Doctor (and other healthcare providers) burnout

[missy]

From Bloomberg.com​

​

Less Fear, More Fury as Delta Strains Hotline for Doctors​

"
Burnout anecdotes abound: The pandemic is pushing doctors beyond endurance, to the point they want to leave the profession.

They’re only anecdotes at this point. There’s no definitive data yet as to the pandemic’s overarching effects on the medical workforce. But a national hotline for distressed doctors offers some powerful clues as to pandemic-era physicians’ mental health — and their plans for the future.

The Physician Support Line, founded by Philadelphia-area psychiatrist Mona Masood, has spoken with more than 3,000 doctors since March of last year, and some of its volunteers say they see the mood shifting, becoming more tinged with anger and hopelessness.

“What I’m hearing is people calling in and saying, ‘I don’t see the light,’” says Boston-area psychiatrist Elissa Ely.

The hotline’s 800 volunteers have often functioned like battlefield medics, Masood says, patching doctors up to send them back in to the fight. Now, “when we get calls, it is what in psychiatry we call escape fantasies — it is ‘I want out,’” she says.

Mona Masood

Photographer: Michelle Gustafson

That urge to escape stems not only from exhaustion but from the sense that “we’re all in this together” has been lost, Masood says. At the same time, they “have gone from being heroes to being called villains” by patients who oppose the vaccines, who demand unproven medications or who just want to take out their Covid-related stress on their doctors.

National surveys suggest that pandemic stress has impelled from 15% to 25% of physicians to think seriously about leaving medicine or early retirement.

“I can’t tell you how many people are plotting to get out,” says Wendy Dean, a psychiatrist who co-founded the nonprofit Moral Injury of Healthcare.

Few doctors are quitting now because they don’t want to abandon their colleagues, Dean says. But she’s increasingly hearing doctors say, “We are breaking. And we will stay in the trenches until the war is over. But then we’re going to get out.”

The helpline aims to continue after the pandemic, Masood says. Though concerns about physician mental health have been rising for years, she says she couldn’t have started the project before Covid-19.

“We were too defensive,” she says. “We do not allow vulnerability. We’re too intellectualized. But the pandemic kind of broke that all open.” —Carey Goldberg

"

 

[MakingTheGrade]

I wrote about this in another thread but I’m certainly witnessing it. And there’s some regionality to it too. ICU and ED docs seem to be getting hit the worst from what I’ve seen.

 

[missy]

I wrote about this in another thread but I’m certainly witnessing it. And there’s some regionality to it too. ICU and ED docs seem to be getting hit the worst from what I’ve seen.

I don’t blame any doctor or nurse suffering from burnout. It’s a terribly challenging situation made worse by ignorant individuals who are far too numerous for comfort.

Thank you to all the doctors and healthcare providers who have worked tirelessly and selflessly during the pandemic.

 

[tyty333]

I've been watching ICU videos on youtube. I don't know how the nurses and doctors do it. It seems like they all try to have compassion
for their patients but when they see one after another come in (most unvaxed) and leave in a body bag it has a major effect on
them. If I was a dr/nurse I would probably cry daily.

Burnout and the plan for a lot of Drs/nurses to retire after this is over does not surprise me one bit. I hope we have a healthy
new crop of Drs/nurses in school right now (they're probably all have second thoughts about their chosen profession).

 

[musicloveranthony]

I'm a nurse in a leadership role at a hospital. We've been seeing massive staff losses - especially in the ICU. Many nurses and providers leaving for non-acute care roles.

 

[ShinyPink]

DD's hospital is constantly asking nurses to work OT and providing good incentives, but few are taking the extra hours. They're having an awful time finding coverage, and have to float nurses to units they aren't familiar with. Awful!

 

[MaisOuiMadame]

I am at the ER with my daughter ATM (severe Asthma, not the first time and surely NOT where I want to be ever, but even less so during Covid). I'm so grateful for the wonderful doctors and nurses. They are very very compassionate , respectful and just truly wonderful all around.

Anyone who's making their life unnecessarily harder is truly evil.

Here in France everyone is wearing masks , though, and vaccination for over 12 y/o is at
77.8% as of today, so our ICU capacity is at 44% . I hope people here in Europe will wake up though and really start changing the whole system. We've been using nurses and doctors in senselessly stressful shift scenarios, understaffed for too many patients for too long. It's nice to step out and clap for them in Covid times, but nothing has really changed and many nurses I know are particularly sad about this. My friend is a highly specialised ICU nurse and about one third of her colleagues quit nursing after the first wave was over.

