Infectious Disease

Neurologists manage the “challenging” care during COVID-19

Source / information

Source:

Healio interviews

Disclosure:
Ayele does not report any relevant financial information.

ADD SUBJECT TO EMAIL ALERTS

Receive an email when new articles are published on

Please enter your email address to receive an email when new articles are published on . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If this problem persists, please contact [email protected].

Back to Healio

Qualitative interviews with community neurologists highlighted four main topics related to the impact of the COVID-19 pandemic on this group, highlighting “the unusual environment” in which these providers operate.

Issues identified included the challenges of the political climate, lack of support for new models of care, practicing “on the front line of suffering” and self-care for clinicians. Taken together, the COVID-19 pandemic and “pandemic policy” created an environment “that made caring for community neurologists a challenge”. Roman Ayele, PhD, MPH, a research scientist at the Denver-Seattle Center of Innovation, Rocky Mountain Regional VA Medical Center in Colorado, and Assistant Professor Adjunct at the University of Colorado, Denver, and colleagues wrote.

Healio Neurology spoke with Ayele to learn more about the results and the suggested strategies to deal with these issues.

Healio-Neurology: What prompted this research?

Ayele: We interviewed clinicians as part of a larger, multi-site, randomized clinical trial providing community-based, integrated, outpatient palliative care for patients with Parkinson’s disease and related diseases. When the changes related to COVID-19 were introduced, we realized that clinicians were breaking new ground. However, since we had anecdotal data, we decided to investigate this further by interviewing clinicians directly. We have added additional questions to our interview guide, focusing on COVID-19, to help understand its impact on clinicians, their patients, and caregivers.

Healio Neurology: Can you discuss the four main topics that emerged?

Ayele: The following describes the four main themes that have emerged.

1) Challenges of the current political climate (before the 2020 US presidential election)

Community neurologists described observing the intersection of the COVID-19 pandemic and related policies that affected their practice. Clinicians described fluctuating patient confidence. They linked this to patient skepticism about COVID-19 and the current political climate in the US, which is negatively affecting trust between patients and doctors. There was serious concern that patients might not trust them. One clinician said, “I think the question I would be interested in is, are you currently trusting providers less because they sometimes just seem skeptical about COVID-19? I don’t know whether this has turned into skepticism among doctors too. It’s definitely political; that’s for sure.”

They also talked about patients living in institutions as being extremely isolated, which creates more stress and worry for these patients and their families. One clinician even said, “… you really felt like prisoners for weeks or months.”

2) Lack of support for new care models

Clinicians talked about using telemedicine as an opportunity, but also as a challenge, because they tried to find out “how” together with their patients. This led to frustration and feelings of burnout and being overwhelmed. They also treated elderly patients who were not used to having serious conversations about their health through technology. One clinician said, “… people who are older … find it very unnatural to have important conversations over a digital medium.” There was no additional support for telemedicine, although institutional support would have made this transition smoother.

3) Be on the forefront of suffering

Clinicians had the front row seat to watch human suffering, which created a heartbreaking environment. It felt like the patients were just giving up and there was hopelessness. One clinician spoke about he believes there have been more non-COVID-19 deaths because people have just given up: “I feel like a lot of people are just sad and kind of given up. You feel like, ‘Well what’s the point?’ It’s kind of difficult because you care about these people. “

4) Clinician Self-Care

Clinicians described a lack of self-sufficiency during the pandemic where they couldn’t check out to take a break because everything was closed. Her usual means of self-care, such as socializing, vacation, and more, weren’t an option, so they kept working. That in turn led to a burnout cycle. They also missed the exchange between colleagues, which increased their isolation.

Taken together, the topics capture the unusual environment in which community neurologists practice, the lack of trust among doctors in some patients, patient and professional isolation, and opportunities to support quality care.

Healio Neurology: What were the main messages of your results?

Ayele: Community neurologists suffered personal and professional losses, such as moral injuries due to a lack of trust, during the pandemic. Despite efforts to provide high quality care to patients through telemedicine, the technology has not been a panacea. Telemedicine and its rapid adaptation have even placed an additional burden on clinicians. In addition, the existing pre-pandemic burnout was made worse during the pandemic.

Healio Neurology: Based on your conclusions, what specific strategies would you suggest that care efforts are needed?

Ayele: Our results call for better structural strategies to support neurological staff during the pandemic and beyond on an individual, organizational and societal level. We need a multi-pronged approach to curb burnout, improve neurologist wellbeing, and connect clinicians to resources that impact patient care. At the societal level, extensive resources and funding are needed to improve mental health programs and provide opportunities to mitigate the culture of silence when discussing and addressing the wellbeing of clinicians. At the organizational level, efforts should be made to combat clinician isolation by building an infrastructure that allows clinicians to collaborate with colleagues and deal with moral injuries in order to reduce burnout and its associated negative impact on patient care. At the individual level, burnout in neurology should be counteracted by identifying and providing resources that are tailored to their needs.

Healio Neurology: Is there anything unusual or surprising about the results that you would like to elaborate on?

Ayele: Political rhetoric influenced the doctor-patient relationship. Clinicians find it difficult to maintain therapeutic relationships with patients during a politicized pandemic and the spread of misinformation, and feel that there is a lack of support for new models of care introduced in response to the pandemic.

Reference:

Ayele R. et al. Neurology. 2021; doi: 10.1212 / WNL.000000000012363.

ADD SUBJECT TO EMAIL ALERTS

Receive an email when new articles are published on

Please enter your email address to receive an email when new articles are published on . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If this problem persists, please contact [email protected].

Back to Healio

COVID-19 Resource Center

COVID-19 Resource Center

Related Articles