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新冠疫情期間,醫(yī)護(hù)人員的心理健康危機(jī)如何解決?

新冠疫情給醫(yī)護(hù)人員帶來了前所未有的壓力,但如果他們?yōu)樽约旱男睦斫】祮栴}尋求幫助,就依然面臨被品頭論足的風(fēng)險(xiǎn)。

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圖片來源:JEFFREY BASINGER—NEWSDAY/GETTY IMAGES

兩年時(shí)間可能讓很多事情發(fā)生變化。我們通常無法真正理解人生的真諦,直到我們不得不在身體和情感上應(yīng)對(duì)一場(chǎng)改變一切的全球疫情。

對(duì)我們的家人而言,變化突如其來。2020年4月,美國(guó)紐約市一位優(yōu)秀的急診科醫(yī)生洛娜·布林自殺身亡。她一直奮斗在抗擊第一波新冠疫情的前線,夜以繼日、爭(zhēng)分奪秒地救治每天大量涌入的新冠肺炎患者。

洛娜醫(yī)生沒有精神病史,但不斷增多的重癥患者,以及嚴(yán)重不足的資源和人手,讓她不堪重負(fù)。如今,有許多醫(yī)護(hù)人員的遭遇可以證明,有很多人像她一樣正在默默忍受著這些壓力。

早在新冠疫情爆發(fā)之前,洛娜醫(yī)生就對(duì)臨床醫(yī)師們的職業(yè)倦怠危機(jī)深有體會(huì)。早在去世的前幾個(gè)月,她曾經(jīng)參與發(fā)表過一篇論文,分析了緩解醫(yī)生壓力的必要性。但在她需要幫助的時(shí)候,卻沒有得到任何幫助。洛娜醫(yī)生曾經(jīng)告訴我們,她認(rèn)為如果自己接受心理治療,就可能面臨失去行醫(yī)執(zhí)照或者被同事排斥的風(fēng)險(xiǎn)。她的不幸是一場(chǎng)本來能夠避免的悲劇,引起了越來越多同行的共鳴。

今年3月,美國(guó)總統(tǒng)喬·拜登簽署了《洛娜·布林醫(yī)生醫(yī)療服務(wù)提供者保護(hù)法案》(Dr. Lorna Breen Healthcare Provider Protection Act),這是美國(guó)史上第一部旨在減少和防止醫(yī)療從業(yè)者自殺、倦怠以及心理與行為健康疾病的法案。

過去兩年,家人們?yōu)橥词迥榷瘋灰?,為了紀(jì)念她,我們成立了一個(gè)基金會(huì),旨在保障像洛娜一樣的醫(yī)療從業(yè)者的身心健康和職業(yè)滿意度。我們希望,未來尋求心理健康治療可以被普遍視為醫(yī)療從業(yè)者強(qiáng)大的標(biāo)志,而不是弱點(diǎn)。

然而,真正理解醫(yī)療從業(yè)者的需求和打破醫(yī)療從業(yè)者接受心理治療所面臨的障礙,仍然有很長(zhǎng)的路要走,這部法律的出臺(tái)只是邁出了第一步。許多人與洛娜醫(yī)生一樣,不愿意接受急需的心理健康治療,因?yàn)樗麄儞?dān)心在工作場(chǎng)所遭到懲罰或排斥、失去行醫(yī)執(zhí)照,甚至失去工作。

目前,在美國(guó)的數(shù)十個(gè)州,醫(yī)療從業(yè)者在申請(qǐng)行醫(yī)執(zhí)照時(shí)都會(huì)被問到與心理健康有關(guān)的侵略性的問題。Medscape最近對(duì)13000名醫(yī)生調(diào)查后發(fā)現(xiàn),43%的醫(yī)生表示由于“不想承擔(dān)向醫(yī)療委員會(huì)披露自身精神狀態(tài)的風(fēng)險(xiǎn)”而沒有尋求幫助以緩解自身的職業(yè)倦怠或抑郁。

