by Martina Schulte, MD Chair of the CMS Committee on Physician Well-being and President of Community Physician Consulting
Featured in the May-June 2020 Colorado Medicine Colorado Medicine.
In the early days of the pandemic, many physicians and other health care professionals were reaching out to colleagues, friends, and online sources in search of answers and guidance to the many questions immediately germane to their lives and practices:
Could I be bringing the virus home to my family?
What protective equipment should I, and my staff, be using in our routine work?
What changes do I need to make to my practice and how I see patients?
Is my primary responsibility to my patients or my family, or both, and how do I navigate this?
Now, there is an abundance, or even overabundance, of information sources and sites for managing one’s practice, transitioning to telehealth (and getting compensated for it), mitigating exposure risks to family and significant others, and caring for oneself. It may feel like too much to sift through and figure out, especially when time is limited and self-care may be taking a back seat to everything else.
But, tending to oneself and one’s needs is even more important than it was pre-COVID-19, given the additional stresses and challenges of the pandemic. So, figuring out how to prioritize self-care and practically make it a reality can become the issue. A framework familiar to physicians, Maslow’s Hierarchy of Needs, offers a simplified guide to approaching one’s self care.
This framework provides a graphic depiction of our needs as human beings, demonstrating the foundational needs at the bottom of the pyramid and our fulfillment and actualization needs at the top. The pyramid structure also illustrates the requirement to meet the base of the pyramid needs first in order to have the capacity to meet the needs at the top.
While many physicians have not had to spend conscious time and energy thinking about the needs at the base of the pyramid, this virus and the pandemic have dictated a refocus on basic/physiologic, safety and connection needs. The time and emotional and cognitive energy that many physicians are now spending on personal and loved ones’ safety is absorbing the space that used to go into addressing other needs. Putting on and removing personal protective equipment multiple times during working hours consumes personal reserve. And after working, many physicians are then spending time upon returning home, changing, cleaning up, and trying to be safe for their families and loved ones.
This newly consuming physical and cognitive load that has accompanied the pandemic and what it means to do physician work now replaces emotional and intellectual space that used to be available for pursuing and investing in the other needs on the hierarchy pyramid. For physicians not in the hospital but experiencing huge disruption to their practices, emotional
and cognitive energy might be going into practice survival.
This is another example of energy being expended for more basic needs, leaving little to none for other needs.
The challenge now is recognizing and allowing this new allocation of energy to basic/physiologic, safety and relationship needs, without self-criticism or judgment. Now is the time in many physicians’ lives when the situation and reality demand that one’s personal and professional focus is on survival, caring for one’s own basic needs, attending to one’s personal safety and the safety of family and community, and staying connected. Now may be the time to acknowledge, allow, and accept that it is necessary and important to spend time and energy in a focused way that does not include the top of the pyramid. Living in this extraordinary time means adapting to one’s own and others’ needs in ways that fit the time. When survival and safety and relationships are again secured, that may be the time to explore and pursue other needs.