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Melanie Cole: This is the Children's Mercy Kansas City Podcast on COVID-19 dated April 28th, 2020. Welcome to Transformational Pediatrics with Children's Mercy, Kansas City. I'm Melanie Cole and today we're discussing pediatric provider wellbeing during the COVID-19 pandemic. Joining me is Dr. Jennifer Bickel. She's a Pediatric Neurologist and the Medical Director of the Center for Professional Wellbeing at Children's Mercy, Kansas City. Dr. Bickel, I'm so glad to have you join us and what a great topic. I think it really applies to providers all over the country, really all over the world, but we're talking about pediatric providers. Since the COVID-19 pandemic has created this unprecedented work environment for pediatricians. Overall, how are they and pediatric specialists such as yourself handling the pandemic on a personal and professional level?

Dr. Bickel: You know, the word unprecedented is used so much, but there's really no other better word about what we're all going through and pediatricians specifically, you know, it's a bit of a unique situation as children are not as terribly affected by COVID as adults, but still many of us are going through drastic changes in our practices. We're also not able to see all the patients that we want to see due to social distancing or stay at home orders. And some practices are struggling to stay afloat.

Host: Certainly true. So when we talk about a pandemic or a health crisis situation like this, how does that impact the physical and mental health of pediatric specialists and providers? You just mentioned that some people are having issues with their practices. Tell us what's going on as far as mental health.

Dr. Bickel: Yeah, absolutely. You know, one of the things is that nobody becomes a pediatrician without the deep desire to help people. There's a definite sense of meaning that we all get from our work, and when there's a limit to how we can help people, either it be not through being able to see patients or through illnesses that we can't help. This really can cause moral injury. It can lead to insomnia, it can lead to excessive worry. And really, I think that most physicians are experiencing grief on many different levels right now.

Host: It's really such a hard situation and as you said, unprecedented is really the best word. And now with social distancing and working from home, they bring their own unique challenges to healthcare providers. How do you recommend physicians and providers deal with a lack of patient and even peer contact?

Dr. Bickel: You know, it's a great question because I think that so many of us get energy, that our buckets are filled by the care that we give our patients as well as our colleagues, right? That we usually rely upon each other quite a bit and so during this time, our typical channels of support have been disrupted. One of my favorite things that I've heard is that we should call it physical distancing instead of social distancing. We should still be doing our best to maintain those social connections however we can virtually or whatnot. The other thing too is that we typically have. in our modern culture, a fairly high threshold for when we call someone and now is a time when we should be considering communicating less through email, less through text, and more through phone calls, more through video calls in order to have more of those human connections. I'd also say that a lot of times people don't want to bother each other during this time. And I think that we really have to make sure that we're in a mindset to understand that we are not a bother to be able to talk to someone. Instead. It's an opportunity to be able to share how we're all getting through this. It's important that we all share our vulnerabilities with each other.

Host: It certainly is. And so then how do you measure or track how physicians are doing in this type of situation? Is there a way that you're keeping track of mental health issues and provider issues at this time?

Dr. Bickel: You know, that's a great question. Again, you know, one of the things is that there are absolutely burnout surveys. There's engagement surveys, but a time like this, what we're doing at children's mercy at least is that we have a team of about 30 psychologists, social workers and chaplains who are leading support groups with our employees. They're also leading meditations and they're doing wellness rounds in the PICU and in the ED. And through that system we've got kind of this funnel of information from how our doctors and nurses and other employees are doing on the front line. And that's really helping to feed how our executive team is serving the needs of our people.

Host: So then tell us, Dr. Bickel some warning signs that a problem is developing. What are some coping mechanisms that physicians and providers can employ? Tell us about both of those things. Because they really go hand in hand.

Dr. Bickel: Physicians typically have a culture of, I can handle this, or others before me. And really even just the idea of somebody who consistently sacrifices their own needs to help other people puts themselves at a higher risk of burnout and a higher risk of problems. And so one of the things is that I think that we need to really lower that threshold for when we need to take care of ourselves. A lot of times physicians have a tendency to wait until it was markedly severe. As a matter of fact, an alarming amount of physicians who commit suicide have never sought mental health services. So I think that the very first thing that we need to really sort of understand is that it is ethical and necessary to take care of ourselves even at the very right, not waiting until the depression is so bad that we can't get out of bed. But instead really sort of at that very first sign of I'm stressed, I don't feel good, I need more sleep. What are some of the things that people can do for it, now is a time where healthcare workers have received free opportunities for different apps that are really pretty good, Unwinding Anxiety, 10% Happier. And another one's specifically for insomnia is available for organizations called Sleepio, which can help with the insomnia that's becoming fairly rampant during these times. I think that what we already talked about as far as communication with peers is incredibly important as well.

