Nurturing Well-Being

In many ways, the well-being of our clinical care teams drives the quality of care we deliver and our rate of medical error. But well-being can suffer when a health-care provider experiences burnout, a phenomenon that occurs when providers reach a point where they have given more of themselves than is healthy. Symptoms include exhaustion, mental distance from one’s work and a sense of lacking efficacy in the job.

Burnout is a concept originally described for the “giving” professions, especially those that are mission-driven, where employees expect themselves and others to go above and beyond. In the health-care field, our training focuses on what’s best for the patient, not what’s best for individual doctors and nurses. As high achievers, many of us enter health care believing we can solve any problem if we only try hard enough. We are applauded for always going the extra mile and can develop a superhero mentality that makes it difficult to ask for help.

A national survey published annually by Medscape reveals that 79 percent of physicians reported that their burnout started before the pandemic. So, burnout is not something that happened just because of the pandemic. In fact, at Weill Cornell Medicine, we didn’t see burnout skyrocket and well-being plummet during the peak of the pandemic, despite the intensity and stress of our work during that time. Why?

The pandemic gave many clinicians a profound sense of meaning and belonging to a community, which research shows can play a protective role and inoculate people, to some extent, from burnout. But we do have data indicating that the incidence of post-traumatic stress disorder, anxiety and depression during the pandemic increased not only in the general population but also among health-care providers. Addressing that, and addressing burnout, involve destigmatizing and normalizing mental health care, while embracing the idea that just as everyone needs a primary care physician, perhaps everyone — health-care workers included — needs a mental health care provider.

In typical academic medical centers, burnout rates hover at around 40 percent. Our rates are slightly lower at Weill Cornell Medicine, but we still have a lot of work to do to make sure our clinical care teams feel valued, receive appropriate feedback and support from supervisors, have the opportunity to experience ownership and growth in their jobs, and have resources available to lessen the burden of electronic health records. More than anything, our surveys tell us that our physicians want to be part of strong, high-performing teams. Nurses have been earlier to recognize that a “go it alone” mentality is unsustainable. Physicians, due to traditional medical training that encourages individual achievement, have more room to grow in this area.

Humans don’t like uncertainty, and we went through more than two years of extraordinarily uncertain times during the pandemic. We all have developed a variety of tools to cope with the stressors of daily life, such as sticking to certain routines. The pandemic depleted those toolkits, potentially requiring us to resort to tools we’ve never used before — or to suffer the consequences.

Some of Weill Cornell Medicine’s own researchers, including Dr. Benjamin Zebley, an assistant professor of psychiatry, and Dr. Conor Liston, an associate professor of neuroscience and psychiatry, conducted what is probably the largest naturalistic study of stress among U.S. health-care workers throughout the pandemic. For this, they tracked longitudinally symptoms of anxiety, stress, depression, sleep issues and social isolation among NewYork-Presbyterian employees, discovering, not surprisingly, that signs of distress kept going up throughout the pandemic, almost in a cumulative way. But the big takeaway from the study — the real punchline — is this: more than any other factor, social isolation put our health-care workers at risk of significant anxiety and depressive symptoms.

This finding aligns with another major study published recently by researchers at the University of Michigan, looking at mental health symptoms of first-year training physicians (interns) nationwide. This one, too, identified social isolation as the biggest risk factor for anxiety and depression. What, then, can these studies tell us?

They tell us that the best hedges against stress, anxiety and depression are to decrease isolation and instill social support among our staff. They suggest, too, that a key component to wellness involves a feeling of “belonging” to a team and that you are part of something bigger than yourself. Wellness is not a single-dose treatment, but requires an attitudinal shift to conceptualize it as something to work at and surveil continuously, as part of our daily life. Just as we need to exercise daily, we need to incorporate routines such as mindfulness and mental health checks.

For health-care workers, some degree of stress will always exist because of the nature of our jobs. That’s why we’re continuing to offer CopeNYP, the free, emotional well-being resource and counseling service launched during the pandemic and used by more than 7,000 NYP employees. During the pandemic, we had to do things reactively, but moving forward, we must do things proactively to enhance our own wellness and resilience.

Emergency physicians and, really, all health-care providers were already experiencing increased burnout, even before the pandemic hit. Then suddenly, we were confronted with an unprecedented health crisis — one that pushed our hospital resources to a breaking point.

As emergency clinicians, we’re always available and on the front line. This unique role was challenging during the height of the pandemic because we not only treated emergency room patients but also served as the safety net for all patients, given that medical and primary care practices were largely unavailable. As providers, we were keenly aware of the inherent risks we undertook and posed to our loved ones — a reality compounded by seeing our colleagues grow ill or even succumb to the virus. It was a tough time.

Several years before the pandemic, we had established a wellness and peer support program to combat rising burnout. Our nationally recognized program centers around peer support, which is a critical component, given that our peers can simultaneously offer a different perspective and understand what we’re feeling. We implemented a three-pronged peer support program for faculty that involved group discussions about wellness-related topics; one-on-one peer support for any staff member experiencing a patient death or bad outcome; and social outings outside of the hospital.

In the clinical environment, it’s important to create calm spaces and institute formal breaks from clinical work to allow for protected time to relax or eat a snack or meal. We redesigned our faculty offices and common areas with this in mind. Likewise, it’s especially critical to alleviate administrative tasks. We live in a culture of information overload, where health-care providers receive a high volume of messages, alerts and texts that can take us away from patient care. Although electronic health records connect patients with clinicians, we need to be mindful of “alert fatigue” by monitoring the well-being of our clinical staff on the receiving end of messages and texts. We also need to make documentation easier, which may include virtual scribes, a dictation software or some other technological solution.

Without question, one cannot effectively take care of others if one cannot take care of oneself. We must support and meet the needs of our frontline staff, so they can provide high-quality care for our patients. A robust wellness program, such as the one we’ve created in our department and continue to build, facilitates exactly that.

Portraits: Rebecca Clarke