 

[missy]

@kipari I hope your DD is feeling better and that she got the help she needed. It is indeed a very scary time for everyone but especially those who need the doctors and nurses and hospital for not just Covid. Recently dealing with not so great asthma myself so I understand. Not being able to breathe and having to go to the ER is terrifying especially during Covid. I am keeping her and all of you in my thoughts. ((((((Hugs))))))).

 

[MaisOuiMadame]

@kipari I hope your DD is feeling better and that she got the help she needed. It is indeed a very scary time for everyone but especially those who need the doctors and nurses and hospital for not just Covid. Recently dealing with not so great asthma myself so I understand. Not being able to breathe and having to go to the ER is terrifying especially during Covid. I am keeping her and all of you in my thoughts. ((((((Hugs))))))).

Thank you so much missy! I wish you relief as well. Asthma is so scary! She is much much better now and I'm grateful we won't have to stay 4 nights like last time. They said I can go home soon (after 7 hours & multiple rounds of treatment).
((Hugs)) and healing dust

 

[missy]

Thank you so much missy! I wish you relief as well. Asthma is so scary! She is much much better now and I'm grateful we won't have to stay 4 nights like last time. They said I can go home soon (after 7 hours & multiple rounds of treatment).
((Hugs)) and healing dust

YAY! So happy she is doing better and can go home soon. I know a bit about how you are feeling because we were in the hospital a lot with my sister and her asthma when we were little. It was very scary. Asthma is a b***ch. Continued healing vibes to your sweet DD and hugs to you.

 

[MaisOuiMadame]

YAY! So happy she is doing better and can go home soon. I know a bit about how you are feeling because we were in the hospital a lot with my sister and her asthma when we were little. It was very scary. Asthma is a b***ch. Continued healing vibes to your sweet DD and hugs to you.

I'm sorry for your sister

 

[missy]

I'm sorry for your sister

Aww thanks. She outgrew the severe asthma and now just has garden variety asthma. Hope that happens for your dd too or even better may she outgrow it completely.

 

[Daisys and Diamonds]

I wrote about this in another thread but I’m certainly witnessing it. And there’s some regionality to it too. ICU and ED docs seem to be getting hit the worst from what I’ve seen.

are you doing ok ?

 

[Calliecake]

@MakingTheGrade , Please take good care of yourself. I can only imagine how stressful your life must feel right now.

I hope your daughter is feeling better @kipari.

 

[MaisOuiMadame]

@MakingTheGrade , Please take good care of yourself. I can only imagine how stressful your life must feel right now.

I hope your daughter is feeling better @kipari.

Thank you, @Calliecake , yes she is!

 

[missy]

Opinion | The Doctor’s Office Becomes an Assembly Line

Consolidation is wiping out private practices and making medical care costlier and worse.

www.wsj.com

​

The Doctor’s Office Becomes an Assembly Line​

Consolidation is wiping out private practices and making medical care costlier and worse.​

By Devorah Goldman
Dec. 29, 2021 12:04 pm ET

"
Since the start of the Covid-19 pandemic, my dad’s rheumatology practice has been flooded with new patients, including many from far-flung cities or out of state. This isn’t thanks to a new marketing strategy or to a notable spike in arthritis sufferers. One elderly woman who had traveled from New Jersey to my father’s Brooklyn, N.Y., office explained that many practices near her home had closed. Those that remained open were so overwhelmed that she would have had to wait eight months for an appointment.

This shouldn’t be surprising. According to a 2020 survey by the Physicians Foundation, 12% of all U.S. doctors either closed their offices during the pandemic or were planning to do so within the year. Some 59% agreed that the pandemic would “lead to a reduction in the number of independent physician practices in their communities,” and half agreed that “hospitals will exert stronger influence over the organization and delivery of healthcare as a result” of the pandemic.

But the pandemic merely accelerated a decadeslong trend. In 1983, more than 75% of physicians owned their own practices, according to American Medical Association physician surveys. By 2018 that figure had dropped to 46%. Many practices have been purchased by hospitals or have merged to form larger clinics, while local hospitals have been subsumed into large health systems. Consolidation is the trend. An AMA report earlier this year found that for the first time, less than half of doctors work in private practices. This is a problem for patients like those who went in search of my father—there are simply fewer places to seek care, and many of those that are available are bureaucratic mega-facilities.

