Pediatric Innovation (iSPI) and Artificial Intelligence in Medicine.

Register for the session here.