By Stephen A. Trevick, MD, Northwest Neurology, IL
The emotional impact of the COVID-19 pandemic will be felt throughout society for months and years to come. This impact will come in many guises and patterns throughout medicine and certainly in the acute care of neurocritical care patients.
Resources will continue to be limited and healthcare providers may be reassigned between specialties and units. Our neurological patients will have concerns, often justifiably, that their care is suffering. Each human being has a hierarchy of needs. It is difficult to worry about the future when today is in question, and it is hard to take a broad picture of the strains on a medical system when you yourself are in need.
As providers we are often strained and pulled in many directions, making it all the more difficult to reflect on the perspective of a patient who may seem selfish. Family members and decision-makers will also have these concerns, solidified by visitor restrictions and limited communication opportunities with providers.
These concerns are valid even in cases where nothing could have been done differently prior to the COVID-19 pandemic. We can anticipate and name this concern for patients and their families if they have not brought it up themselves. Very broad questions such as, “How do you feel about everything going on?” can be confusing in their openness. On the other hand, asking “Are you angry that your care is not as good because of the pandemic?” can seem accusatory and place people on the defensive. Often empathic statements, or “offering statements,” can help open a path in the conversation. Simply stating, “Sometimes, people can be hurt or even angry when trying to understand limitations that currently exist in the hospital” provides an opening for further discussion.
By discussing things openly, we can prevent the degradation of trust. We recommend identifying the concern and focusing on your own understanding of their situation. While very good justifications may be present for visitor restrictions and even rationing of ventilators, it is unlikely to help a neurological patient’s concerns to discuss such reasoning. Instead, refer to these as hospital policies external to this patient and discuss what can be done to provide the best care given current constraints. Additional emotional support of our patients and caregivers may feel like an added burden, but with the appropriate tools and preparation, these efforts can add to the meaning we obtain from providing health care and help to avoid exhaustion and burn out.
By addressing the emotional needs of our patients and families, we can avoid conflict, improve treatment compliance and decision-making and decrease the trauma they experience in the hospital that may have a long-lasting impact that affects the quality of life down the road to recovery. This sort of response also takes some of our own emotional resources. In the long run, these conversations improve our own experience of the provision of medical care.
In order to be successful, however, we need to be aware of our own stressors and capacities. Emotions often conflict within us and may even seem illogical. We may be proud to be able to be part of the solution to the COVID pandemic, while still resentful that this burden has been foisted upon us. And we may feel exhausted and annoyed with our patient’s needs even as we feel empowered to meet them. We will all, at least occasionally, grieve at the loss of what we had before the pandemic and our uncertainty of what will happen next. Being aware and accepting of these feelings will allow us to provide the best care to our patients and to ourselves.