Less Fear, More Fury as Delta Strains Hotline for Doctors

Often, doctors call from cars. They’re on their way home from a brutal shift, or on their way in for the next one. Sometimes they weep, like a critical-care physician who spoke recently with Elissa Ely, a Boston-area community psychiatrist.

The spouse of a dying patient had insisted a transfusion be “only unvaccinated blood.” Horrified at such a nonsensical demand, the doctor needed to ask: “Am I insane?” Ely offered reassurance: The doctor wasn’t crazy — the situation was.

Ely and her fellow volunteers on the national Physician Support Line are having such conversations more than ever amid the delta surge. The helpline has been offering emotional support to thousands since the pandemic began. Lately, the tenor of the calls has grown angrier, more tinged with hopelessness.

“What I’m hearing is people calling in and saying, ‘I don’t see the light,’ ” Ely said.

Mona Masood, the Philadelphia-area psychiatrist who founded the Physician Support Line in March 2020, said the doctors who called in during past surges often needed the psychiatric equivalent of battlefield medicine. “We’re patching them up and we’re sending them back in,” she said.

Less Fear, More Fury as Delta Strains Hotline for Doctors

Now, “when we get calls, it is what in psychiatry we call ‘escape fantasies’ — it is ‘I want out,’ ” she said. It stems not only from exhaustion but from the sense that “we’re all in this together” has been lost. At the same time, they “have gone from being heroes to being called villains” by patients who oppose the vaccines, who demand unproven medications or who just want to take out their COVID-related stress on their doctors.

The hotline, which counts 800 psychiatrists around the U.S. among its volunteers, doesn’t keep data on how many callers say they plan to quit, but a Medscape survey found the pandemic impelled 1 in 4 doctors to consider early retirement. The Medical Group Management Association reports that the pandemic has amplified feelings of isolation, disengagement or being undervalued. Its survey found the pandemic prompted 15% to consider leaving medicine altogether.

“I can’t tell you how many people are plotting to get out,” said Wendy Dean, a psychiatrist who co-founded the nonprofit Moral Injury of Healthcare.

Medicine has long been known as a profession with high rates of anxiety, depression and even suicide. There’s no definitive data yet on the pandemic’s mental health effects on health-care staffers, but the Covid era clearly has exacted a toll, including the high-profile suicide of New York physician Lorna Breen.

Less Fear, More Fury as Delta Strains Hotline for Doctors

Few doctors are quitting now, because they don’t want to abandon their colleagues, Dean said. But she is increasingly hearing doctors say, “We are breaking. And we will stay in the trenches until the war is over. But then we’re going to get out.”

The helpline is a boon to doctors in distress, Dean said, because many don’t feel safe disclosing at their workplaces that they’re struggling emotionally.

Last week, she was invited to lead a discussion for helpline staffers — who are themselves getting weary — about the challenges of “compassion fatigue,” particularly during a surge dominated by people who chose not to be vaccinated. To a psychiatrist, it’s not surprising to see the earlier-pandemic sadness and anxiety morph into anger and frustration.

The discussion with Dean included how to cope with rising feelings of hopelessness and helplessness, Masood said, along with the importance of maintaining strong emotional boundaries while connecting with patients.

Dean described those limits as “our emotional PPE” — needed as a last resort, for self-preservation. 

The helpline has taken calls from more than 3,000 doctors, Masood said, and aims to continue after the pandemic. Though concerns about physician mental health have been rising for years, she said she couldn’t have started the project before Covid-19: “We were too defensive. We do not allow vulnerability. We’re too intellectualized. But the pandemic kind of broke that all open.”

And it’s sure to continue highlighting the need for such support. Ely, the psychiatrist, volunteers at least twice a week. She compares what she’s hearing from doctors to the classic Samuel Beckett line, “I can’t go on, I’ll go on.”

In their cases, she’s hearing, “I can’t go on, I can’t go on — I’ve got to go now, because I just pulled into the driveway of the hospital.”

©2021 Bloomberg L.P.

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