我們認(rèn)為,這些州的行醫(yī)執(zhí)照申請(qǐng)經(jīng)常提問與心理健康病史有關(guān)的侵略性問題,可能違反了《美國(guó)殘疾人法案》(Americans with Disabilities Act)。最近的法院判決和美國(guó)司法部(U.S. Department of Justice)都得出了類似的結(jié)論。

《美國(guó)殘疾人法案》當(dāng)然適用于醫(yī)院和醫(yī)療體系,因此醫(yī)療從業(yè)者為什么會(huì)經(jīng)常遇到旨在進(jìn)一步污名化心理健康問題甚至可能危害其就業(yè)的問題?各州醫(yī)療委員會(huì)和議員有能力改變這種狀況。各州監(jiān)管部門必須從行醫(yī)執(zhí)照發(fā)放和更新申請(qǐng)步驟著手,為醫(yī)療從業(yè)者尋求心理健康治療掃清障礙,這是讓臨床醫(yī)生們安心接受治療的第一步。

為了保證醫(yī)療從業(yè)者的安全,醫(yī)院往往會(huì)考慮提供防護(hù)裝備,我們同樣需要承認(rèn),身心健康同樣重要。一名外科醫(yī)生不會(huì)只戴著一只手套走進(jìn)手術(shù)室。醫(yī)療從業(yè)者已經(jīng)承受著過重的壓力,還要面臨人手不足的問題,為了保證他們能夠繼續(xù)為我們提供醫(yī)療保障,我們應(yīng)該為他們提供所有必要的支持和工具。

一個(gè)廣泛的聯(lián)盟組織正在合作研究令人激動(dòng)的新途徑,使醫(yī)療從業(yè)者也可以獲得系統(tǒng)性幫助。最近,國(guó)家地理(National Geographic)頻道的紀(jì)錄片《第一波》(The First Wave)備受歡迎。這部紀(jì)錄片記錄了新冠疫情初期的混亂以及公眾、患者和醫(yī)護(hù)從業(yè)者所展現(xiàn)的人性,用講故事的方式激發(fā)了對(duì)于支持醫(yī)護(hù)從業(yè)者身心健康的討論,包括鼓勵(lì)各州醫(yī)療委員會(huì)在行醫(yī)執(zhí)照申請(qǐng)中限制與心理健康有關(guān)的問題。

對(duì)于整個(gè)醫(yī)療體系和行業(yè)領(lǐng)導(dǎo)者而言,為了做出實(shí)質(zhì)性的改變,“竭盡全力:醫(yī)療從業(yè)者身心健康優(yōu)先”(ALL IN: WellBeing First for Healthcare)計(jì)劃能夠幫助培養(yǎng)工作者身心健康優(yōu)先的職場(chǎng)文化,該計(jì)劃提供的五個(gè)循證措施應(yīng)該在每個(gè)醫(yī)療體系內(nèi)執(zhí)行,為保障員工身心健康提供支持。

我們的醫(yī)療保健從業(yè)者同樣是人,他們正在利用現(xiàn)有的資源,竭盡全力應(yīng)對(duì)這場(chǎng)史無前例的全球健康危機(jī)。

為了照顧好那些用心照料我們的醫(yī)護(hù)人員,我們需要做出更多改變。隨著我們開始理解疫情對(duì)心理健康的影響,尤其是對(duì)醫(yī)療從業(yè)者的影響,我們必須接受這個(gè)不斷變化的新現(xiàn)實(shí),繼續(xù)為他們接受心理健康治療掃清障礙。

我們希望明天更加美好,醫(yī)療從業(yè)者可以感受到他們得到了重視和支持,讓他們重新找回治病救人的快樂。(財(cái)富中文網(wǎng))

本文作者詹妮弗·布林·菲斯特(Jennifer Breen Feist)和J·科里·菲斯特(J. Corey Feist)是洛娜·布林醫(yī)生英雄基金會(huì)(Dr. Lorna Breen Heroes’ Foundation)的聯(lián)合創(chuàng)始人。

