Stress coping tips for providers during COVID-19

By Melanie Fox, PsyD and Carolyn Turek, PhD. 

Any time of uncertainty commonly leads to increased stress, and the COVID-19 pandemic is the perfect definition of uncertainty. Things are changing daily, we are learning in real time, and we cannot predict with certainty exactly what is going to happen.

What we do know with certainty though is that if providers don’t practice self-care during these tumultuous times, you cannot be as effective for patients, your team and your family.  

While it can feel impossible to engage in self-care right now, it is truly imperative as stress can easily rise to traumatic and toxic levels and this biochemical reaction can cause a range of physical and mental health problems.

Read on for some tips that can easily be worked into your day – and can make a big difference.

Common stress responses

First, it’s important to understand what happens to our bodies when we experience overwhelming stress. Humans often respond in these four characteristic ways:

  • Flight: We may feel trapped, fidgety, tense in our bodies, numb in our extremities, or experience urges to leave work or cancel patients.

  • Fight: We may feel irritable or agitated. Our jaw can tighten. We may grind our teeth. We can glare, show anger in our voice, or feel a burning sensation in our chest or stomach.
  • Freeze: We often experience a sense of dread, hoping for cancellations, difficulty making decisions, feel our heart pounding, or notice ourselves checking out.
  • Avoidance: We may feel calm and composed, but anxiety manifests through impatience, irritability, short-temper, tense muscles, changes in sleep or eating patterns, and/or increased use of substances.

Tips to help in the short term

To remove yourself from the fight/flight/freeze/avoidance response, try to focus your mind and body to the present moment. Grounding exercises can help. Here are a few exercises to try:

  1. 5-4-3-2-1: Name to yourself five things you see, four things you feel, three sounds you hear, two things you smell and one thing you taste.
  2. Box breathing: Breathe in counting to four with each inhalation and count backward from four with each exhalation. Do this 4 times.
  3. Get moving: Take a quick walk before starting your next task.

These exercises can be helpful when you notice yourself reacting from a stressed place, or when you notice patients, families or other health professionals responding to you in ways that feel unhelpful or stress-inducing.

Tips to build  wellness

While no one will ever be completely stress-proof, building wellness can strengthen our ability to withstand stress.

One way to do this is by focusing on the meaning behind our work. When things seem uncontrollable or stressful, it often helps to reflect on our values and why our work is important to us.

Practicing consistent self-care is another way to build wellness. Self-care is actually patient care. Here are a few ideas to try:

  • Take deep breaths.
  • Maintain regular meals and snacks, as possible.
  • Try to get as much sleep as is possible.
  • Engage in regular physical activity.
  • Practice mindfulness.
  • Stay connected with loved ones.
  • Reduce consumption of news and social media: Studies from previous epidemics find a link between time spent on social media and increased anxiety/stress. Try to consume news at a set time from a reliable source and then try to leave it until that time the next day.
  • Try technology: Headspace, a mindfulness app, is free until the end of 2020 for anyone with a national provider number.

Physician Wellness: Benefits of Gratitude

CHOC Physician Wellness Subcommittee Update
by Dr. Grace Mucci, Pediatric Neuropsychologist

Physician burnout is prevalent. According to the Mayo Clinic, up to 54% of doctors report at least one symptom of burnout. Further, it is estimated that the annual cost of that burnout is $4.6 billion per year in the form of physician turnover and reduced clinical hours, according to a study recently published by the Annals of Internal Medicine.

The experience of burnout results in feelings of cynicism, detachment from work, low sense of personal accomplishment, and emotional exhaustion. The reasons for burnout remain complicated, and a recent systematic review by the Journal of the College of Physicians and Surgeons Pakistan revealed both individual characteristics of physicians and variables within the working environment as contributory factors.

More specifically, work load appeared to be one of the main drivers and includes working hours, overnight duty, administrative duties, schedule and flexibility, and complexity of tasks. Feeling disconnected from colleagues or patients, poor communication or cooperation between colleagues and dealing with patients who disagree with treatment choices are additional sources of burnout.

Just as the causes of physician burnout are multi-factorial, the solutions encompass many strategies that include engaging in various lifestyle changes and systemic interventions.

One individual intervention that has been receiving more interest among researchers is gratitude. A 2017 study at UC Berkeley shows that the health benefits of expressing gratitude include increasing resilience to stress and boosting mental health. Gratitude also has been found to strengthen relationships and enhance mindfulness.

So, just how can we implement gratitude in everyday life? Here are a few ideas that can be applied easily:

  • Express gratefulness for the beauty in nature
  • Give thanks before eating food that has been prepared
  • Acknowledge service people you encounter throughout the day, such as a barista or worker
  • Keep a gratitude journal and write about all the things you’re thankful for prior to retiring for the night
  • Remember to tell your loved ones how much they are appreciated and one thing that you are grateful that they do every day
  • Surprise coworkers or even strangers by performing a random act of kindness
  • Keep a gratitude board where you document things you are thankful for, and be sure to review those items when you are having a difficult moment

At CHOC, several initiatives that promote this practice of expressing gratitude are underway. CHOC has partnered with the Institute for Healthcare Excellence (IHE) to offer an outstanding curriculum that helps build respect, trust and compassion, ultimately improving communication and empathy toward co-workers and patients and restoring joy to the practice of medicine.

