Physician Mental Health Expert: Please, Check In with Each Other

Michael Myers, MD, has cared for physician mental health for more than 30 years. He says that the COVID-19 pandemic has created unprecedented conditions not only for practicing medicine but also for health care professionals' ability to emotionally process daily experience.

Dr Myers speaks to the toll on health care workers of the daily tragedy they witness despite their herculean efforts - and also to the possibility that the greater vulnerability so many of them have displayed and also witnessed among colleagues may have unforeseen positive consequences.

Dr Myers also remembers ED physician Lorna Breen, MD, who took her own life after being infected with COVID-19, returning to her demanding job, and sliding into major depression. He describes the Dr Lorna Breen Health Care Provider Protection Act, bipartisan legislation that aims to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care professionals, as a direct--and essential--result of the pandemic.

For more information:

• Dr Lorna Breen Hero's Foundation
• The Dr. Lorna Breen Health Care Provider Protection Act

The following transcript has been lightly edited for clarity.

Patient Care Online: You mentioned earlier the issue of grieving through this process. Why don't you talk about that for a bit?

Myers: I will. I think in its largest form, of course, it is people who have been right on the front lines, and they've been sort of grieving just so much death, I heard so many say that “I'm used to dying patients, but not so many on one shift.” You know, that sort of thing. And also, too is, you know, this is also an illness that has particularly affected minorities, and also older individuals as well. And, as you know, not exclusively though, because across all ages, and all ethnicities, etc, etc. Even that, though, there's a great sorrow in these just a sort of sense of this could be my father, my mother, my grandmother, this kind of thing. In fact, when we lost one of our own, one of our critical care specialists that was particularly difficult for all of our frontline people, and we also lost a head nurse in our emergency room as well.

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.

Patient Care Online: Was she the one who was in the national news?

Myers: No. You may be thinking of Dr. Lorna Breen, an emergency physician. I was, if we have time, Grace, I was just going to mention something about her in a minute if we could. But with regard to this, that was a type of grieving as well that we needed to be recognized and really, really allowed and be allowed to happen. And as you mentioned earlier about so many physicians that have been open, that's what I've witnessed as well, that attending physicians are talking in terms of their vulnerabilities with their trainees. They're just being human. And I think that that's extremely important role modeling. I think they're still respected as the teacher, the supervisor, etc, etc. But their humaneness is really coming through.

The other thing I want to mention about mourning, though, is that that's a collective thing. I think the entire world is grieving. We're grieving, what once was, you know, the predictability, the sameness, the certainty, and there's been so much uncertainty, it's, you know, we're all feeling a little bit of hope now, with a vaccine. And that's a very good thing. But of course, we still have to remain cautious, all of these sorts of things about masks, and social distancing, etc, etc. So, there is there's that going on. I noticed the word loneliness creeping up so much in both the scientific and lay literature, that people are feeling just lonely, you know, we're not allowed to hug each other, not allowed to touch. You know, we can’t even, you know, when we put our masks on, people can’t even see our smiles now; maybe they can see our crinkly eyes and things like that. And yeah, I think that people, we’re all missing that.

Patient Care Online: There is a line of thought, going through the literature, that people who, up until March had not had emotional issues or mental health issues. And there may be a huge, huge population of people now desperately needing emotional support of some kind, whether it's through loss of loved ones, loss of employment—there’s so much that can have been lost. And I would think that that would affect you know, our health care professionals as well.

