In view of the COVID-19 crisis, CSPL is committed to providing short and practical papers, podcasts and possibly webinars. All will be available on the CSPL website in a special COVID-19 section. Useful national and international links will also be available on the website. Info overload is the last thing we need, so we will keep it short, minimal, and although everything will be evidence-based, we will keep references to an absolute minimum. If you have specific needs, please let us know. Stay well, and be kind.

Your CSPL

Ensuring Our Own Wellbeing as We Care for Others During the COVID-19 Crisis

Dr. Mamta Gautam, MD, MBA, FRCPC, CCPE, CPE

As individual physicians, we can practice strategies to increase and maintain our personal resilience. Feeling stress does not mean we are not coping well or not able to do our job.  In fact, it is a normal human response, and may be useful in allowing us to function during this difficult time.  The important thing is to manage it effectively so that stress does not become distress.  Using the 5 C’s of Resilience framework (1), there are tangible things we can do to remain well.

1. Control: There is a lot of uncertainty, with the COVID-19 situation changing daily, even hourly.

  1. Can control: We can identify what we can control – such as following guidelines, enjoying time at home, being positive and kind – so we can focus on this.
  2. Cannot control: It is helpful to identify things that we cannot control – such as trying to predict what is ahead, knowing how long this will last, or whether other people are practising social distancing – so we can let go of them.
  1. We can control how much time and energy we spend thinking about COVID-19.  It is helpful to limit your time on social media and be discerning about what you read, and for how long.  Stick with trusted sources of information such as your hospital or clinical department, your medical association, Public Health Agency of Canada, Government of Canada COVID-19 Updates, and reputable news sources such as CBC or the New York Times.

2. Commitment: The work we do is difficult and intense.  Yet we have made a commitment to this vocation.  We also need to balance this with our personal commitments.

  1. It is not easy to establish meaning in our work when it feels overwhelming and futile, when we are frustrated that we do not have enough resources to do our work properly, or when we are dealing with losses.

3. Connections:  We cannot do this alone.  We need to establish and maintain caring connections, both at work and in our personal lives.

  1. In your workplace, take time to say hello to your colleagues, ask how they are doing.  Offer to help as needed, and reach out to ask for help. Share resources and useful information.
  2. Upon arrival at home, ensure that you have sanitized and decontaminated from work effectively, taking off your clothes from work, washing them in hot water, showering, and dressing comfortably to spend an evening at home.
  3. Plan to spend time together with your family after work, enjoy family meals together, watch movies, dance together, play board games.
  4. If you live alone or are in isolation, stay connected to family and friends by phone calls, emails, text, Skype or Zoom.  In view of the COVID-19 crisis, CSPL is committed to providing short and practical papers, podcasts and possibly webinars. All will be available on the CSPL website in a special COVID-19 section. Useful national and international links will also be available on the website. Info overload is the last thing we need, so we will keep it short, minimal, and although everything will be evidence-based, we will keep references to an absolute minimum. If you have specific needs, please let us know. Stay well, and be kind.
  5. We are being asked to practise social distancing, but this does not mean social isolation.  Reach out to people you love and who love you.  Reach out to those you know are alone and isolated.  Stay connected as above.
  6. Offer to help others if you can – buy groceries, pick up something at the pharmacy, listen, reassure.

4. Calming:  Many of us are experiencing COVID-19-related anxiety and fears and associated insomnia.  You are not alone.  Consider the ABC’s of calming: Allow It, Burn It Off, Calm Down.

  1. Allow your feelings.  It is natural to feel anxiety and a sense of panic, and have fears such as: being afraid to treat sick patients; worry about getting sick with COVID-19, passing it on to your family, or worrying about your baby if you are pregnant or nursing; being concerned about being drafted into doing something in medicine that you have not done for a long time or are not trained for; struggling with social distancing when you just want to see family and friends; feeling guilty because you are not in the front lines (or are relieved because you are not); or worrying about your finances. These feelings are normal.
  1. Vent your feelings – Share how you feel with a trusted friend or colleague, in a closed FaceBook group, or join (or start!) a COVID-19 support group.
  2. Write out your feelings in a journal, so you can validate them.
  3. Studies show that if you allow a feeling, and sit with it for 20 minutes, that is long enough to express it, process it and let it go.
  4. Use cognitive therapy to allow and reframe your thinking.
  5. Use gratitude to identify positive aspects and shift away from negative thinking.

b. Burn off the energy.  When we are upset or anxious, we often feel the need to physically burn off energy.     Exercise at home, go for a run outside by yourself, do some housework, do yoga, get up and dance.

c. Calm down.  Now, it may be easier and more effective to use calming techniques.  These can include self-   affirmations, breathing exercises, positivity, gratitude, spirituality, visualization, relaxation exercises, mindfulness   meditation.

d. Use apps to help you calm such as Calm and HeadSpace.

5. Care for self:  We know this is going to be a difficult time.  Self-care is a necessary investment.  When we take care of ourselves, we are better able to meet the needs of our patients, colleagues, family and community. Take breaks.  Pace yourself at work.  This is a marathon, not a sprint.

  1. Nutrition: Eat healthy foods, drink lots of water.  Eat regularly to maintain your energy. Enjoy a moderate amount of alcohol.
  2. Exercise:  Exercise is beneficial for both our both physical and our mental health.  Move your body, do something that you enjoy.
  3. Sleep:  Try to get enough sleep at night, so you have the energy to go back to it the next day.  Establish a bedtime routine, restrict screen time, take a warm bath. If you are having trouble falling asleep, just relax and enjoy resting in bed without pressuring yourself to fall asleep.  Focus instead on what is good about being in bed: having your feet up, your nice pillow, your soft sheets, the lack of responsibility.  Often, letting go of the worry of not falling asleep helps you fall asleep.
  4. Learn to enjoy down time:  Social distancing offers an opportunity to take and enjoy time at home.  Identify activities that you enjoy or want to try now that you have more time: cooking, baking, phoning friends, board games and puzzles, reading, knitting, listening to music, learning something new.
  5. Laugh: Laughter is therapeutic.  Enjoy the COVID-19 jokes going around; many of them are funny.  Tell a funny story.  Look for a chance to laugh out loud; share with people around you.
  6. Remain optimistic.  We will get through this
  7. Be kind.

References:

1. The 5 C’s of Physician Resilience. Gautam M. Canadian Journal of Physician Leadership. Winter 2015.p 24-27.

Dr. Mamta Gautam, MD, MBA, FRCPC, CCPE, CPE is an Ottawa-based psychiatrist, with special expertise in Physician Health and Physician Leadership.  She is a member of the Department of Psychiatry, University of Ottawa, Ottawa;  CEO of PEAK MD Inc; Chair of the OMA Burnout Task Force; and a Board member of CSPL.

This COVID-19 Physician Wellness podcast is part two of the first of a series of podcasts aimed at assisting physicians cope in this difficult time. Dr. Curtis Johnston, Edmonton Zone Deputy Medical Director, and Dr. Debrah Wirtzfeld, Associate Chief Medical Officer, Physician Health, Diversity & Wellness, speak about the impact social isolation and social media can have on wellness.