In addition, CHOC’s Physician Wellness Subcommittee is busy planning a Wall of Gratitude in the physician dining room, where doctors can show gratitude and appreciation for their peers in real time.

We know that peer-to-peer recognition is important for strengthening the level of engagement and positive bonds among colleagues. We have all experienced the satisfaction of receiving kudos from our peers, and we want to make this easier and more visible to others. As we continue to advance these initiatives, be sure to practice those small but powerful strategies of expressing gratefulness in your everyday life.

Physician Wellness – From Burnout to Wellness

By Dr. Grace Mucci, CHOC Children’s Physician Wellness Subcommittee

One year ago, a group of CHOC Children’s physicians gathered to begin the process of defining and building a meaningful wellness program throughout the health system.

As many know, physician burnout has become of great concern, and we are only beginning to appreciate the scope of this phenomenon, including the impact of burnout on ourselves, our patients and our colleagues, in addition to the complexity of issues involved.  More importantly, we struggle with identifying the signs and symptoms leading to burnout, and how best to address them.

A recent survey of more than 15,000 physicians found that 44 percent of physicians reported symptoms of burnout, 11 percent reported subclinical depression, and 4 percent reported clinical depression. The gender disparity is notable, with 39 percent of males compared to 50 percent of female physicians experiencing burnout. The factors that lead to burnout are complex, and range from bureaucratic tasks and long work hours, to the challenges of electronic medical record keeping and loss of control/autonomy.

In a recent survey of physicians, 44 percent of reported symptoms of burnout, 11 percent reported subclinical depression, and 4 percent reported clinical depression.

Coping strategies vary and include a number of activities, including exercise, talking with close friends and family, and ensuring adequate diet and sleep. But sometimes these approaches aren’t enough.

Depressive symptoms can begin to emerge, leading to more serious functional impairment. If left unchecked, clinical depression can result. Unfortunately, many physicians contemplate suicide. It is estimated that one doctor a day dies by suicide in the United States, the highest rate of any profession1. Even more concerning is that of those physicians who report suicide ideation, 42 percent do not tell anyone or get professional help2. Obviously, this needs to be addressed, and it needs to be addressed now.

CHOC’s Physician Wellness Subcommittee is comprised of a group of physicians dedicated to help CHOC continue to be proactive and supportive of physicians. Our mission, “To promote physician wellness to benefit ourselves and others,” captures our focus. We have been meeting since January 2018 and have established several key goals with the Stanford Medicine Model of Wellness, below, as a guide3.

Using the key areas as a guide, we have determined the following short-term goals to address each area below:

  • Personal Resilience: A “Wall of Gratitude” displayed in the physician dining room (PDR) will give physicians a platform to recognize colleagues in an informal format posting words of appreciation and encouragement to one another.
  • Efficiency of Practice: Improvements to the computer work station in the PDR will ease charting while also gaining needed nourishment. Results of an EMR survey, conducted with the ARCH Collaborative, will provide us with specific and targeted data that will allow us to address common EMR frustrations and issues to help increase our efficiency.
  • Culture of Wellness: We are in the beginning phases of planning a “refresh room” where physicians can go to recharge, meditate and decompress. We’ve also made some improvements to the coffee machine in the PDR.

Additional long-term goals include:

  • Peer-to-peer mentorship training
  • Optimizing EMR practices
  • Gathering Information from physicians willing to help to improve our culture of wellness

Another noteworthy CHOC-supported activity that helps to meet our Personal Resilience and Culture of Wellness goals includes restoring the joy of practice through the Communication in Healthcare seminar that we’ve deployed. Approximately 60 physicians and additional allied health providers have completed the patient communication program. Participants have reported extremely positive feedback and state the training has increased their sense of fulfillment, communication efficiency, and overall resulted in more meaningful relationships with their patients.

While there is much work to be done, we are grateful for the support we have received from CHOC, and are confident, with our collective effort, that a culture of wellness is achievable.

If you would like to help in our efforts, reach me at 714-509-8225.

Physician Wellness Subcommittee:
Co-Chairs:  Drs. Felice Adler, Anjalee Galion and Grace Mucci

Members:  Drs. Richard Chang, Ashish Chogle, Susan Gage, Charles Golden, Jen Ho, Himala Kashmiri, Jessica McMichael, Shoba NarayanAshley Plant, Christina Reh, Andrew Shulman and Anita Shah

1Anderson P. Doctors’ suicide rate highest of any profession. WebMD. May 18, 2018. Source Accessed February 28, 2019.

2Pappas S. Suicide: Statistics, warning signs and prevention. LiveScience. August 10, 2017. Source Accessed February 28, 2019.

3Bohman, B., Dyrbye, L., Sinsky, C., Linzer, M., Olson, K., Babbott, S., & Trockel, M. (2017). Physician well-being: the reciprocity of practice efficiency, culture of wellness, and personal resilience. NEJM Catalyst.