This doesn’t bode well for medical care. Doctors aren’t—or shouldn’t be—natural subordinates. A substantial portion of their training consists in learning to make independent judgments rooted in hard-earned authority. Writing in City Journal in 2012, Theodore Dalrymple lamented the U.K. government’s influence over medicine, which he argued “is becoming ever firmer; it now dictates conditions of work and employment, the number of hours worked, the drugs and other treatments that may be prescribed.” Doctors “are less and less members of a profession; instead, they are production workers under strict bureaucratic control.”

Former AMA President Barbara McAneny, who co-owns a private cancer center, echoed this idea in a 2019 article. When she and her colleagues wanted to add new services for their patients, she wrote, they “didn’t have to go through 27 hospital committees and ask permission from a bunch of vice presidents for various things.”

The shift from the small doctor’s office to big-box medical care can be attributed to many factors. Cuts in Medicare reimbursement for private-practice services have pushed doctors out of business or into new business models. For a long time, Medicare funding mechanisms also encouraged hospitals to purchase private practices, so that the hospitals could bill Medicare for more lucrative outpatient hospital services.


Medicare also reimburses hospitals at higher rates than private practices for a variety of drugs and services—and hospital systems have more administrative resources to negotiate payment from insurers and the government. More recently, rules pushing doctors to adopt onerous, time-consuming electronic health records have interfered with their capacity to attend to patients. The rise in EHRs reflects a tension between companies interested in accumulating health data, and doctors, who prefer to focus on individual needs.

For a long time, the AMA and other medical establishments such as the American Association of Medical Colleges quietly celebrated the turn away from small medicine. They assumed that larger, more consolidated health systems would also be more efficient. On the whole, this has not turned out to be the case. Kathleen Blake, AMA’s vice president of healthcare quality, earlier this year cited studies showing that hospital acquisitions of private practices—which doubled from 2012 to 2018—have led to “modestly worse patient experiences and no significant changes in readmission or mortality rates.”

Flawed electronic health record systems in hospitals have resulted in ghastly medical errors and millions in settlements. And while physicians in a variety of settings struggle with administrative and regulatory burdens, independent doctors are significantly more satisfied with their work than are their hospital-employed counterparts. In a 2018 survey by the Physicians Foundation, only 13% of doctors agreed that “hospital employment of physicians is likely to enhance quality of care and decrease costs.”

The AMA has begun to acknowledge this as a problem. In April 2021, the group launched a new initiative to support private practices. Among other things, the association is lobbying against the impending Medicare cuts that could elbow doctors out of business. While important, this doesn’t address deeper problems with the evolution of medicine in recent decades.

Bureaucratic structures often suffer from inflexibility. Throughout the Covid-19 pandemic, medical bureaucracies at the national level have struggled to adapt to sudden changes in medical information in the way that frontline physicians can. Doctors must operate with a clear sense that they are serving the patients in front of them, not the government, data-collection systems, insurance companies or hospital directors.


When Amazon took on the independent bookstore, it inspired outrage of the sort captured in the 1998 film “You’ve Got Mail.” Unlike the book business, however, the replacement of the small doctor’s office with large-scale facilities hasn’t made medicine cheaper or access to it easier. It threatens to remove a core advantage of the small, privately owned practice: the sense of personal, immediate responsibility between physician and patient.

"

 

[missy]

The Patchwork U.S. Public Health System | NEJM

Perspective from The New England Journal of Medicine — The Patchwork U.S. Public Health System

www.nejm.org

"
At a national summit on food safety held in Baltimore, attendees participate in panel discussions and training on such topics as public education, food preparation, and outbreak response. Soon after the summit ends, 16 attendees experience stomach pain and diarrhea.

In this not-hypothetical case,1 stricken conference-goers first reported their symptoms using the local 311 line to the Baltimore City Health Department — a city health agency that investigates localized foodborne outbreaks on its own. Had the outbreak crossed a jurisdictional boundary or been large enough to require additional personnel, the state health department would have joined the response. Had a pathogen been identified, the local or state communicable disease team would have queried federal databases to spot a genetic link to outbreaks in other states. At that point, federal health agencies would have become involved.