譯者:劉進(jìn)龍

審校:汪皓

兩年時(shí)間可能讓很多事情發(fā)生變化。我們通常無法真正理解人生的真諦,直到我們不得不在身體和情感上應(yīng)對(duì)一場(chǎng)改變一切的全球疫情。

對(duì)我們的家人而言,變化突如其來。2020年4月,美國(guó)紐約市一位優(yōu)秀的急診科醫(yī)生洛娜·布林自殺身亡。她一直奮斗在抗擊第一波新冠疫情的前線,夜以繼日、爭(zhēng)分奪秒地救治每天大量涌入的新冠肺炎患者。

洛娜醫(yī)生沒有精神病史,但不斷增多的重癥患者,以及嚴(yán)重不足的資源和人手,讓她不堪重負(fù)。如今,有許多醫(yī)護(hù)人員的遭遇可以證明,有很多人像她一樣正在默默忍受著這些壓力。

早在新冠疫情爆發(fā)之前,洛娜醫(yī)生就對(duì)臨床醫(yī)師們的職業(yè)倦怠危機(jī)深有體會(huì)。早在去世的前幾個(gè)月,她曾經(jīng)參與發(fā)表過一篇論文,分析了緩解醫(yī)生壓力的必要性。但在她需要幫助的時(shí)候,卻沒有得到任何幫助。洛娜醫(yī)生曾經(jīng)告訴我們,她認(rèn)為如果自己接受心理治療,就可能面臨失去行醫(yī)執(zhí)照或者被同事排斥的風(fēng)險(xiǎn)。她的不幸是一場(chǎng)本來能夠避免的悲劇,引起了越來越多同行的共鳴。

今年3月,美國(guó)總統(tǒng)喬·拜登簽署了《洛娜·布林醫(yī)生醫(yī)療服務(wù)提供者保護(hù)法案》(Dr. Lorna Breen Healthcare Provider Protection Act),這是美國(guó)史上第一部旨在減少和防止醫(yī)療從業(yè)者自殺、倦怠以及心理與行為健康疾病的法案。

過去兩年,家人們?yōu)橥词迥榷瘋灰眩瑸榱思o(jì)念她,我們成立了一個(gè)基金會(huì),旨在保障像洛娜一樣的醫(yī)療從業(yè)者的身心健康和職業(yè)滿意度。我們希望,未來尋求心理健康治療可以被普遍視為醫(yī)療從業(yè)者強(qiáng)大的標(biāo)志,而不是弱點(diǎn)。

然而,真正理解醫(yī)療從業(yè)者的需求和打破醫(yī)療從業(yè)者接受心理治療所面臨的障礙,仍然有很長(zhǎng)的路要走,這部法律的出臺(tái)只是邁出了第一步。許多人與洛娜醫(yī)生一樣,不愿意接受急需的心理健康治療,因?yàn)樗麄儞?dān)心在工作場(chǎng)所遭到懲罰或排斥、失去行醫(yī)執(zhí)照,甚至失去工作。

目前,在美國(guó)的數(shù)十個(gè)州,醫(yī)療從業(yè)者在申請(qǐng)行醫(yī)執(zhí)照時(shí)都會(huì)被問到與心理健康有關(guān)的侵略性的問題。Medscape最近對(duì)13000名醫(yī)生調(diào)查后發(fā)現(xiàn),43%的醫(yī)生表示由于“不想承擔(dān)向醫(yī)療委員會(huì)披露自身精神狀態(tài)的風(fēng)險(xiǎn)”而沒有尋求幫助以緩解自身的職業(yè)倦怠或抑郁。

我們認(rèn)為,這些州的行醫(yī)執(zhí)照申請(qǐng)經(jīng)常提問與心理健康病史有關(guān)的侵略性問題,可能違反了《美國(guó)殘疾人法案》(Americans with Disabilities Act)。最近的法院判決和美國(guó)司法部(U.S. Department of Justice)都得出了類似的結(jié)論。

