A Crisis Of Health In Healthcare Workers

IRA FLATOW: This is Science Friday. I’m Ira Flatow. You know, health care workers take care of other people for a living. And that takes a toll mentally and emotionally. Depression and anxiety are extremely common in health care workers. Health care workers have higher rates of suicide than the general public. Doctors are twice as likely to die by suicide. It’s a staggering statistic. And that’s when the world is operating normally.

Now add into the mix that health care workers are now dealing with a devastating pandemic that we still don’t know a lot about, add protests for racial justice where some health care workers are using what little emotional labor they have left to advocate for justice, and what you have is burnout in the industry. Some health care workers via our Science Friday VoxPop app, told us what they are going through.

VALERIE: I am a little bit burnt out, I have to say. I work at Texas Children’s Hospital as a medical interpreter. And in the clinical area, we are not seeing very many patients, but our patients are high risk, and our families are limited in technology usage. And I have to say that everybody’s having a very hard time.

BRENDA: I am a health care worker. And I have been a respiratory therapist for 32 years. I was burned out before the pandemic. I’m sometimes jealous of those who get to stay home, but I’m also very grateful that I still have a job, and I’m still working.

KIM: Yes, I am a health care worker. I am quite honestly just attempting to navigate life and hopefully drive change from within the system.

IRA FLATOW: Those listeners were Valerie in Texas, Brenda in Missouri, and Kim in Colorado. Thank you to everyone who left us messages on the Science Friday VoxPop app. And I’m sorry we can’t get to all of you. Joining me today to talk about burnout in the health care industry are two physicians, Dr. Steven McDonald, an Assistant Professor of Emergency Medicine at Columbia University Medical Center in New York, and Dr. Kali Cyrus, a psychiatrist, and Assistant Professor at Johns Hopkins Medicine in Washington, DC. Welcome, both of you, to Science Friday.

STEVEN MCDONALD: Thank you for having me.

KALI CYRUS: Thanks for having me.

IRA FLATOW: Just a quick note, there is some discussion of suicide in this conversation. Let me start asking you both this question, and I’ll let Dr. Cyrus answer first. Let me start with a question I don’t usually ask my guests on mic, and that is, how are you feeling?

KALI CYRUS: Well, you asked me a question at an interesting time, admist all of the George Floyd protests, and I’m here in DC. And seeing patients not only on a telasite platform, but I see patients in the community. And I actually found myself feeling– as a psychiatrist, I can name my feelings– a little depressed yesterday. It was pretty hard to get out of bed. And think everything finally caught up to me. So this conversation is quite timely.

IRA FLATOW: Yeah, well, do you feel the same way, Dr. McDonald?

STEVEN MCDONALD: You know, as you were speaking, I was reflecting on my own feelings. I’m not a psychiatrist, so I have sometimes to search for the words that I need. But I’m actually feeling quite energized this week. I think as a black physician in America at this moment, having seen COVID, now thinking about protests, I’m energized on the fact that my voice is sort of mattering for the first time in a while. And I’m feeling like I want to speak loud and bring a voice to these concerns.

IRA FLATOW: Well, that’s what we hope to do today. And Dr. Cyrus, you did say you’re feeling a bit of burnout. What does burnout look and feel like?

KALI CYRUS: Yeah, so burnout for me actually looks a lot like I think what folks consider the definition of burnout. It’s sort of an exhaustion. It feels like the rewards don’t compare to the amount of effort that’s required to do your job. And it’s usually in the context of job. And so you feel kind of strained. You feel a little tired. And it just, it’s really hard to do the things that you would normally be able to do.

IRA FLATOW: I see, I see. Steven, you’re an ER doctor. And as I mentioned earlier, there’s a mental health crisis among health care workers, the obvious doubling of suicide rate among doctors. I’m wondering based on your experience, why do you think this might be?

STEVEN MCDONALD: Sure, there’s a lot of causes to that elevated suicide rate, I think, among physicians. Unfortunately, I think it’s something that we sort of just accept as a society, like doctors have a higher rate of suicide, so it goes. And there aren’t many institutional reforms in place to correct that. And the things that make for this are manifold.

I would say one, at least in the emergency room, where we have notoriously high rates of burnout and also increased rates of suicide, there’s really no control over your schedule. You really have no autonomy. And so to be always beholden to the demands of the sick people coming through the door does not allow you to really tend to any of your own emotional wounds. And so those can sometimes linger and be variously deep, and can cause real trauma, and have real psychiatric consequences down the line.

