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Regaining balance during ‘reality vertigo’: six insights gleaned from the front-line to manage pandemic-related anxiety
  1. Heidi Allespach1,
  2. Yvonne Diaz2,3,
  3. Joan E St Onge4,5
  1. 1 Family Medicine, Medicine & Surgery, University of Miami School of Medicine, Miami, Florida, USA
  2. 2 Jackson Memorial Hospital, Miami, Florida, USA
  3. 3 Medicine, University of Miami School of Medicine, Miami, Florida, USA
  4. 4 Medicine, Faculty Affairs, University of Miami School of Medicine, Miami, Florida, USA
  5. 5 Graduate Medical Education, Jackson Memorial Hospital, Miami, Florida, USA
  1. Correspondence to Dr Heidi Allespach, Family Medicine, Medicine & Surgery, University of Miami School of Medicine, Miami, FL 33136, USA; h.allespach{at}med.miami.edu

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One month ago, most of us had never heard of ‘Zoom’. One month ago, most of us would never imagine that scarcity of toilet paper, masks or ventilators would become a global concern. In academic medicine in the USA 2 months ago, our reality and focus were on caring for patients, equipping trainees with the skills to become good doctors, working to identify ways to navigate and improve electronic health records (EHR) and systems in order to enhance physician-well-being. However, as we are all now exquisitely aware, previous plans and efforts—our entire reality—has suddenly nosedived at a dizzying pace as we collectively turn our focus to the new reality of COVID-19. Life as we knew it has disappeared in a heartbeat. We now find ourselves on an emotional rollercoaster in the theme park of uncertainty.

No one likes to feel out of control, especially smart people. And physicians are very smart people. Perceiving oneself as out of control creates overwhelming feelings of anxiety and dread. Unfortunately, at this moment in time, uncertainty permeates every aspect of our lives: from what course this pandemic will take, to the future economic repercussions, to concerns about family and colleagues.

We have written previously about the concept of ‘reality vertigo’1 but from a patient’s perspective. This term refers to the idea that receiving a potentially life-altering diagnosis leads to intense perceptual shifts and emotional turmoil. During this turbulent period, it appears that the individual’s entire world view, as well as his or her plans and hopes for the future, are suddenly thrown into question. Depression, anxiety and somatisation of emotional distress may be strongly related to this overall belief that one has completely lost control over his/her life as the result of his/her (diagnosis).1

It could be proposed that our entire healthcare system has just received a life-altering ‘diagnosis’. Working from this idea, we have scheduled regular remote meetings with junior doctors and physician faculty from a wide variety of different departments at our institutions and, by doing so, have gleaned some important insights from our courageous colleagues. The most important message we have gained from our colleagues and trainees is that physicians on the front-lines can pull themselves up from the dizzying tailspin of reality vertigo and restore balance—even during this uncertain time.

Six insights from the front-line

You are not alone

No one should have to decide which patient gets a ventilator, personal protective equipment or other tough choices alone. Senior faculty, colleagues, your institution’s ethics committee, hospital and the healthcare system leadership (Faculty Affairs, Graduate Medical Education, Chief Medical Officers) and others should be beside each physician to offer help in a variety of ways. Hospitals must be transparent and provide information to healthcare providers. Information must be shared frequently and fluidly by leadership. Specific healthcare data can help to restore order and control for physicians. Physicians are natural problem-solvers; their best work stems from hard facts and precise data.

You do not need to be perfect

This is a global learning experience. Everyone is learning as they go. No one has gone through this before. You will make mistakes and when you do, be gentle with yourself and with others. Everyone is doing the best they can while also dealing with their own struggles and anxiety about their patients, families, parents, grandparents, selves. Support one another. Verbalise your appreciation to one another.

Accept that anxiety is the norm now

You will feel bouts of anxiety and irritability interspersed with calm. Faith which switches to fear. Life right now is an emotional roller-coaster in the theme park of uncertainty! Know that even when you get facts and stats (regarding number of COVID-19 cases in the hospital, number of ventilators, masks and so on), you will still not feel fully in control. And uncertainty plus loss of control equals anxiety. Even when there is no immediate threat, the only thing we can control is our own thoughts, feelings and behaviours. This crisis has only served to bring this daily underlying truth to the forefront and, of course, since we all like to feel we are in control, we do not like being so aware of this fact! But it is OK to feel whatever you feel and, like making tough decisions (item #1), you don’t have to, and should not, go through distress alone.

Talk to your family

About the tough topics you have avoided in the past. First, reassure them you will be OK and are doing everything you can to protect them and yourselves. Normalise family's anxiety (‘everyone is feeling anxious right now and that's OK because this is a very new and even surreal experience for most’). Teach your family (and adopt this idea for yourself) that thoughts create feelings and, when we think about the ‘What Ifs’ of the future, we feel worried/anxious. Encourage family to get in touch with what their ‘Wise/Higher Self’ (the part that has gotten them through difficult times in the past) would tell them, or, if they are spiritual, what God/Higher Power/Allah would say RIGHT NOW to comfort them (ie, ‘This too shall pass’, ‘Everything will be OK’, ‘We will get through this difficult time’) and then write those ‘wise’ thoughts down and read often.

For those working on the front-line, now is a very good time to discuss what you would like to happen with your kids if something happened to you. Now is a very good time to tell your loved one what you would like him/her to do if you did get the virus and ended up in the hospital (Should they try to visit? What if they could not?) Do not spend too much time on these difficult conversations but do discuss all scenarios. Make a will. These discussions, and making a will, should happen even when there is not a pandemic…the act of engaging in these dialogues will likely help you to feel more in control (especially if you have young children). At the end of the discussion (remember: thoughts create feelings), end on a positive and very hopeful note. Reassure family (and yourself) that you will all get through this.

Laughter

While this is a very serious situation, use laughter to lighten up (there are some really great memes out there). Laughter can help lighten the burden and dispel fear.

Stay hopeful

When not working, immerse yourself in literature/videos/movies that are positive and inspiring and help you to feel regain a sense of calm. Remember, this is a LEARNING EXPERIENCE. We will all get through this and learn a great deal; this moment by moment, rapidly changing ‘trial by fire’ will make you into a better physician. And the lessons we are all learning—from our mistakes as well as from our successes—will also equip future generations of doctors and healthcare providers to provide better care during pandemics.

Regaining balance and decreasing pandemic-related anxiety after reality vertigo may require day-by-day (or moment-by-moment) practice but this balance can be restored. Our global reality will certainly be altered—for the better—after this storm has passed. But, for now, remember this important message: We will get through this.

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Footnotes

  • Contributors HA was responsible for substantial contributions to the conception or design of this work; drafting the work and revising it critically for important intellectual content and the acquisition, analysis and interpretation of qualitative data associated with this work and for final approval of the version to be published. In addition, she agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. YD was responsible for revising the work for important intellectual content and the acquisition and for final approval of the version to be published. In addition, she agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JESO was responsible for revising the work for important intellectual content and the acquisition, assisting in interpretation of qualitative data and for final approval of the version to be published. In addition, she agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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