《美國(guó)殘疾人法案》當(dāng)然適用于醫(yī)院和醫(yī)療體系,因此醫(yī)療從業(yè)者為什么會(huì)經(jīng)常遇到旨在進(jìn)一步污名化心理健康問題甚至可能危害其就業(yè)的問題?各州醫(yī)療委員會(huì)和議員有能力改變這種狀況。各州監(jiān)管部門必須從行醫(yī)執(zhí)照發(fā)放和更新申請(qǐng)步驟著手,為醫(yī)療從業(yè)者尋求心理健康治療掃清障礙,這是讓臨床醫(yī)生們安心接受治療的第一步。

為了保證醫(yī)療從業(yè)者的安全,醫(yī)院往往會(huì)考慮提供防護(hù)裝備,我們同樣需要承認(rèn),身心健康同樣重要。一名外科醫(yī)生不會(huì)只戴著一只手套走進(jìn)手術(shù)室。醫(yī)療從業(yè)者已經(jīng)承受著過重的壓力,還要面臨人手不足的問題,為了保證他們能夠繼續(xù)為我們提供醫(yī)療保障,我們應(yīng)該為他們提供所有必要的支持和工具。

一個(gè)廣泛的聯(lián)盟組織正在合作研究令人激動(dòng)的新途徑,使醫(yī)療從業(yè)者也可以獲得系統(tǒng)性幫助。最近,國(guó)家地理(National Geographic)頻道的紀(jì)錄片《第一波》(The First Wave)備受歡迎。這部紀(jì)錄片記錄了新冠疫情初期的混亂以及公眾、患者和醫(yī)護(hù)從業(yè)者所展現(xiàn)的人性,用講故事的方式激發(fā)了對(duì)于支持醫(yī)護(hù)從業(yè)者身心健康的討論,包括鼓勵(lì)各州醫(yī)療委員會(huì)在行醫(yī)執(zhí)照申請(qǐng)中限制與心理健康有關(guān)的問題。

對(duì)于整個(gè)醫(yī)療體系和行業(yè)領(lǐng)導(dǎo)者而言,為了做出實(shí)質(zhì)性的改變,“竭盡全力:醫(yī)療從業(yè)者身心健康優(yōu)先”(ALL IN: WellBeing First for Healthcare)計(jì)劃能夠幫助培養(yǎng)工作者身心健康優(yōu)先的職場(chǎng)文化,該計(jì)劃提供的五個(gè)循證措施應(yīng)該在每個(gè)醫(yī)療體系內(nèi)執(zhí)行,為保障員工身心健康提供支持。

我們的醫(yī)療保健從業(yè)者同樣是人,他們正在利用現(xiàn)有的資源,竭盡全力應(yīng)對(duì)這場(chǎng)史無前例的全球健康危機(jī)。

為了照顧好那些用心照料我們的醫(yī)護(hù)人員,我們需要做出更多改變。隨著我們開始理解疫情對(duì)心理健康的影響,尤其是對(duì)醫(yī)療從業(yè)者的影響,我們必須接受這個(gè)不斷變化的新現(xiàn)實(shí),繼續(xù)為他們接受心理健康治療掃清障礙。

我們希望明天更加美好,醫(yī)療從業(yè)者可以感受到他們得到了重視和支持,讓他們重新找回治病救人的快樂。(財(cái)富中文網(wǎng))

本文作者詹妮弗·布林·菲斯特(Jennifer Breen Feist)和J·科里·菲斯特(J. Corey Feist)是洛娜·布林醫(yī)生英雄基金會(huì)(Dr. Lorna Breen Heroes’ Foundation)的聯(lián)合創(chuàng)始人。

譯者:劉進(jìn)龍

審校:汪皓

A lot can change in two years. These days it’s often impossible to fathom life before we had to contend–physically and emotionally–with a global pandemic that has changed everything.

