VOLUME 33, ISSUE 2

“Inhale deeply, slowly. Ground yourself, feeling your center. Gently lean one knee forward, while straightening the other. Anchor yourself to the Earth, inhale deeply, and embrace this warrior pose. Free yourself from distractions, stress and, worries. Embrace this time of peace in a sea of chaos.” I exhale heavily allowing the yogi to guide me into a relaxed state. How I have missed these sessions. While the pandemonium outside this sanctuary is reflected by the masks we now wear during yoga and meditative practice, there is still the opportunity to mentally and emotionally escape during these sixty-minute sessions.

Yoga is meant to restore balance and energy. The goal is to promote soundness of the body and mind through physical posture and patterned breathing. The practice is very efficient for gaining clarity, peace, and focus. Can it help weary physician warriors combat the burnout (some would even go so far as to call it moral injury) that we have experienced during the pandemic?

Burnout is regarded as a destructive force caused by excessive workload, system inefficiencies, failure of the team model, feelings of being devalued, chronic stress, and never-ending production pressure. The end-result is widely publicized: distracted and distressed physicians are more prone to errors and are less likely to appropriately engage patients in their care. This can translate into poor performance on quality metric surveys, patient dissatisfaction, poor patient compliance, and an increased potential for malpractice claims.

Prior to the onset of the corona virus pandemic, progress had been made in recognizing burnout as a threat to healthcare systems and enacting plans to combat it. I am concerned, however, that new stressors spurred by systemic practice changes related to COVID-19 have caused us to lose ground on the momentum gained. As a practicing anesthesiologist during one of the worst public health crises in recent history, I am now constantly worried about myself and my colleagues’ mental health and wellness. Anesthesiology already involves exposure to complex patient encounters and stressful events that require life and death decisions. These situations can engender feelings of inadequacy, guilt, grief, sadness and a whole litany of other emotions. The additional burden of airway management for patients who have the potential to transmit aerosolized COVID-19 to us has heightened our anxiety and stress.

We are fighting on the front lines to treat patients while simultaneously worrying about protecting our health and the health of our loved ones. A moral conundrum has arisen between the duty to treat versus the duty to protect ourselves. While signs were erected outside of hospitals exclaiming “Heroes work here,” we are not the same as comic book heroes who seemingly never fatigue and remain emotionally unaffected by the tragedies they witness. As physicians, we have pledged to dedicate our careers to alleviating the suffering of others, but we are not immune to fatigue, stress, fear, and sadness. These feelings were especially compounded early on in the pandemic when so much about the virus was unknown and the worldwide supplies of proper personal protective equipment (PPE) were drastically inadequate to meet the sharp increase in demand. These situations left many healthcare workers feeling torn ethically between protecting our patients and protecting ourselves and our families.

Anesthesiologists were expected to practice in increasingly risky circumstances, without clear preventative guidance, proper protection and, oftentimes, without adequate support (from technicians, residents, or nurses), in an effort to reduce the number of team members exposed. Many were left feeling devalued by these circumstances. This division of the team dynamic and the perceived devaluing of the anesthesiologist can worsen burnout. Many of the safety measures that we had made progress on previously were forced into the background as we dealt with this new crisis. In many instances, it felt as though our climate of safety had regressed as we all struggled to implement new protocols to protect our patients, our colleagues, and ourselves. These circumstances have challenged not only our practice methodologies, but our resolve and psychological soundness.

We feel like weary warriors pleading for leadership to take notice and change the battle plan so that we may emerge triumphant. How can we foster resilience? Some have advocated for the promotion of wellness activities like mindfulness training, stress management education, fitness, meditation, healthy eating, yoga, spiritual support, and counseling. The emphasis placed on physician heal thyself. Is self-care the answer? Is there simply the need for us to accept that self-care is not a luxury item, but a necessity to overcome the current increased levels of stress many in our anesthesia community are dealing with?

While I am certainly an advocate for self-love, respect, and care, I do feel that close attention should be paid to addressing structural failures that foster working conditions rife with burnout potential. Leaders of healthcare organizations need to be in-tune with the hardships faced by physicians. This is unlikely to be the last pandemic we face, so concrete improvements to ensure safety in difficult times are needed. Efforts like reducing staff shortages, educating leaders on crisis management, investing in adequate back up stores of PPE, creating disaster protocols, and strengthening financial reserves are potential ways that leaders may prepare for future pandemics.

In addition to focusing on safety culture, healthcare leaders should be active proponents for protecting physician overall health and wellbeing. System and policy failures have been “unmasked” during the pandemic. Healthcare systems must address how to protect their employees who are at highest risk, many of whom have existing health issues that put them at even higher risk. Hospital and anesthesiology practice leaders may also need to consider the mental health of their employees and ways that they can foster better overall employee health.

The slowdown of elective surgeries allowed our health system to catch up with restoring adequate supplies of PPE. The virus spread seems to have slowed, likely due in large part to vaccines that a majority of our profession have accessed. As we seem to be moving to the recovery phase of this pandemic, we can look back over the past year and see that we have learned so much about our strengths, as well as our limitations. We must regain all ground that we have lost in areas of patient safety and our own well-being as we take a proactive approach to mitigating stress and burnout in physicians. We must regain our warrior postures and stand proud with clarity of thought and mental soundness. To do so, we need our leaders, our proverbial yogis to guide us. To ensure that we are able to stand strong, tall, and proud. Arms extended wide. Confidently astride in warrior pose.