Wellness During the COVID-19 Pandemic: Q&A with Dr. Lisa Richardson

Mar 24, 2020
Dr. Lisa Richardson, Department of Medicine Vice-Chair, Culture & Inclusion

Richardson_Lisa.jpgI want to acknowledge the incredible dedication of the members of our Department of Medicine during this seemingly surreal time.  As we adapt and change our practices based on the evolving COVID-19 pandemic, many of us are faced with the tension between our desire to serve our patients and communities, and concern about our own safety, as well as that of our families.  My new role as Vice-Chair of Culture & Inclusion in the DoM includes the portfolio of Wellness. In recent weeks I have received many questions and thoughts about how to support the wellbeing of our learners, staff and faculty during this stressful time.  We are compiling a list of resources in a new section on the DoM website and I invite you to share useful resources with me to help us expand this section (please email them to dom.communications@utoronto.ca and lisa.richardson@uhn.ca). In addition, the following Q&A includes information based on questions, thoughts and concerns which people have been sharing with me.

I'd like to extend an acknowledgement to Drs. Isaac Bogoch, Wayne Gold and Malika Sharma in the Division of Infectious Diseases for providing their expertise in this Q&A. 

If I am a providing care to patients with COVID-19, is it safe for me to live with my family?

The following response is based on feedback from members of the Division of Infectious Diseases:

It is safe to continue to live with your family as long as you continue to practice hand hygiene and social distancing both at work and outside of work.  Other important reminders are to avoid touching your face and to wipe down devices and hard, high touch surfaces (such as door handles, toys and phones) frequently with approved cleaners. More information from Health Canada can be found here.

While at work, it is also critical to use personal protective equipment (PPE) diligently.  Please review your PPE donning and doffing technique. When seeing patients with possible, probable or confirmed COVID-19, N95 masks are required only during aerosol generating medical procedures, such as CPR or intubation.  Droplet and contact precautions and surgical masks are applicable in all other situations. This video from Sunnybrook Health Sciences Centre has an overview of donning and doffing technique for aerosol-generating procedures.

If you have been exposed to COVID-19, you must self-isolate.  If you develop any symptoms that may be related to COVID-19, you must self-isolate, contact your hospital Occupational Health & Safety and await further direction.  Trainees must notify PGME and their Program Director or Fellowship Director if they have symptoms. If you are returning from travel, you must follow your hospital’s self-isolation policy before returning to work. Trainees must follow the policies in place by PGME.

Full instructions from Health Canada for self-monitoring, self-isolation and isolation can be found here.

Some practitioners may feel anxious about living with others despite a strict adherence to the above recommendations.  A healthcare provider may have a different threshold of risk based on their specific clinical context (for example, performing frequent intubations versus not having any physical contact with a patient) and/or their living situation (such as living with elderly parents or someone who is immunocompromised).

In summary, although it is safe to continue to share living space with family or others during this time as long as you continue to adhere to guidelines for infection prevention, it is understandable and advisable for each clinician to carefully consider their specific context while making this choice, including its mental and psychosocial impacts.

Should I wear scrubs while at work, and is there a specific routine to follow when I get home from work?

Although proper use of PPE protects you and your clothing, many people have chosen to wear scrubs while they are providing care.  If you choose to do so, please remove the scrubs before leaving the clinic or hospital.  Other considerations include not wearing jewelry that is covered by PPE such as earrings. For those who may need to wear an N95 mask, ensure that you are clean-shaven. Remove the clothes you were wearing at work once you return home.

Is there enough PPE? 

On March 20, 2020, the federal government announced a plan to mobilize private industries to increase the production of PPE. Health Canada has indicated that no manufacturer of prescription drugs or medical devices has reported any shortage related to COVID-19, though they are monitoring the situation closely. Please only use PPE as required, and do not stow away hospital or clinic supplies for your own use.

What services are considered essential in hospital with respect to consultations? Can inpatient consultations be done virtually?

Please refer to guidelines at your local institution or reach out to your Physician-in-Chief since these practices may vary by site.

What are the expectations with respect to academic and educational obligations during the pandemic?

At this stage, the primary focus for everyone in our Department is on clinical care and on the safety and wellbeing of faculty, trainees and staff.  Currently, education leaders in the Department are considering how to restructure educational activities.  In the interim, please practice social distancing during clinical rounds with learners. Please click here for the latest information from PGME regarding postgraduate medical education and COVID-19.

Where can I get assistance with household activities such as childcare or grocery shopping?

Medical students at the University of Toronto have organized a program to support healthcare providers in the GTA with some of these activities. More than 240 students have volunteered to help out. Click here for more information and to sign up if you need assistance.

Where can I get psychosocial or mental health support?

The Physician Health Program organized by the Ontario Medical Association welcomes self-referrals from medical students, residents and physicians in Ontario who may have concerns about their health and well-being. They provide confidential services to assist those experiencing distress, substance use or mental health issues that can have personal or professional impact. They have provided on their website resilience and stress resources specific to the COVID-19 pandemic.

The Department of Psychiatry has also offered to help clinicians access urgent care. The Faculty of Medicine will be coordinating this response with the Department of Psychiatry and we will update the DoM website with this information as soon as it is available.

Project ECHO Ontario Mental Health at CAMH is offering a virtual education and capacity building program that aims to build a community of practice, promote resilience, provide skills and resources, and support overall mental wellbeing amongst residents and hospital-based health care providers currently supporting the COVID pandemic.

Please see the COVID-19 wellness resources on our website for other tools.