If held elsewhere in the United States, this same ill-fated food-safety summit would most likely have elicited a different response. In New Mexico, the state health department is the first to respond to a report of an ill diner; in Louisiana, a regional health department takes the call. In some locations, there may be no investigation at all; the number of outbreaks reported per capita varies by a factor of nearly 10 across the country. At the federal level, the Centers for Disease Control and Prevention (CDC) coordinates the epidemiologic response to foodborne disease; the U.S. Department of Agriculture has authority for beef, poultry, and some egg products; and the Food and Drug Administration has authority for many other food items. Involvement of multiple offices from all three agencies might be needed to trace a given problem to a production facility or coordinate product recalls.

The response to foodborne illness — a quintessential public health activity — is a microcosm of the uneven patchwork that characterizes all of U.S. public health. In the shadow of a pandemic, understanding this haphazard architecture is a step toward appreciating the U.S. paradox of enormous health expenditures but poor outcomes for population health.

Key Components of the Architecture of the U.S. Public Health System.
To begin with, there is no clear administrative structure that organizes the many federal agencies involved in public health (see table). Twenty-one major federal agencies have a role in pandemic preparedness and response, for example, and more than 100 federal offices have been engaged in work during the Covid-19 pandemic.

At the state and local levels, variation is the rule, not the exception. Twenty-nine state health departments stand alone, and the others are part of larger health and human services agencies. About half of states have a board of health to provide guidance for public health activities; in the other half, no such board exists. About two thirds of state health officials are appointed by the governor, and the other third are appointed by the secretary of the larger human services agency, a state public health board, or some other entity.

Similarly, there is little consistency in the relationships between state and local health departments. In 7 states, the state health department operates all local health offices; in 30 states, local health departments operate largely without state control; and in the remainder, various amounts of collaboration occur. A 2012 review noted the challenge of classification:

“Even in states that are considered centralized, it is not uncommon for local government entities to exhibit some authority; likewise, in some decentralized states, state government has some powers regarding the local health unit.”2

There are about 2800 local health departments in the United States, most of which serve fewer than 50,000 people. About half of local health departments report to a local board of health, which may be an elected body such as a county council or an independently appointed group. Another 20% work with the local board of health in an advisory capacity.

The activities undertaken by health departments also vary. In 1994, the U.S. Department of Health and Human Services convened the Core Public Health Functions Steering Committee to define the 10 Essential Public Health Services, a list that was recently updated by a coalition of public health groups (see box) to center equity and include addressing structural causes of poor health, including poverty, racism, and gender discrimination. The federal agencies and state health departments have broad responsibilities, but typically, local health departments perform less than half of vital public health activities. Nearly all local health departments report that they respond to outbreaks of infectious disease (including foodborne disease), support childhood immunization programs, and participate in community health assessments.

However, one fifth of local health departments do not offer tobacco prevention programs, more than half do no work to prevent opioid addiction, three fifths do not offer programs to prevent chronic diseases, and nearly two thirds do not conduct surveillance on injuries.3

THE 10 ESSENTIAL PUBLIC HEALTH SERVICES.*​

ASSESSMENT​

• • Assess and monitor population health
• • Investigate, diagnose, and address health hazards and root causes

POLICY DEVELOPMENT​

• • Communicate effectively to inform and educate
• • Strengthen, support, and mobilize communities and partnerships
• • Create, champion, and implement policies, plans, and laws
• • Take legal and regulatory actions

ASSURANCE​

• • Build and maintain a strong organizational infrastructure for public health
• • Improve and innovate through evaluation, research, and quality improvement
• • Build a diverse and skilled workforce
• • Enable equitable access

