Time for reflection: Pause to recognise our frontline workers

2020 is remarkable not just for doctors, but all our frontline workers in the medical fraternity. As COVID-19 pandemic continues to rise, our doctors, nurses, carers and paramedics around the world are facing an unprecedented workload in overstretched health facilities, and with no end in sight, believes Dr Kishore Kumar, Founder Chairman and Neonatologist, Cloudnine Group of Hospitals, Bengaluru

Every year, 1^st July is observed as National Doctors’ Day in India to express grattitude and acknowledge the dedication and commitment of the doctors’ towards our society. The observance of the day honours legendary physician and West Bengal’s second Chief Minister Dr Bidhan Chandra Roy whose birth and death anniversary coincide on the same day.  2020 is remarkable not just for doctors, but all our frontline workers in the medical fraternity. As COVID-19 pandemic continues to rise, our doctors, nurses, carers and paramedics around the world are facing an unprecedented workload in overstretched health facilities, and with no end in sight.

The pandemic has taught us three critical things. Firstly, the economic cost of physician burnout; secondly, getting used to the new- normal which has significantly impacted everyone and doctors’ life and their families also had to change; thirdly, as rightly said in the words of Amy Edmondson at the Harvard Business School, “Psychological safety at work takes effort; it’s not the norm, but it’s worth the effort.” Across the world, there is a need to make our employees and frontline workers psychologically safe.

Physician’s burnout costs

Physician burnout costs the United States healthcare industry $4.6 billion a year, a number that brings a new spotlight to an age-old problem. There are no such studies from India. For a country like ours, with huge population burden, the number of available medical professionals and the doctor-patient ratio is dismal.

Due to this, doctors, especially those working in the public sector, are faced with significant patient load. It is not uncommon to hear a single doctor catering to 100-200 outpatients a day. This out-patient load is further compounded by the in-patient load, attending to emergencies, looking after the administrative responsibilities, etc. Further, if the doctor is a trainee or a teacher/supervisor, they have an additional load of academics, teaching and supervising the academics. All these are compounded by the fact that doctors are considered as vultures, who are interested in only earning money. This is further compounded by the medico-legal issues, different laws governing the medical profession and violence against medical professionals. It is not uncommon to hear that doctors are being thrashed, due to no fault of theirs. Some studies have associated burnout with an increase in medical errors, especially in situations like the ongoing pandemic.

In India, the pandemic has made most physicians and surgeons over the age of 60 to take up voluntary retirement. Many Intensive Care Units (ICUs) don’t have enough allied health workers, which complicates the issue. Even though physician burnout is widespread, it’s difficult to put a price tag on the phenomenon in a way that medical institutions can understand.

New normal for doctors

Around the world, healthcare professionals are putting their lives on risk to combat and control the pandemic. However, it is important to note that some of the physicians, nurses and paramedical staff have taken major life decisions too. They are working in stressful work environments, not just because the virus is little understood, but because in most settings, they are under-protected, overworked and themselves vulnerable to infection. They are staying away from their families to ensure the infection is contained and not spread. Many of them are also seeing patients pass away while on a ventilator.

Clinicians at times also feel frustrated by the limitations of overstretched health systems. They moved into unfamiliar clinical areas, joined new rotas at short notice, and covered gaps created by the pandemic. They have left other roles in research and education to help with the clinical efforts, increased working hours. We have also seen that the snowflake generation has shown their steely resolve and commitment to their patients and profession. Teaching programmes and learning opportunities are yet to restart. While face-to-face events are likely to be cancelled for several months to come, there is a need for employing trusts, local education and training boards, specialty societies and royal colleges must embrace technological solutions to continue the engagement.

One of the notable trends of the new- normal scenario has been that your “Doctor is online.” Parents no longer had to take time off work or find transportation to get their children to an appointment. “I’m asking questions and answering questions,” seeing kids in their homes and with their families. “It feels like a very complete visit. The pandemic taught us that teleconsultations are the new normal and we, as doctors, have made full-scale transition to it. After nearly two months, we all have discovered the myriad benefits of connecting with people in rural areas and meeting patients where they’re comfortable — in their own homes.

The pandemic also underscores the urgent need to strengthen the global health workforce. A new report by the World Health Organization (WHO) titled “The State of the World’s Nursing 2020” calls for an urgent investment in nurses. They account for more than half of all the world’s health workers, providing vital services throughout the health system. There is a need amongst countries across the world that are experiencing shortages – need to increase the total number of nurse graduates by on an average eight per cent per year, along with improved ability to be employed and retained in the health system.

Preserving mental health and resilience in frontline healthcare

It is important to understand that healthcare workers are not just treating a flood of critically ill patients during the pandemic; at the same time, they are risking their own health, witnessing higher rates of death and experiencing acute stress that could lead to mental health issues. Therapeutic support is lacking. From a psychological perspective, although, prior to this pandemic, there were undoubtedly situations where clinicians could be at risk of being physically harmed by their patients. The pandemic changes this all as GPs and nurses whether working in the community or in hospitals, run a significant risk of catching the virus from their patients; and not only catching the virus, but also potentially taking it home to their families. Thus, one thing is essential –  the power of connecting with colleagues.

It’s humbling to think that there are millions of stories like these around the world right now. I feel incredibly grateful to every single doctor and nurse working around the clock, pushing themselves to the limit and putting their lives on the line, often with limited resources – they are the true heroes.