For our family, that change came suddenly. In April 2020, Dr. Lorna Breen, an accomplished NYC emergency room physician working on the frontlines of the first wave of COVID-19, died by suicide after treating the daily deluge of coronavirus patients she faced minute after minute, shift after shift.

Lorna, who had no history of mental illness, had grown overwhelmed by the unending surge of severely ill patients, not to mention being severely under-resourced and understaffed to treat them. As so many healthcare professionals can attest to today, she was far from alone in silently enduring these stresses.

Lorna was fully aware of the burnout crisis among clinicians even before the pandemic. She co-authored a study on the necessity of reducing those stresses months before her death. But when Lorna needed help, she didn’t receive it. As she told us, Lorna thought she would risk losing her medical license or being ostracized by colleagues if she sought treatment. Her death was a preventable tragedy that is resonating with more and more of us with each passing day.

In March President Joe Biden signed the Dr. Lorna Breen Healthcare Provider Protection Act, a first-of-its-kind legislation that aims to reduce and prevent suicide, burnout, and mental and behavioral health conditions among healthcare professionals.

Over the past two years, as our family has grieved the loss of Lorna and through the foundation, we’ve established in her honor, we’ve fought to safeguard the well-being and job satisfaction of healthcare professionals like Lorna. We envision a world where seeking mental health services is universally viewed as a sign of strength, not weakness, for healthcare professionals.

However, this law is only a first step in understanding and breaking down the barriers to care that healthcare professionals face. Like Lorna, many don't seek the mental health care they need for fear of retribution or exclusion in the workplace, loss of license, or even their job.

Currently, dozens of states have invasive questions regarding mental health on medical licensure applications. A recent Medscape survey of 13,000 physicians found that 43% said they had not sought help for burnout or depression because they “don’t want to risk disclosure to the medical board.”

We believe that these state medical license applications, as they often ask intrusive questions about mental health history, may violate the Americans with Disabilities Act (ADA). Recent court decisions and the U.S. Department of Justice have drawn similar conclusions.

The ADA clearly applies to hospitals and health systems, so why are healthcare workers often met with questions intended to stigmatize mental health further and potentially jeopardize their employment? State Medical Boards and legislators have the power to change this. Regulators at the state level must remove disincentives to mental health care on licensing and renewal applications as a first step to allowing clinicians to feel safe seeking care.

Just as hospitals consider the protective equipment medical professionals need to do their jobs safely, we have to recognize that well-being is equally critical. A surgeon wouldn’t head into the operating room with just one glove. We should provide all the support and tools needed to an already overburdened and understaffed healthcare workforce to ensure they can continue taking care of us.

A broad coalition of groups has been working together in new and exciting ways to make the system work for healthcare workers, too. The recent, acclaimed National Geographic documentary “The First Wave” captures the chaos and the humanity facing the public, patients, and healthcare providers during those early days of the pandemic and uses the power of storytelling to spark conversations about supporting the well-being of healthcare workers, including encouraging State Medical Boards to limit questions regarding mental health on licensure applications.

For health systems and leaders looking to make tangible change, the ALL IN: WellBeing First for Healthcare initiative helps cultivate workplace cultures that prioritize worker well-being, and provides five evidence-based actions every health system should be taking right now to support the well-being of their workforce.

Our healthcare workforce is made up of humans who, like us, are doing the best they can with the resources they have, all during an unprecedented global health crisis.

A lot more change is needed to ensure we take care of those who care for us. As we begin to comprehend the mental health impact of the pandemic—and especially the effects on the healthcare workforce—we must continue to remove barriers to care that reflect this new and evolving reality.

Let’s hope for a brighter day when health care workers feel valued and supported so they can recover the joy they once found in practicing medicine.

Jennifer Breen Feist and J. Corey Feist are the co-founders of the Dr. Lorna Breen Heroes’ Foundation.

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