And then at the same time, I think there’s sort of a lack of– or a mismatch maybe is the way to say it, between the expectation of becoming a physician and the actuality of being a physician. And so a lot of us entered this field hoping to elevate other people, and improve their lives, and to cure disease. And what you find when you actually become an attending physician, you reach the end of your training is that there is a system that is so stacked against you your success that it becomes very difficult, if not impossible, to make the kind of change that you thought you would be making.

And so when you bring that all together in people who may be already predisposed to mental illness, or not even, then you can get outcomes such as anxiety, depression, and in the worst case, suicide.

IRA FLATOW: And then you throw in all the pressures we have now.

STEVEN MCDONALD: Right, so then you add COVID on top of that, you add the challenges of being a block physician on top of that, and you get even worse outcomes, would be what I would imagine.

IRA FLATOW: Mm-hmm. A study came out recently that looked at the mental health toll of COVID-19 on young doctors in China. And they found even in cities that were far from Wuhan, doctors had a sharp drop in mood and a rise in depression and anxiety. Do you think if someone came in and studied you and your peers, they’d find similar outcomes?

STEVEN MCDONALD: I mean, absolutely. I don’t know if you were made aware of this, but I actually work at the hospital where one of my colleagues committed suicide, in part due to the COVID pandemic.

IRA FLATOW: Sorry to hear that.

STEVEN MCDONALD: And so that’s– that on its own is a clear indicator that this was an unprecedented tax on our emotional health in the emergency department.

IRA FLATOW: Kali, as a psychiatrist you’re in a position where you’re hearing about people’s trauma and mental health problems all the time. Does that take a toll on people in your profession?

KALI CYRUS: Oh, definitely. I think it relates back to the numbers that Dr. McDonald was discussing, about high suicide rates and physicians. So there’s compassion fatigue. There’s also the caregiver stress of re-experiencing other people’s trauma. And with psychiatrists, we tend to have lower rates of suicide when compared with other rates of physicians. I think some of that just has to do with our lifestyle. It tends to be a bit more flexible in schedule.

But having to experience other people’s trauma, even though you– you find a way around it. We choose to go into psychiatry for our own reasons. I can separate and compartmentalize my trauma, and what I’m going through compared with that of my patients. But it’s definitely stressful hearing the stories of– even when I’m seeing other medical professionals as their psychiatrist, hearing their stories about what’s happening in the hospital as it pertains to COVID, or the stress of their own jobs, especially as it pertains to seeing black mental health professionals or professionals in general, who are talking about some of the stress that has to do with the politics of their medical community.

So I think it’s probably the worst when you find yourself identifying with the client, and you feel like you have some sort of experience, personal experience that also relates to the trauma that they’re experiencing. And you start to kind of compare what your experience is, compared to theirs. And I think that that’s probably when it’s at its worst.

IRA FLATOW: Well, that was my next question. Do you have to go for therapy because you’re giving out therapy to other people?

KALI CYRUS: Yeah, and I so I will say– I’ll use this as an opportunity to kind of pooh-pooh on medical training. As psychiatrists, it’s actually not required that we’re in therapy. But for psychologists, they’re required to be in therapy. And so I’ve been in my own therapy for years. I happen to be pretty neurotic and pretty open about how neurotic I am. But it’s not necessarily a requirement. But I find that it’s essential. And a lot of people learn how to be better therapists by being in their own therapy.

IRA FLATOW: Well, let me follow up on that. Steven, how do you cope with it? Are you in therapy? Or how do you seek counseling for all the work that you’re doing?

STEVEN MCDONALD: Absolutely. So when I was actually in medical school, I lost my mother. And in residency, I lost my father. And so both of those events actually had kicked me into therapy. So I’ve been in therapy now for several years, and have found it to be a really helpful outlet for managing my own burnout at various points in the hospital, and as an emergency physician.

IRA FLATOW: I want to move on about talking about a little bit more of your feelings. God, I’m talking to a psychiatrist about her feelings. Because the world isn’t just dealing with COVID right now. You’re both– you’ve both been active in advocacy and the protests that have been going on for racial justice. I would imagine this is a lot of emotional work. How do you navigate that when you’re already feeling burnt out? Kali, you can tell us first.

KALI CYRUS: Yeah, so for me, I’ve described my experience of feeling burnt out in the past couple days. But I actually feel like the past couple of weeks, I felt quite energized by everything. For the first time, folks are really trying to get the voices of black physicians. And so I find that– and this is a positive defense mechanism. So this is, if you get back to Freud, and what we do when we’re feeling anxious or depressed, I typically will channel my anxiety into being productive.