* From the Public Health National Center for Innovations and the De Beaumont Foundation. The Centers for Disease Control and Prevention website states, “The 10 Essential Public Health Services provide a framework for public health to protect and promote the health of all people in all communities. To achieve equity, the Essential Public Health Services actively promote policies, systems, and overall community conditions that enable optimal health for all and seek to remove systemic and structural barriers that have resulted in health inequities. Such barriers include poverty, racism, gender discrimination, ableism, and other forms of oppression. Everyone should have a fair and just opportunity to achieve optimal health and well-being” (https://www.cdc.gov/publichealthgateway/publichealthservices/essentialhealthservices.html. opens in new tab).
Although information technology and data capacity are key to public health capacity, much of state and local public health work remains based on paper, with large gaps in the ability of health departments to obtain, analyze, and share information expeditiously. More than one third of local health departments are unable to access an electronic surveillance system with data from local emergency departments, which could facilitate early identification of illnesses of concern, including foodborne illness. Only 3% of local health departments reported that their information systems are all interoperable, a limitation that hampers both daily prevention work and coordinated responses. Complicating this picture further is a lack of systematic collection of data in critical areas, such as data on race and ethnicity needed to track disparities and equity.
Another key issue is the dearth of financial resources: although there is no systematic accounting for all relevant spending, it is clear that public health in the United States has been chronically underfunded. In addition to gaps in support for specific federal health efforts such as pandemic preparedness, state government funding for public health has stagnated, with no growth occurring between 2008 and 2018.4 A recent proposal calls for additional investments of $4.5 billion annually in the state and local public health system.
Meanwhile, the public health workforce is in crisis. Nationally, all local health departments employ an estimated 153,000 workers, down from more than 184,000 before the recession of 2008. Few public health departments have staff in specialized roles that are critical to the delivery of essential public health services, such as community health workers, epidemiologists and statisticians, or public information professionals. These gaps are even more acute in rural areas, where many health departments are struggling to maintain the provision of safety-net health care services.
In 2007, the federal government and philanthropic foundations launched a national effort to strengthen state and local public health agencies by means of accreditation. Fourteen years later, 37 state health departments and 269 local health departments have achieved accreditation, a status associated with offering more comprehensive services. There is evidence, however, that health departments with higher capacity at baseline are the ones that seek accreditation. A recent survey found that 37% of local health departments are undecided or do not know of plans to apply, and an additional 32% have decided not to seek accreditation at all.3


The Covid-19 pandemic has brought the weaknesses of the U.S. public health system into sharp relief. Other countries with strong, centralized public health systems have been able to rapidly implement testing, case investigation and contact tracing, and vaccination. In the United States, federal agencies and state and local health departments have struggled to mount a full-scale response, with major consequences for health and equity.

Before the pandemic, funds for public health represented less than 3% of health care expenditures in the United States. This imbalance in support persisted despite the worst public health catastrophe in a century. In early 2020, Congress provided $178 billion to support the health care system, even as many health departments could not scale their efforts or were forced to lay off workers. This disparity exposed the long-standing dynamic whereby powerful interests in health care can make their needs clear to policymakers, while public health agencies, which have much less visibility, rarely succeed in inspiring essential investments in disease control and prevention.

Political polarization has complicated matters further. Health leaders supporting evidence-based public health measures such as mask mandates have experienced unprecedented levels of harassment, intimidation, and threats. Hundreds of public health officials across the United States have been fired or have resigned, and 32 states have adopted new laws limiting public health authority during emergencies.5

Appreciation of the struggles of the U.S. public health system during the Covid-19 pandemic has created the best chance in many years for change. The American Rescue Plan, the most recent and largest infusion of funding for public health, includes, among other investments, $47 billion for Covid mitigation (including testing and contact tracing), $7.7 billion to expand the public health workforce, and $500 million for the CDC to update the public health information technology infrastructure throughout the country. A next step would be to establish a national plan for achieving a high-functioning public health system to guide new investments, establish realistic expectations, and deliver meaningful improvements in health, equity, and preparedness.

As the pandemic’s impact wanes, the window of opportunity may start to close. The powerful desire to return to “normal” quickly, however, will not erase the fact that the United States relies on a patchwork public health system at its own peril. Only with a major and sustained upgrade to the national public health infrastructure will a salmonella outbreak at a food-safety summit be just an ironic news story, and not also a metaphor for the distance between the aspirations and the reality of health in the United States.

Disclosure forms provided by the authors are available at NEJM.org.
This article was published on January 1, 2022, at NEJM.org.
"

 

[missy]

The Demise of the Social Contract in Medicine​

— Recent health policy changes benefit patients but ignore demoralized healthcare workers​

by Ali Khan, MD, MPH, Shikha Jain, MD, and Vineet Arora, MD, MAPP January 6, 2022


As we enter the third year of the COVID-19 pandemic, much attention focuses on the public's lack of trust in healthcare. Yet, virtually no one is considering how the pandemic has affected healthcare workers' trust in healthcare organizations and our society at large. That distrust was exposed in the swift and brutal reactions of healthcare workers to recent policy changes made by the CDC and the American Heart Association (AHA) before it that benefit patients, but without equal attention to the impact on healthcare workers.