Host: Well, it certainly is. And as you say, self care, and really recognizing that none of us are infallible and exercise and eating healthy. And all of these things can come into play. So as they do, what should hospital or practice leaders be mindful of in this outbreak environment as it relates to their staff? Dr. Bickel, what changes do you feel are needed to better support staff in an outbreak environment such as this?

Dr. Bickel: I think that when we approach the problem of COVID, you know there's a lot of discussion around PPE, there's a lot of discussion around social distancing. There's a lot of discussion around those aspects. And I think that anything that we can do to bring in wellbeing as an essential part of the conversation as well. As a matter of fact, I would say that, you know, at least with our staff, they're more at risk of their wellbeing being injured then physically from COVID right now. And so what does that mean? It means that we have to include it in all of our leadership discussions. You know, one of the small things that we did here was the COVID leadership team that meets several times a week, starts with a 10 minute meditation so that we can ensure that our leaders are focused and present while making decisions for others and also role modeling this sort of behavior that we need during these trying times.

We're working on so many different mechanisms down from assessing wellbeing at the daily huddles and teaching frontline leaders how to do that. As well as we've got many virtual support groups, guided meditations as well as wellness rounds. Our chaplains just started a 24 hour service line. One of the things about wellbeing is that we have to make sure that we offer many different levels of service for individuals because different people have different needs at this time. Some people need one on one counseling. Some people need an app that they look at. Some people need more intensive psychiatric services that are provided through our EAP. The idea of really supporting a team of, you know, we have almost 9,000 employees and it's incredibly crucial that we set up multi-tiered approach to be able to meet the various needs of our patients.

Host: Such an important topic and before we wrap up, how well do physician practices and hospitals manage staff wellbeing in general, before all of this and before extra measures had to be taken, and please while you're saying that, summarize for us the key takeaway for provider wellbeing in situations like this. And what you want other providers to know about the importance of self care seeking help when needed so that they can care for their patients the best that they can.

Dr. Bickel: Wellbeing is not something that the healthcare system has typically done a very good job at. We've historically thought of wellbeing as being a, let me put it this way, that burnout or mental health problems is an individual weakness and it needs an individual response. But in reality, we know that somebody's wellbeing is directly linked to their environment and that if our environment does not support the wellbeing of our people, of our physicians, of our other providers, of our nurses, then we are not going to have a healthy frontline. And so this is something that, you know, it worries me because overall I don't believe that healthcare workers were in a very good state going into this. And so it's even more crucial now that we pay attention to it and really bring it into the dialogue as much as possible, as well as ensure that we develop leaders that assess wellbeing, that don't look just at RVU productivity, but also are skilled in how to create environments that promote wellbeing.

One of the things that I often struggle with when it, when it comes to wellbeing is the fact that most people, you know, especially physicians, are aware of what they need to do to be able to do wellbeing, you know, in order to be well, they're aware of the healthy living, they're aware of the exercise, they're aware of the sleep, they're aware of counseling, they're aware cognitively of the different benefits. But, but often there's that gap of recognizing that I should be doing that or that it could help me. And I think that really what I want docs to really know is the fact that it is unethical to not take care of yourself. Your wellbeing is directly related to the wellbeing of your patients, directly related to the wellbeing of your team. They look to you as a leader. And so if you are not taking care of yourself, your other team members will not take care of themselves. And if you're not taking care of yourself, you're more likely to make a safety mistakes. You're more likely to burn out. And so it's really about knowing that when I take this 30 minutes of time for myself, that it is not an act of selfishness, that it is actually something That you are doing in order to help those around you.

Host: Very well said, Dr. Bickel, that is excellent advice for other providers. Thank you so much for joining us today and sharing this important information. It's so needed at this time. This has been Transformational Pediatrics with Children's Mercy, Kansas City. For more information or to refer your patient, please visit transformpeds.childrensmercy.org. Please also remember to subscribe, rate, and review this podcast and all the other Children's Mercy podcasts. I'm Melanie Cole.