And so I ended up making a couple of videos that went viral. I ended up doing some writing. I felt like I was probably the most active, in terms of advocacy, that I’ve been in a while. But I think this is just a show of how emotions really catch up to you. Because at some point, if you’re not– you can’t be like that the entire time. And so I think the sadness is now hitting me.

But for me, the advocacy is a way that helps me channel my privilege as a black physician, feeling like I have a lot more means than a lot of my clients, and have a voice that people will respect by virtue of just the position that I’m in. And I found that it’s been incredibly reassuring and sort of fulfilling, is actually I think how it’s been for me. I’m not sure has been for you, Steven.

STEVEN MCDONALD: If I could copy and paste everything you just said into my voice, I think I would do that. I think around the time that coronavirus started becoming headline, and became a real problem for New York City hospitals, I began to actually do some writing and do a little advocacy around physicians. And I was advocating for things that I felt I needed to do my job well.

And that actually gave me a sense of purpose and feeling energized, and gave me something bigger than the patient in front of me to focus on, which was sort of essential to my going to work every day. Like, I needed to feel like in the face of so much government failure and so much failure of leadership, that I was able to combat that as well, not just the individual patient afflicted with a virus.

And it’s now panning out to be somewhat the same thing in the case of these protests. Like, I want to be doing more than addressing the individual patient in front of me. And so, like you said, channeling my privilege, and this platform that I suddenly have to stand on, and writing about that. And I actually wrote something in The New York Times this last weekend about the importance of protests as sort of the medicine for both coronavirus, and for police brutality, and injustice in law enforcement.

IRA FLATOW: Let me pursue that a little bit further, because I want to ask you if you think there is racism within the health care system that could contribute to physicians of color burning out.?

STEVEN MCDONALD: I mean, so the answer to that is, of course, in my perspective. I mean, it’s at every level. It’s too much to go through all of it in this time, but I think one sort of instructive example– I had a patient, probably six months ago, who I treated for back pain. He refused to leave the emergency room. And so then security was escalated. And he then refused to leave with security. And so what ended up happening to this gentleman, who’s a young black man, is that he was arrested on the spot for trespassing and was taken away.

I then recently– this was now two days after the murder of George Floyd, had two white women come into the emergency room for back pain. They had me, the same doctor. I treated their back pain in the same way I treated that of the young man. And these women then also refused to leave the emergency room. Security was then activated.

They then refused to leave with security. And instead of being arrested on the spot for trespassing, both were allowed to file complaints against me and the care I provided with them. And one used particularly nasty, devastating, racist language to discredit any authority I had as a physician. And to basically say that I had not treated her appropriately. And so, that is on the most granular level, I think, how race operates. Like the two patients coming in for the same things, and how they were treated completely differently.

IRA FLATOW: I’m Ira Flatow and this is Science Friday from WNYC Studios. Last question, because we’re running out of time. I want to ask both of you, are there steps that could be taken that you think would help alleviate burnout for doctors and health care workers, particularly those of color? Who wants to answer that first?

KALI CYRUS: I’ll go. I’ll go. I do think there are steps. And this is talking as someone who has sort of left academia because of feeling burnt out. And I have one foot in and one foot out for that reason. And so I think the first step is actually hiring faculty of color or of the minority identity. So as a black queer person, I not only– I checked two boxes, found myself sort of torn between going to all the LGBTQI events, starting the LGBTQI clubs.

Also having to be there as a black physician to the minority trainees, and not just in my department, but across departments and the entire university. So I think that one, just actually putting your money where your mouth is in terms of academic institutions, and academic medical centers, and hospitals, and just hiring more faculty of color and from diverse backgrounds just helps on the ground.

IRA FLATOW: Steven, what would your response be?

STEVEN MCDONALD: The one thing I would add is that I also need to feel protected in my workplace. I have to say specifically after the 2016 election, there was a really palpable uptick in racist, hateful, homophobic language towards my colleagues and towards myself. And so, in the emergency department, we operate under the obligation to assess, stabilize, and treat anyone who comes through the doors, regardless of creed, ability to pay, color, sex, et cetera.

But at the same time, I also need to feel protected at work. And so, I need to know that my department has my back, and that we can find a middle ground, where we’re able to really treat the people who need treatment, but at the same time, where we’re able to expel people who are stable to leave, but are also bringing in that kind of inflammatory and hateful language.

IRA FLATOW: That’s all the time we have today. I’d like to thank my guests, Dr. Steven McDonald, Assistant Professor of Emergency Medicine at Columbia University Medical Center in New York. Dr. Kali Cyrus, a psychiatrist and Assistant Professor at Johns Hopkins Medicine in Washington, DC.

STEVEN MCDONALD: Thank you.

KALI CYRUS: Thanks for having us.

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