First, to respond to the acute staffing crisis created by sick healthcare workers, the CDC in late December shortened the isolation period for COVID-19 positive healthcare workers from 10 days to 7 days, and said it could be cut even shorter in a crisis. A few days later, the isolation period was further cut to 5 days for everyone. In October, the AHA interim guidance on CPR and resuscitation for COVID-19 patients resurfaced. That guidance specifies that "chest compressions should not be delayed for retrieval and application of a mask or face covering for either the patient or provider," citing the low risk of COVID-19 transmission in healthcare settings.

While both of these decisions were clearly made to benefit patients, they are, unfortunately, slaps in the face for a demoralized healthcare workforce -- one that simply lacks any trust right now, both in the healthcare system and the public at large.



While one could potentially chalk these up as missteps in messaging or decision-making by these organizations, we believe it is a harbinger of something even larger: the demise of the social contract in American medicine.

That social contract has, for generations, formed the bedrock of healthcare in America. Defined as a foundational understanding between medical professionals and society that forms the underpinning of "professionalism," that social contract implores physicians, nurses, and other health professionals to fulfill their role as healers -- thereby ensuring competence, altruism, morality, integrity, and promotion of the public good. In exchange, society grants medicine trust and high social prestige, the ability for the profession to self-regulate, and shares in the responsibility for improving public health and ensuring that our healthcare infrastructure and systems are resourced and supported.

But not anymore.

Indeed, both the CDC and AHA decisions assume the social contract is healthy, alive, and well, thereby anticipating these policies will be received with minimal pushback. By this reasoning, the healthcare workforce should want to do everything in its power to ensure access to care for the public in light of the staffing crisis, and would welcome the shortened isolation period to get back to work. Similarly, it assumes healthcare workers would not want to delay life-saving chest compressions for a patient, as long as the risk to them was minimal.



Unfortunately, that is far from where our profession stands right now.

Unlike the early days in spring 2020, where many parts of the country honored the social contract by answering our call to "flatten the curve," banging pots and pans, sewing masks, and providing a slew of services and support for our healthcare workforce, society has moved on -- and so too has the profession. Research showsthat physicians are leaving the field at a rate four times higher than before the pandemic, and since February 2020, nearly 1 in 5 healthcare workers have quit their jobs -- data collected well before the omicron wave.

Our social contract is in need of major resuscitation after over 20 months of a pandemic prolonged by: society's inadequate vaccination rates; a persistent and increasing distrust of the medical establishment; the viral proliferation of disinformation; continued attacks on healthcare workers for promoting public health and vaccinations; and a blatant disregard for the sustainability of the healthcare system and the healthcare workforce itself.



In spring 2020, our profession charged to the frontlines, even as we begged for PPE better than the garbage bags available amid national PPE shortages, because -- despite the many inconsistencies of American healthcare -- our workforce fundamentally believed in medicine as a social contract and never questioned our obligation to patients above ourselves.

Two years later, as the reactions to the AHA and CDC's recent decisions demonstrate, that contract is in shambles. As our healthcare workforce and institutions are now asked to hold the line against all odds, we would all do well to anchor ourselves in this new reality -- one in which the social contract and the healthcare workforce must both be healed.

Ali Khan, MD, MPH, is a general internist in Chicago and chief policy officer for the Illinois Medical Professionals Action Collaborative Team (IMPACT). Shikha Jain, MD,is an assistant professor of medicine at the University of Illinois in Chicago and CEO of IMPACT. Vineet Arora, MD, MAPP, is the Herbert T. Abelson Professor of Medicine and Dean for Medical Education at University of Chicago Medicine.

Last Updated January 06, 2022

 

[Arkteia]

I have been working nonstop since the Covid started, thanks god for Zoom and telemetry. Covid kills not only directly; isolation enhances depression, and I am afraid we have not yet reached the peak of mental breakdowns; historically, during wars and pandemics. they happen en masse when things are seemingly normalizing, when people start counting the losses. The worst thing is the fear - what if someone is not doing well, and is not reaching out?

It is all very hard. If we travel somewhere, I work during vacation. My dad is 92 and in a very bad shape and lives in another country. I just came back and am working all weekends, too, because I can’t imagine what happens if I have to fly out.

I catch myself being irritable, I used to charge for missed appointments but stopped doing it. Instead, if people don’t show up three times, I cancel services as other people need them.
I lost several colleagues to Covid in 2020, in pre-vaccine time and that was horrible. RIP.

