“We as physicians are a special breed of people. We become physicians because we have a general willingness to give and help others. We sacrifice our own comforts to become physicians, and the duty that we have towards our community surpasses our self-care most of the time. But at times like this we have to try to balance our selfless care with our care of self, so that we can continue to serve for a longer period of time.” -- Dr. Simran Singh”

Editor’s Note: Auburn’s Harbert College of Business recently contacted members of our Physicians Executive MBA (PEMBA) program to find out how the front lines of health care delivery have changed during the COVID-19 pandemic. In the following article, a psychiatrist discusses the additional pressures doctors are facing.

In the face of COVID-19, we see physicians on the front lines working to treat patients suffering from an illness of extraordinary strength and reach. Amid the pandemic, the perception of physicians and other healthcare workers as intrepid heroes and warriors has only deepened in the public’s consciousness. 

Now more than ever, physicians are viewed as far stronger and more resilient than the rest of us. These men and women witness horrific scenes every day, struggling to save as many lives as they can.

But Dr. Simran Singh, a board certified psychiatrist in California, said a crucial piece of the picture is missing: the vulnerable human facing seemingly insurmountable stress.  

Dr. Singh comes from a family of physicians and is surrounded by fellow physicians every day. As a psychiatrist who specializes in physician well-being, she has gained knowledge and keen insight into what they are experiencing. The stress that just goes with the job is not something that they talk about, she said—and that is a big problem. 

Physicians carry a strict, heavy sense of responsibility, where not following the rules means getting into trouble. 

“In general, they are trained in a cocoon going forward, right from their medical schools, to follow the direction of colleagues and seniors. And their ability to think out of the box or adapt is somehow clipped very early in their career,” said Singh, who is affiliated with multiple hospitals in the Bay Area near her Mountain View, California, home.

In many cases, a physician’s foremost sense of confidence lies in his or her ability to function as a physician, she said. Work becomes life and forms one’s sense of self. For instance, a surgeon runs into an unexpected problem—one that is out of anyone’s control—and a bad, or even tragic outcome results. That surgeon, like all physicians working under duress, becomes extremely critical of herself, even questioning her abilities and seeking solutions.

Add a pandemic to the mix, and stress levels rise exponentially. Not only is there a deluge of patients in critical need; now physicians’ health, and by extension the health of their families, is at stake.

And roles have suddenly transformed. Physicians who in the past have seen little action on the front lines of medicine are abruptly called to serve and collaborate with other specialties.

“Suddenly, they (physicians) have been called into action, and they have not seen that kind of acute event take away so many lives. It’s an emotional burden, it’s a physical burden, it’s a fear factor.””

“Now, they are collaborating with their ICU colleagues, advising, predicting outcomes, trying to figure out who’s dying and who’s not,” Singh said. “Suddenly, they have been called into action, and they have not seen that kind of acute event take away so many lives. It’s an emotional burden, it’s a physical burden, it’s a fear factor.”

Another layer forms: there is a lack of needed supplies—masks, ventilators, personal protection  equipment. Physicians can foresee worst-case scenarios, calculating far in advance the essentials they will need. Again, there is loss of control. The fact that these supplies may not be delivered adds more stress.

As these layers of stress accumulate, physicians’ highly touted resilience fades away. 

“I have found an increase in my requests from physicians who have reached out to me in hallways, in emails, to say, ‘I can’t do it,’” Singh said. “With each type of stress, they spend more energy to try to cope. It really breaks down the physician, and they need a lot of emotional support and encouragement.”

She said emotional support and social structure are sorely lacking in most medical communities, with physicians hesitating to reach out to colleagues. Either they have not formed close relationships with their fellow doctors or, if they have, the prospect of showcasing their distress is out of the question.

“When physicians reach out to colleagues to say, ‘How are you doing?’ the answer is most likely, ‘I’m great. I’m OK,’” Singh said. “They don’t say, ‘I’m having a hard time because three of my patients died today.’ They believe they are supposed to help others without any outside help. They’re supposed to be self-sufficient.”

Singh said that when physicians have reached out to her, they’ve done it indirectly, asking, for instance, if she can direct them toward helpful coping information online. It is rare for them to request a private talk, even for 15 minutes, because in the physician’s world, transparency equals weakness. What if word gets out that they have reached out for help, just to cope with this unfathomable predicament?

“I think the pandemic could create a new enlightening around the physician community. We can look at how this can all wrap into creating a better social structure for our physicians so that when another crisis does happen, they can put those things into action very quickly.””

It’s common for them to believe that the information will leak into the communities and to colleagues, that they are likely to make mistakes, that they will not be seen as strong enough to take care of others. After all, how can they take care of others when they are struggling to take care of themselves?

Singh believes that as devastating as COVID-19 has become, something positive could emerge.

“I think the pandemic could create a new enlightening around the physician community,” Singh said. “We can look at how this can all wrap into creating a better social structure for our physicians so that when another crisis does happen, they can put those things into action very quickly.”

She said members of the medical community are increasingly looking toward helping one another. The intense competitiveness among specialties and individual physicians is fading into the background; a cohesiveness is taking its place. People are smiling at one another, asking about each other’s well-being, about their families’ well-being. From the leadership down, people are seeking ways that they can help; daily updates of equipment, cases and positive notes from leadership are keeping the community of physicians encouraged.

Their focus is to overcome the struggle, to create normalcy amid the unknown. Even if that goes against everything physicians have always believed about themselves and their work.

“We as physicians are a special breed of people. We become physicians because we have a general willingness to give and help others. We sacrifice our own comforts to become physicians, and the duty that we have towards our community surpasses our self-care most of the time.

“But at times like this we have to try to balance our selfless care with our care of self, so that we can continue to serve for a longer period of time.” 

Next in the series: Managing Health Care Delivery in a Pandemic

Learn more about the PEMBA Program.