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Diversity matters: Well-being, burnout and recovery through… : Emergency medicine news

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DEI, well-being, health equity, burnout

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Burgeoning wellness and burnout crises in medicine have accelerated during the pandemic, with several pre-existing conditions contributing to the current mental health crisis being felt by many medical professionals.

These crises are particularly palpable among front-line doctors. Emergency physicians receive disaster preparedness and rapid response training for isolated disasters focused on maximizing resources to improve patient outcomes, but they have no physical impact preparedness training , psychological and emotional of an ongoing daily global catastrophe over several years, such as the COVID-19 pandemic.

It is imperative, as society enters the recovery phase of the pandemic, that we reflect on its immense impact on the wellbeing of emergency physicians, particularly using a diversity, equity and diversity lens. inclusion to recognize the disproportionate impact felt by people from underrepresented and marginalized backgrounds.

Burnout in a crisis

Burnout is characterized by high emotional exhaustion and depersonalization, with a low sense of work-related personal accomplishment. (National Academies of Sciences, Engineering, and Medicine. October 23, 2019; https://bit.ly/3QC21B8.) The National Academy of Medicine described an imbalance in which the demands of the physician’s job exceeded the resources available to do the job effectively, resulting in critical levels of burnout rates. These pre-pandemic reports identified significant burnout in 35-54% of nurses and physicians and 45-60% of medical students and residents.

The United States Surgeon General has described COVID-19 as an entirely and uniquely traumatic experience for healthcare personnel. (Tackling Health Worker Burnout. 2022; https://bit.ly/3y7aS6J.) Emergency physicians first responded quickly to support the community early in the pandemic, and many are struggling two years later with more than a million American lives lost after countless COVID surges.

We must recognize that emergency physicians have sacrificed their own lives to care for and support others, including providing direct care to colleagues and loved ones. Studies examining the well-being of healthcare professionals during the pandemic have reported extremely high rates of stress, anxiety, exhaustion, loneliness and general exhaustion. Burnout is costly in terms of the human cost felt by healthcare professionals, the monetary cost associated with high staff turnover, and the profound impact on societal health and safety given the implications for patient care. patients. The direct result of high burnout among healthcare professionals is evident in rising rates of heart disease, diabetes, substance use disorders, anxiety, depression, insomnia and, unfortunately, of documented suicides since the pandemic.

The well-being of all frontline healthcare professionals has been profoundly affected during the pandemic, and groups known to be underrepresented or marginalized in medicine have been disproportionately affected, particularly those belonging to sexual minorities. and racial/ethnic.

Female professionals have consistently reported higher rates and sequelae of burnout, which have been exacerbated during the pandemic. Female colleagues are also more likely to take care of children and the elderly. School closures and nursing home outbreaks have added further stress to an already heavy workload, leading to significant career disruptions with implications for academic advancement and financial consequences for some.

Frontline medical workers from racial and ethnic minority groups continued to have a higher rate of COVID-19 and a negative impact on well-being. People of color are disproportionately represented in roles such as health care aides, personal care workers, direct contact support workers and nursing home workers. These frontline healthcare workers were more likely to report inadequate PPE or having to reuse PPE, while these types of jobs made them more likely to have direct contact with COVID-19 patients and increased their risk of exposure in the workplace. (Kaiser Family Foundation. Nov. 11, 2020; https://bit.ly/3xwGwZM; Lancet Public Health. 2020;5[9]:475; https://bit.ly/3QpJlEs; Health Affairs Health Policy Briefing Note. June 4, 2021; https://bit.ly/3xYNlEX.) Healthcare workers of color were subsequently nearly twice as likely to test positive for COVID-19 and accounted for the largest percentage of frontline healthcare worker deaths from COVID compared to their white counterparts.

Hate crimes, mass shootings

Many people from racial and ethnic minorities have also come face to face with the realities of systemic racism in this country after police killings of unarmed black Americans sparked what many have considered the world’s largest human rights movement. civics in history, all against the backdrop of the COVID-19 pandemic and local government shutdowns and increasing anti-Asian, anti-Semitic and anti-immigrant violence, and mass shootings.

Recent mass shootings at a grocery store in Buffalo, NY, an elementary school in Uvalde, TX, and a hospital in Tulsa, OK have shifted national attention to gun reform. Sadly, more than 100 people are killed every day due to gun violence, while 200 are injured by gunshots every day. (CDC WONDER Database. Underlying cause of death [Yearly average: 2016 to 2020].) Emergency physicians are in a unique position as they administer care to perpetrators and victims of violence, with little time to process the enormous emotional and psychological impact these events have on them.

The impact is particularly profound when there is a racial and ethnic match between urgent care professionals and victims of hate crimes and targeted attacks. This growing phenomenon deserves special attention to recognize the cumulative impact of treating patients in these situations, especially when patients remind healthcare professionals of their loved ones and magnify the dangers they themselves face once they leave the hospital.

It is crucial to create an environment and culture that recognizes the impact of gun violence and allows space for nuanced discussions between healthcare teams. A certain degree of compartmentalization is necessary to carry out our duties in the emergency department, and it is vitally important that we create a culture that allows colleagues to begin to decompress and process this trauma.

Immediate critical debriefing sessions after ER deaths and difficult traumas have been shown to positively affect patient safety, improve compassion fatigue, and promote resilience and subsequent group healing. (Emerg Med Australia. 2021;33[5]:922; J Trauma Nurses. 2017;24[5]:317.) Recent studies continue to recommend a heated debriefing session immediately after the event in the emergency department. (Emerg Med Australia. 2021;33[5]:922.)

Recovery and reconstruction

The pandemic has been truly traumatic for frontline healthcare professionals. Several opportunities to implement systemic changes aimed at shifting organizational cultures and improving working conditions can help promote recovery and healing as we move towards rebuilding the community.

These systemic efforts should focus on embedding a commitment to the health and safety of frontline healthcare professionals into the fabric of workplace culture. This includes actions to show that frontline healthcare professionals are valued by offering competitive salaries; challenge prejudice and discrimination in the workplace; promote family-friendly policies regarding the care of children and the elderly; and building a culture that encourages and normalizes the use of sick leave, family leave and mental health breaks.

Deliberate efforts must be made to improve access to high-quality mental health and addictions care while creating environments that seek out and integrate explicit feedback about work stress, grief, stigma, and health issues. mind in systemic solutions. Frontline workers should be encouraged, not deterred, from seeking mental health care.

The US Surgeon General has recommended that professional license and credentialing forms be revised to ensure that professionals are not discouraged or reprimanded for disclosing mental health issues. Recovering from any insult is difficult, and we have a unique opportunity to rebuild with a focus on mindfulness and attention to creating an environment where colleagues are supported to present themselves as authentic to doing the work they once loved and ultimately making the whole thing better. community health.

Dr. Knightis the Director of Faculty Experience at Zuckerberg San Francisco General Hospital and Trauma Center, the Associate Chair of Diversity and Inclusion in the Department of Emergency Medicine, and an Endowed Professor of Diversity, equity and inclusion in emergency medicine at the University of California, San Francisco. Follow her on Twitter@StarrKnightMD.