hitting the wall header
Marcie Hopkins, U of U Health.
wellness
Hitting the Wall During COVID-19: New Ways of Discovering our Well-being
What can happen when a pandemic meets medicine’s existing culture of overwork? Burnout. Pediatrician Diane Liu, radiologist Yoshimi Anzai, and family medicine physician Amy Locke provide three ways to re-engineer the workday to address clinician well-being during COVID-19 and beyond.
H

ealth care “Heroes” has been a well-used phrase this year, particularly with the COVID-19 pandemic. Medicine is no stranger to hero culture. It's the idea that health care providers extend themselves above and beyond—no matter the cost—to do the right thing. While any patient wants a committed clinician when it comes to their care, that vital dynamic suffers when we don’t recognize when to step back and consider our own needs. Being able to take a break is essential for our ability to continue to provide excellent care. We know that physicians who regularly take time away from work are more resilient and engaged with work than those who do not.

When pandemic meets a pre-existing culture of overwork 

Physicians are losing the race to keep up with electronic communications between patients, peers, staff, superiors, and the system. Hundreds of daily emails are compounded by ever-growing MyChart messages. The institutional norm—and socially reinforced expectation—is “all we need to do is become better managers of our time.”  Physicians, by nature, worry that responsibilities for patient care will fall through the cracks, so we check and double-check. We often feel obligated to make sure things are “done” and “done the right way.”

But COVID-19 has pushed us to the breaking point. This pandemic has removed the barriers between work and home life for many. We find ourselves juggling parenting, homeschooling, patient care, teaching, and other tasks minute to minute. With no commute or clear definition of the workday, work is always looming, with more to be done. Additionally, early-career faculty members face increasing difficulty to find time to pursue academic scholarly productivity during the COVID-19 pandemic. Journal editors have noted a decrease in submissions from women during COVID-19, suggesting women are disproportionally losing scholarly productivity during the COVID-19 pandemic.

Here are three ways we can transform our culture to build healthy boundaries for self-care.

Technology—use wisely and know when to “turn it off”

We live in a world of information overload. Information is literally at our fingertips through phones or emails. Although easy access to information serves a positive purpose in many ways, there are serious downsides.

It wasn’t too long ago that email did not exist. Physicians would dictate a letter—or note—and someone else would type, print, and send it off in the mail. This created a buffer of time. A response was not expected immediately, but rather in days, if at all. This buffer created a boundary that no longer exists today. A cell phone alert, page, email notification, all prompt immediate attention. There is no boundary between when the workday ends, and personal life begins. Cooking while checking email, responding to messages while waiting in line; these behaviors have all become a cultural norm. 

Despite knowing time away may recharge us, it takes conscientious thought and deliberate effort to turn technology off. Consider setting an example for your family by limiting phones at the dinner table, determine a time to unplug, or go for a walk without your device. Give yourself permission to take a weekend without checking email or the electronic medical record. 

Understandably, some clinicians (due to increasing work demands and responsibilities) have limited available time away. Reevaluate your timing when replying to emails. Since not all emails require immediate response, set a schedule to check emails, i.e., three times a day, in the morning, mid-day, and in the evening. Use the filter setting to eliminate emails that you do not need to read. 

Time—re-engineer the workday and clinical workflow

Lack of time is the most frequently cited barrier to well-being among physicians. Even before the pandemic, our hospitals and clinics were incredibly busy—critical capacity, inpatient census, operating room time, access needs, and space—all coordinated down to the minute to improve operational efficiency. In the current fee-for-service environment, clinical volume remains a priority so physicians often do not have control over their schedules. Additional teaching and research demands leave minimal protected time to care for oneself. 

As we pick back up with in-person visits, we are unlikely to resume delivery as usual. Virtual visits are now integral to care delivery. COVID-19 only amplified our need to accelerate virtual care. Virtual visits, for all of their faults, provide high-value care for some patients. They are an efficient and meaningful way to check in on patients, to touch base about their progress, or evaluate someone with limited access to health care. They may allow us to lower our overhead costs while simultaneously improve access and patient satisfaction. The number of lengthy MyChart messages may be decreased by being converted into virtual visits. 

We have a moment of opportunity requiring careful thought and analysis to implement a new system where virtual care is seamlessly integrated into in-person care. We need to make sure that we take the opportunity to optimize the system to improve cost, efficiency, and professional well-being. A value approach can minimize waste (downtime for the health care team, wait times for patients) and consider a clinic flow and schedule that best meets everyone’s needs. 

On par with patients needing flexible access to health care, physicians need flexible work hours. Some faculty prefer working early morning and picking up children from school; others want to stay home during the day and work in the evening. Flexibility allows re-engineering the workday to be suitable for work-life balance. To accomplish this, however, we need to recognize the value of a flexible work schedule to enhance the well-being of health care professionals.

Turning point—from work-life balance to work-life integration

Is your work and personal life mutually exclusive? Some industries may permit work and life as separate entities. However, this might not be the case for health care professionals; we are motivated to help others even at the expense of our own comfort (back to heroism). Therefore, boundaries between "work" and "life" are vague or no longer existent. For some, this blurring results in an inability for consistent time away or, at minimum, taking a scheduled break from work. 

The most important skills for achieving balance include your ability to recognize the value of and prioritize the need for time off. This will require you to examine your life through the lens of self-awareness. Knowing what is the right amount of separation for an individual at their life stage with their current job responsibilities will increase their likelihood of thriving both in their personal life and at work. For many, harmoniously integrating work and life will result in a feeling that we are ‘in the driver’s seat’ to determine the degree of integration needed.  

Sometimes, work takes over a personal life and vice versa. The point is that we choose how and when. Taking time to be off from constant work-related stress allows physicians to be the best possible providers. Organizations that embrace a Culture of Wellness and resiliency of faculty and staff ultimately thrive and grow when the needs of physicians and patients are simultaneously supported, even in the most challenging time of health care history.

Contributors

Diane Liu

Associate Chief Value Officer, Pediatrics, University of Utah Health

Yoshimi Anzai

Associate Chief Medical Quality Officer, Radiology, University of Utah Health

Amy Locke

Co-Director, Resiliency Center, Family Medicine, University of Utah Health