One of the people I know personally moved to another (big) state and could not find a provider there, even for cash. So she sold her house and moved again.

Not complaining. But it has been very hard emotionally,

 

[smitcompton]

Hi,

I watched two doctors on a TV show who explained another reason for alienation of our doctors. They have lost empathy for those that are unvaccinated and come to the hospitals looking for help. Doctors are only people and resent the fact that they must risk their lives for people who really don't care a wit about them or others. We certainly must feel more for our healthcare workers, who do the job, than the un-vaxx persons who seek their help. I don't believe doctors really want to leave their profession. They want the stupid people out of their sight. So do I.

Annette

 

[allycat0303]

I was in Quebec during the first wave of pandemic and my main role was putting people on ECMO. It’s a different system and access to the ICU and ECMO was restrained. We also have an 85% double Vax rate so it was different.

I’m in US now. My only role is putting chest tubes in ventilated patients with pneumothorax. I am tired of putting in tubes in patients that are dead 6 hours later. It’s happened 8 times in the 3 months I’ve been here. And it’s always the same story … 25 to 30 year old with 2-3 young children. Why do the patients I’ve worked on ALWAYS have young children?

I also hate that ICU attending will say to me “I told the family this might work” and then the family looks at you like there’s hope. In my opinion, there’s none. By the time a patient needs CT surgery for barotrauma or ECMO…they are not leaving the ICU. Maybe I’ll change my mind when I’m involved in a “success story” but I hate it. I just feel it’s an incredible,

I also hate that we had 2 patients die waiting for surgery because the hospital didn’t have ICU beds to do the procedure. And at least 5 people who had lung cancer that were no longer resectable from waiting so long.

I don’t think it’s burnout. But I do seem to have a short fuse. And I don’t even work directly with COVID patients.

An ICU staff told me, “We have a don’t ask, don’t tell about vaccination status. That way, you don’t resent the patient.” Wise.

 

[wildcat03]

It's so bad right now. My hospital has declared "crisis standards" which means that, COVID or not, if you feel up to working you come to work. We got emails over Christmas and New Year's that said "If you are having symptoms or have an exposure, come to work. If you feel you can not work, please seek medical attention." Basically carte blanche. I am trying desperately not to bring it home to my kids - one just past her second dose of active or placebo in the Pfizer study and one too young to be in the study. I took over my shift the other day from someone who had a positive PCR midway through her own shift. I spend my work time in a 10x8 pod with 3 other people, with a large, loud HEPA filter running the entire time. Midshift I always have a headache (from my N95 and eye protection) and a sore throat (from my N95 and lack of hydration). I don't dare even take a drink of water while sitting there. Twice a shift I run to the back and chug 40 ounces of water and pump frantically for 20 minutes, hoping I can make enough milk for my EBF baby despite barely being hydrated. I shove fast food in my mouth because our grocery deliveries have been terrible and the cafeteria is too far and too much work. The hospital provides lunch for nurses, techs, unit secretaries and housekeeping but has decided that physicians don't need lunch provided for them.

Amidst this, families and patients snark at me because they waited longer than they would like to be seen. THey're mostly unvaccinated and when I ask "why" and "if there are any questions I can answer about the COVID vaccines today?" they wave a hand at me and tell me they "need to do more research about these vaccines." UGH. You've had 9 months of having them available to the entire population. You've had almost 13 months since the first EUA. What kind of "research" do you think you're going to do that HASN'T ALREADY BEEN DONE?

 

[smitcompton]

Hi,

I am going to pose a question. Why can't hospitals elect to keep some beds open for people with other medical emergencies.? It seems to me that these unvaxxed people are preventing others from receiving care that may save their lives if hospitals were not so over-crowded by covid. It seems, to me, to be the ethical choice. Can you make only so many beds available for covid. Bring your vaxx card. That way the hospital will know for certain if you are unvaxxed. Is it possible to limit covid patients in hospitals? I admit if I were in charge it is what I would do. Unvaxxed people create chaos and others deserve the care more. I don't think anything could be more clear.

I have a home health nurse who also works at our local hospital as well and keeps me updated on admissions. She is repeatedly asked to come in, which she declines, as she also does not wish to expose her family to covid, although they are all vaxxed. Each week it gets worse.

Thank you doctors for your sacrifice. Its nice to see you again Arkteia. Slow your pace. Don't get sick yourself.

