Physician, heal thyself

The battle against COVID-19 is far from over. Considerable work is going on globally to find the right drug or combination of drugs and vaccines. Therapeutic strategies and low-cost medical equipment to manage the pandemic, governments building make-shift hospitals, taking over private medical establishments to provide affordable facilities to the stricken population – all are constantly under review. But with all this amazing work being done encompassing and covering all aspects of efficient healthcare delivery, one area seems to have drawn less attention: The care of health care workers.^[1]

Frontline health care workers find themselves in an increasingly difficult position. The entire medical profession is fighting the biggest battle of the century. A study conducted on 1257 health care workers in China during the coronavirus pandemic reported that 50.4% had symptoms of depression, 34.0% reported insomnia, 44.6% reported symptoms of anxiety and 71.5% reported distress.^[2]

The pandemic has also restored the issue of physician burnout to the front page. The issue had been simmering since long; the pandemic has opened the Pandora’s box. A survey conducted to study burnout among medical practitioners in India indicated a high prevalence, with 45.02% scoring high on emotional exhaustion, 65.98% on depersonalisation and a whopping 87.14% scoring low on the personal accomplishment scale.^[3] Another survey indicated that there has been a significant increase in the feelings of depression, fear of failure and a chronic feeling of stress among physicians year on year.^[4]

The containment measures such as quarantine, social distancing and self-isolation can have a detrimental impact on mental health of not only patients but also physicians and other health care workers who are at high risk. With the shortage of appropriate protective gear, health care workers risk carrying the infection home to their loved ones. Being away from home for long periods also deprives them of the much-needed emotional support from their families. COVID-19 may well be the proverbial last straw to break the camel’s back, as physicians worldwide have had to isolate themselves physically from their family and friends to deal with the rising illness.^[5] Richard Smith, the former editor of the British Medical Journal, summed it up in one of his Editorials, ‘Why doctors are so unhappy?’ wherein he states the reasons that they are ‘overworked and under-supported.’^[6]

It is possible that in the coming months, when the pandemic is under control, we may be staring at a shortage of health professionals due to burnout, mental exhaustion or even change in profession.^[7]

Physicians need to accept the situation and realise that it is alright to be anxious, fearful, tired and stressed and that this will in no way derail the physicians high and only mission – to restore the sick to health.^[8] Promoting a greater sense of collective mindfulness and fellowship among physicians is both powerful and empowering.^[9]

Other than family and friends, physicians reach out to their colleagues for support – personal as well as professional – as they are likely to have similar experiences; relating with peers always helps.^[10]

Peer-assisted learning (PAL) has been a mainstay of medical training. It is known to enable physicians to improve their clinical knowledge, skills and attitude along with their interpersonal relations. It also enables collaborative and constructive learning and enhances physician’s sensitivities, allowing them to learn from each other. In this issue, we have an original research paper by Dr. Bipin Jain bringing out the utility of PAL to enhance clinical skills at the bedside. The learning will surely help us extend the concept of PAL to other areas of healthcare education in enhancing patient care and carrying out formative assessments.^[11]

We also have an original paper by Dr. Kavita et al. that evolves the image of the Muriatic group of Remedies, using the Conceptual Image as a tool for logical interpretation and representation of data. The findings of the study will surely open a whole new way to study our Homoeopathic Materia Medica.^[12]

The concept of Miasms has been viewed by other systems of medicine with a little suspicion, but a Homoeopath knows its relevance and importance. In this issue, we have an interesting case series study by Dr. Sunita that demonstrates the importance of Miasms and Homoeopathy in managing cases of autism spectrum disorders.^[13]

An interesting case report demonstrates the application of Homoeopathy in a patient in an IPD set-up of a Homoeopathic hospital.^[14] The learning derived from this case report will surely inspire a lot of us to venture into hospital-based practice.

In current testing times, physicians will have to take charge of their own lives and try and heal themselves and thus must first ‘know thyself.’ Homoeopaths are blessed as it was Dr. Hahnemann who has referred to this idea a, since the second edition of Organon. The original Greek phrase translated by Becker as ‘Know Thyself ’ is present in a footnote to Aphorism 141.^[15]

As physicians move ahead in their efforts to combat the crisis posed by the current pandemic, it is time for the profession to pause, breath, reflect, think and care, not just for their patients and families but for themselves as well. These are truly testing times, but things can only get better from here. I recollect lines from a song titled ‘Oh What a World’ written, composed and sung by the American – Canadian performer Rufus Wainwright. In addition to Rufus’s trademark tenor, it has the musical arrangement of a full opera concert. The lines are:

‘…. Still I think I’m doing fine

Wouldn’t it be a lovely headline?

‘Life is Beautiful’ on the New York Times’^[16]

I hope not just The New York Times, but all newspapers and media around the world carry the headline – ‘Life is Again Beautiful’ very soon. Till then, Physician, Heal Thyself and the World!