On Doctoring in the COVID-19 ICU
Authors: Traci N. Adams
Journal: Annals of Internal Medicine (2024)

LettersJanuary 2024On Doctoring in the COVID-19 ICUFREETraci N. Adams, MDTraci N. Adams, MDUniversity of Texas Southwestern Medical Center, Dallas, TexasSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L23-0418 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: I sincerely appreciate the comments by Drs. Barrett and Smith as well as the efforts of the ACP to support the mental health of physicians through the Emotional Support Hub. In addition to providing resources for clinicians to opt in to mental health treatment, I propose that ACP encourage institutions to screen for psychopathology among frontline workers and couple this with education efforts and terminology to destigmatize psychiatric disease. The disaster mental health literature reveals that a proportion of those exposed to an intense stressor will develop psychopathology (1). However, well-intentioned programs to support frontline mental health during the COVID-19 pandemic often fail to screen for psychopathology and are labeled as “wellness” or “emotional support” programs; such terminology has 2 unintended implications.The first implication of a wellness program is that clinicians who are distressed should self-manage. Individuals with psychiatric illness need more than an emotional support program; they need a screening program to detect risk factors for psychopathology, followed by a full diagnostic assessment by a trained mental health professional and appropriate medical therapy for their psychiatric diagnosis (1). Two psychiatric screening and intervention programs have recently been described (2), and I suggest that ACP call for similar programs to be implemented around the country. For all individuals, including those with psychopathology, resources to improve coping skills may be useful when accompanied by appropriate psychiatric care (1), and I applaud ACP on their efforts to improve access to these resources on their website.The second implication to the use of such terminology as “wellness” or “emotional support” programs is that these terms can further stigmatize psychiatric illness (3). When we order mammography, we inform the patient that we are screening for breast cancer; however, we routinely use watered-down terminology to describe interventions to screen for and manage psychiatric disease. By omitting any mention of psychopathology in the way we name and publicize mental health programs, we imply that psychiatric disease is too awful to address directly and therefore risk further stigmatizing it. We do not treat breast cancer with a wellness program nor should we treat or name psychopathology screening and treatment programs by such broad terminology.I sincerely appreciate the efforts of ACP to support the mental health of physicians, and I suggest that these interventions be accompanied by screening programs for psychopathology and terminology that begins to destigmatize psychiatric disease.References1. Adams TN, Ruggiero RM, North CS. Addressing mental health needs among frontline health care workers during the COVID-19 pandemic. Chest. 2023;164:975-980. [PMID: 37451432] doi:10.1016/j.chest.2023.07.004 CrossrefMedlineGoogle Scholar2. Mangurian C, Fitelson E, Devlin M, et al. Envisioning the future of well-being efforts for health care workers—successes and lessons learned from the COVID-19 pandemic. JAMA Psychiatry. 2023;80:962-967. [PMID: 37494012] doi:10.1001/jamapsychiatry.2023.2355 CrossrefMedlineGoogle Scholar3. North CS, Pfefferbaum B. The need to clarify professional terminology in psychiatry. Ann Clin Psychiatry. 2022;34:149-151. [PMID: 35849774] doi:10.12788/acp.0079 CrossrefMedlineGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Traci N. Adams, MDAffiliations: University of Texas Southwestern Medical Center, Dallas, TexasDisclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L23-0418. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoOn Doctoring in the COVID-19 ICU Traci N. Adams On Doctoring in the COVID-19 ICU Eileen D. Barrett , and Cynthia D. Smith Metrics Current Issue January 2024Volume 177, Issue 1 ePublished: 16 January 2024 Issue Published: January 2024 Copyright & PermissionsCopyright © 2024 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...