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Plight of Covid warriors! Can the broken healthcare system be healed?

As the COVID-19 pandemic has swept its way across the country, doctors and other healthcare professionals {HCP) have emerged as the heroes who assist the sick and dying till end  or succumb themselves to the wretched dragon virus unsung, denied basics of food, sleep, rest, protection, wages or access to family . Despite facing physical and psychological challenges, such as physical exhaustion and mental stress and feeling powerless to handle patients' conditions or pile of dead bodies, HCP show amazing resilience, as per a study in Lancet  HCP face enormous pressures during outbreaks due to a variety of factors, including pressures from bureaucrats  and family members of patients, manpower shortages, confusion, discrimination, isolation, patients with negative emotions, and burnout. These pressures can lead to mental health problems such as stress, anxiety, depression, insomnia, denial, anger, and fear, which not only affect HCP attention, understanding, and decision-making ability, but could also have a lasting effect on their physical and psychological wellbeing.  A study reported the following: 50.4% depression, 44.6% anxiety, 34% insomnia, and 71.5% distress. Failure to support healthcare workers in a crisis like this, can erode their “wellbeing and resilience,” leading to chronic burnout. Some healthcare workers could leave the profession, be absent more often from work, or develop Post-Traumatic Stress Disorder, and exacerbation of any preexisting mental health conditions.

Furthermore, HCP are human like the rest of us, and under extreme stress, they could be prone to making mistakes — which could lead to worse outcomes for patients. While it's too early to truly quantify the effect, preliminary research  highlights the mental health risks involved.  It may be interesting to know that HCP treating COVID are not starting with a baseline of zero. They had super- elevated depression, suicide rates and burnout even prior to COVID.  They agonized over the prospect of running out of oxygen or ventilators and having to withhold care from the dying older people. Many doctors, who practiced another specialty, were put on duty in ICU, outside of their field. They took on grueling shifts, with no sense of when the outbreak would crest. Burnout was brutal. They slept in hotels, isolated, to protect their families, or went home each night, and worried about putting their families at risk.

Mental health issues are common among HCP and patients

Feeling of loneliness has been associated with poor sleep, depressive symptoms, and suicidal thoughts and behavior. Additionally, research has demonstrated that feeling socially isolated is associated with higher levels of psychological distress, low energy and grogginess.

A typical HCP in COVID care is expected to wear double exam gloves, an isolation gown, an N95 mask with a plastic face shield or a PAPR, which is a powered air-purifying respirator.  A PAPR has a hood that looks like it belongs to a “moon suit” and is attached to a pack that sits on the waist. By using the N95 with a face shield or wearing the PAPR, they are protecting the mucous membranes of eyes, nose and mouth. As they go home or another facility for rest, they have to i)Put all the items that they wore that day straight into the washing machine ii)Leave shoes outside iii) Take a shower before getting close to family or any pets iv) Leave backpacks or other items they had with them outside or wash them thoroughly. Some may resort to alcohol drinking, which may seem like a quick fix for angst, but it can actually increase anxiety and depression in some of them. 

Thorny road to medical career?

There is probably no way to completely eliminate the itinerancy that medical training demands. A nomadic lifestyle is essentially inherent to the process of becoming a doctor. Geographic flexibility is required to overcome the tough competition for medical admission. Displacement continues into postgraduate training. The constant moving inherent in  medical education alienates young doctors from their families, patients, and communities. Medical training is no bed of roses. It entails  throwing away prime of life holed up in the library or wards, taking call endlessly on weekends and holidays. Even to after getting  medical degree or postgraduate diploma or spend long years as consultants the problems galore continues, making it a tough and bitter profession. Sixty-five percent of physicians in a survey were found to consider an early exit from medicine. Why? 

The average physician completes training, looks around, and sees his or her profession in complete shambles. Burnout is rampant. Doctors are committing suicide daily. Many seem to be miserable over their lack of autonomy and loss of standing. Overall, one senses great disappointment and anger among physicians about what many perceive to be increasing disregard for the tremendous amount of hard work during training and  sacrifices while on duty. Devaluation appears to be happening on many fronts especially after application of Consumer Protection Act and Clinical establishment Act. The use of the term "provider" instead of "physician," is offensive to doctors. Reimbursements from commercial payers are declining. Health policy "experts" unfairly blame rising healthcare costs on physicians and have pushed legislators to find ways to lower physician compensation further. There are fewer physician meeting spaces in hospitals, such as doctors' lounges or physician dining rooms, which used to serve as important spaces for physicians to commiserate and collaborate. If doctors complain about such devaluation are labeled "greedy doctors" by politicians, the press, and even fellow physicians."Private practice is no longer about profitability. It's about financial sustainability." In addition, the costs of purchasing premises, equipments, maintaining health records and running a staff to deal with authorization and billing issues have made private practice extremely difficult. Many physicians are crying for help and nobody is listening. Some sadly feel that the only way out is to end their lives. What is driving brilliant doctors to the edge?  We do not support the alleged loot by corporate hospitals, who charge astronomical amounts from COVID cases!

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