Expert on Physician Mental Health Discusses COVID-19 Impact

Michael F. Myers, MD, Professor of Clinical Psychiatry, immediate past Vice-chair of Education and Director of Training, Department of Psychiatry & Behavioral Sciences , SUNY-Downstate Medical Center, Brooklyn, NY.

Michael F. Myers, MD, has been in private practice serving the mental healthcare needs of clinicians and their families for 3 decades. He talked to Patient Care Online^© about the state of physician mental health in the United States leading up to the COVID-19 pandemic and then described the impact he has witnessed as he and colleagues have convened and conducted support groups for healthcare personnel at all levels of patient contact.

Mounting daily death tolls drove feelings of uselessness; fear of contagion and of infecting their own families kept them isolated from loved ones when they needed connection the most; and the death of colleagues from the disease they were fighting to contain felt almost unbearable.

The following transcript has been lightly edited for clarity.

Patient Care. Well, before we talk about the COVID-19 crisis, I wonder if you could sort of paint a psychographic for us of what the state of mental health is generally among us physicians these days, or in the before times -- before March of this year.

Myers. Okay, I'd be happy to do that. What we read, of course, and see in the in the medical media, of course, is the high index of burnout in today's physicians, and we've been seeing that now for what, I'd say almost 20 years, a ballpark figure—50% of practicing physicians suffer from one or more symptoms of burnout. And it varies from one specialty to another, etc, etc. So that's the short answer. The longer answer is a little more complicated.

I think we're not hearing from a huge cohort of physicians who actually love what they do. They're happy being physicians. They’re stressed, but many of them will say, “But, I’m no more stressed than other hard-working people. We don't have a monopoly on this…” that sort of stuff. They just, that's the way they talk. I also know, of course, that because I interview so many applicants to our medical school, if the applications to medical school are sky high, in fact, they've gone up even since COVID-19. So, we know that that we must be doing something right that medical students who are doing preceptorships and shadowing want to become physicians themselves. And the final part of it all, just add to your question, has to do with the fact that then there's this other group of doctors which I'm quite happy to talk about, who will become my patients over the years and doctors are human too. So, we can suffer from anxiety disorders, depression, trouble with alcohol or other drugs, PTSD, things like that, that people in our general enroll society suffer.

Patient Care. So, there's isn't anything absolutely about the medical training that creates these stoical figures that we tend to see on television or in other media, although they are allowed a little more humanity on television these days, and they used to be,

Myers. Yes, yes, I would agree.

Patient Care. Well, now to talk a little bit more about the pandemic, which really hit the US healthcare system like a tidal wave. And a lot of elements of that system have totally failed at things as basic as access to protective equipment that let physicians do their jobs day to day. What is it like for physicians, in your experience, living through this kind of a crisis day to day?

Myers. Yes, it's been really tough. I'm going to tell you what some of the things are. And as you know, of course, New York City became the epicenter very quickly, in late March, April, May, etc., of the pandemic. And where I work at SUNY Downstate, our major teaching hospital, University Hospital Brooklyn, was designated a COVID-only hospital by our governor, Governor Cuomo. So basically, then we began to see, you know, many, many patients, the entire hospital was converted to COVID-only patients. So, what we did in our Department of Psychiatry, we did 2 things. Because we're not on the immediate front lines, what we did is we offered weekly support groups, for the hospitalists, for the emergency medicine doctors, for the critical care specialists, etc, etc, that whole group. And then we also offered weekly groups for another group of physicians as well who were a little bit, sort of removed from the frontlines, but some of them were redeployed. And then we also had groups, of course, for medical students, for residents. In fact, the resident groups ran 7 days a week, and we had groups for nurses, etc, etc. But what we were seeing and witnessing in those early days and weeks was just what you said, shock, anxiety, of course, about contagion, about getting it oneself, about contagion to one's own family. Some of our doctors, you know, didn't go home, they would stay in at the hospital or stay in rentals, right on site. And because they really wanted to protect, you know, their family at home. We didn't know that much about it at that time, too, and its contagion. The isolation was so difficult. As you know, patient families were not allowed to be in the hospital. And patients were dying so rapidly. And it was really, really awful for our doctors on the front lines. I remember so vividly in our groups, how so many of them felt it felt useless or something that they really weren't doing anything. Now, I think what that came from was more of a, almost like an algorithmic approach to medicine, the things that we're used to doing, they didn't have that toolkit. I mean, these patients were so sick and dying so quickly. But what my colleague and I reminded them of, is that they were basically doing so much for their dying patients by just being present, by communicating with her families through FaceTime, holding the phone up to her ears, by showing them the badge, the face behind all of the protective equipment, basically, the humanistic touch of that kind of work at that time. And so that's was sort of in early, early days. Exhaustion, fear, of course. Oh, and in the beginning, of course of grieving so much are even which I'm prepared to talk about later, if you would like.