Annette

 

[Dandi]

We are back to cancelling all elective surgery, which for a major private hospital is bad news, as I shudder to think of the pressure we will be under when things resume, and we need to catch up on the backlog. We have also been told that if we test positive but are asymptomatic, we can still work. The only time we take off our masks is for a break, which we have to take in our car or an isolated room alone. Our double vax rate is about 95%, so issue currently is staff on sick leave causing shortages, not the fact that we are overrun with Covid patients. I'm not feeling burnt out as I'm used to high pace and often 16 hour shifts, but it's more the anticipation of what may be yet to come.

 

[MamaBee]

It's so bad right now. My hospital has declared "crisis standards" which means that, COVID or not, if you feel up to working you come to work. We got emails over Christmas and New Year's that said "If you are having symptoms or have an exposure, come to work. If you feel you can not work, please seek medical attention." Basically carte blanche. I am trying desperately not to bring it home to my kids - one just past her second dose of active or placebo in the Pfizer study and one too young to be in the study. I took over my shift the other day from someone who had a positive PCR midway through her own shift. I spend my work time in a 10x8 pod with 3 other people, with a large, loud HEPA filter running the entire time. Midshift I always have a headache (from my N95 and eye protection) and a sore throat (from my N95 and lack of hydration). I don't dare even take a drink of water while sitting there. Twice a shift I run to the back and chug 40 ounces of water and pump frantically for 20 minutes, hoping I can make enough milk for my EBF baby despite barely being hydrated. I shove fast food in my mouth because our grocery deliveries have been terrible and the cafeteria is too far and too much work. The hospital provides lunch for nurses, techs, unit secretaries and housekeeping but has decided that physicians don't need lunch provided for them.

Amidst this, families and patients snark at me because they waited longer than they would like to be seen. THey're mostly unvaccinated and when I ask "why" and "if there are any questions I can answer about the COVID vaccines today?" they wave a hand at me and tell me they "need to do more research about these vaccines." UGH. You've had 9 months of having them available to the entire population. You've had almost 13 months since the first EUA. What kind of "research" do you think you're going to do that HASN'T ALREADY BEEN DONE?

I wish I could give you a hug @wildcat03…I don’t even have the words to describe how I feel about what you wrote. My heart goes out to you..XO

 

[MaisOuiMadame]

This thread made me cry. I seldom cry.
I am grateful for all that you do. I'm sorry Yiu have to do it.

@wildcat03 this is inhumane. Don't know what to say to you because, "take care of yourself " doesn't even begin to cover it. Best wishes to you and your children

 

[smitcompton]

Hi,

Well, I'm going to partially answer my own question. After I wrote my post, I came across an article that also voiced the fact that those that are unvaxxed do not have consequences for their actions. So, several, companies have hiked the health insurance of theiir unvaxxed workers, which is perfectly legal as they do it with smokers. The example given was an increase of $60 per week. A second,company did the same and within a short time of increased premiums the company had a 91% vaccination rate.

Health Insurance companies determined a unvaxxed hospitalized worker costs them 50,000. They have increased the premiums of those people.

I am very sorry for those that cannot get a bed in a hospital when they have an emergency.

If this has been discussed elsewhere ,I apologize, as I don't read the other covid threads usually.

Annette

 

[kenny]

Beautiful kitchen table! ... but impractical.

When they kids spill milk (or adults, wine) into those beautiful old metal hinges (and into the cracks between the boards) how can it be cleaned?
Sure, you could wipe on top of the hinges, but the liquid that seeps under the metal is going to get all stinky and moldy.

Maybe they hire 4 strong people to carry it outside and hose it off.
Maybe, being rich, they just buy a new one every week.

But hey, it looks cool.
That's all that matters.

 

[MamaBee]

Beautiful kitchen table! ... but impractical.

When they kids spill milk (or adults, wine) into those beautiful old metal hinges (and into the cracks between the boards) how can it be cleaned?
Sure, you could wipe on top of the hinges, but the liquid that seeps under the metal is going to get all stinky and moldy.

Maybe they hire 4 strong people to carry it outside and hose it off.
Maybe, being rich, they just buy a new one every week.

But hey, it looks cool.
That's all that matters.

@kenny It looks like a sofa table to me..so you wouldn’t eat on it. It still would be a bear to dust and clean..

 

[kenny]

Thanks MamaBee.
I've never heard of a "sofa table".
I've heard of "coffee tables".

Clearly I need to get out more.