Myers: It definitely does. It really does. I mentioned earlier, right, you're prompting Dr. Lorna Breen, her death by suicide reached national news. When she died while recovering from COVID-19, she contracted it herself. She was the head of Emergency Medicine at the Allen hospital here, affiliated with Columbia University in New York City. And after being off for COVID, came back to work but was not well, and crashed into a very, very severe depression and despite treatment ended her life. But her sister, Jennifer, and her husband, Jennifer's husband, Cory, they have been doing amazing advocacy work in Dr Lorna Breen’s name. In fact, the Dr Lorna Breen Health Care Provider Protection Act, it's a bipartisan bill, initiated by Senator Tim Kaine of Virginia. And, what it's doing, and this is a very hopeful note, because it gets back to what you were asking about earlier, the changes that might need to occur is that there is now going to be with passage of this provisions for education of our of our health professionals about well-being, reducing the stigma so that more and more health professionals will go for help. Because there's still that stigma, the hesitancy to go for help. There's going to be much more done in terms of also reducing the fear that doctors have that this could have implications for their medical license, for their malpractice insurance or disability insurance. It's a huge, it's a huge bill that will make a difference. And it really is, it’s an honor, of course, in the memory of Dr. Greene, that it is a salute to health professionals all across the country, and the important, hard work that they do.

Patient Care Online: It’s interesting in talking with specialists in different disciplines over the last couple of months, many of them have talked about how the pandemic has boosted many or propelled many of the changes that had just begun to take hold or that have been plodding and plodding along, like home blood pressure measurement or let's see continuous glucose monitoring feedback loops, etc. All these things that were sort of just moving along had been catapulted. And I'm bringing it up because perhaps the movement, the grassroots movement about the plight of the medical student, the resident, who's working double shifts, and etc, without support and one of the precursors to that burnout, perhaps this shines a light, the whole issue shines a light on it that will make it less onerous will help to reduce the stigma, I guess is what I'm saying.

Myers: That's right, and that gets back to a little bit like what you said earlier about the healthcare providers being so transparent, their nakedness, their emotional nakedness being you know, that sort of thing, it’s like that’s like, you know, we'll be able to, I think they're just that we're all human, you know, doing important work, but we're all human. And so those are the kinds of things that I think are long overdue. And, and I'm hoping that it'll make it easier for individuals to just reach out for help.

Patient Care Online: So that's, and that's actually where I would like to, to wrap up with, what should our, my audience primary care physicians be looking for, or be attuned for in themselves and their colleagues, as the pandemic we hope winds down, but you know, there are some tough days still ahead.

Myers: Thank you, Grace, for that question. Yeah, I have been preaching and writing for years, that more specifically to medicine, but if it occurs across all health professionals, that we must be our brothers’ and sisters’ keepers. Now, I know that firsthand, because being a psychiatrist, I know how elusive some illnesses can be. In other words, somebody can be slipping into a problem with alcohol or drug use. Or they can slip into a depression and not realize it, that it's actually beginning to affect their wellbeing, the work that they do, and things like that. So that's why the next step is for all of us, well, to pay attention to our own selves, and our own symptoms and signs; we need to listen to those loved ones of ours, who are concerned about us and reach out to us—our parents, our spouses, our kids, our parents, those kinds of overtures to us that we need to seek some help. And then of course, each other. And, and I know we're hearing this so much today, it's very simple. “Are you okay?” And if you get a dismissive response, then I think it's best to follow up with, “Are you really okay?” you know, that kind of thing. And then, too, to create a safe place where an individual can open up a little bit, and then if they could benefit from some help, when we've got resources available to them, we can assist them with a passage. I learned a long time ago, too, that when people are feeling quite ill, it's very hard to make those phone calls to call somebody and ask for help. So, I often recommend that you make that phone call. And in when I was in practice, I don't know how many phone calls I got from family members or friends of doctors who came to see me they said, “Look, I’m an office mate of doctor so- and-so; she's willing to see you, but she can't make the phone call. Would you be open to seeing her?” and I say, “Absolutely.” And then I say, “If you can, if you have the time or can get away, come with her and just wait in the waiting room. That will ease the journey.

Patient Care Online: Amen. Amen. Excellent, excellent guidance. And thank you so much for your perspective and for sharing the experience that you've had. Take care.

Myers: And thanks for having me, Grace. You take care.