In the January 2020 issue of ENTtoday, I enthusiastically shared tips for making achievable new year’s resolutions, suggesting many daily actions we can take to achieve better physical, emotional, mental, and spiritual well-being. How inadequate my article seems now after an unprecedented pandemic year and into 2021!
This year, ENTtoday physician editor Alexander Chiu, MD, asked me to write about optimism, which I was able to do only after much reflection and emotional catharsis of my own exhaustion, anger, anxiety, grief, and frustrations that have accumulated all year.
It’s difficult to be optimistic these days. Pre-pandemic, Medscape’s “National Physician Burnout & Suicide Report 2020” and “Otolaryngologist Lifestyle, Happiness, & Burnout Report 2020” highlighted the following disturbing statistics:
- Only 29% reported being happy at work.
- 24% were burned out, 3% were depressed, and 11% were both.
- 13% have had suicidal thoughts.
- 16% were seeking professional help for depression and/or burnout, and 14% had been under professional mental healthcare in the past.
- 50% were unlikely to participate in a workplace mental health program.
- Only 9% (always) and 37% (most of the time) reported spending enough time on their own personal health and wellness.
Surely these percentages have changed for the worse since the advent of COVID-19, increases in civil and social unrest, a progressively intense political divide, and the recent presidential election.
For me, I found that being “flexible” was no longer a choice. As surgeons, our training and career mandate that we are precise, systematic, laser focused, and decisive, and that we almost always need to plan and anticipate every minute of our daily lives. Yet this was a year with nothing but unpredictability. The most vulnerable and unwell versions of myself appeared whenever I tried to take control over countless situations at work for both clinic and OR workflow. The harder I tried to gain control, the more I thought I had “fixed” something, or the harder I tried to master new information (that changed week to week), the more frustrated I became. Emotional exhaustion ensued.
The best version of myself had surfaced early in the pandemic when I sent a daily positivity email to my entire division and colleagues every weekday for 38 days in a row during the mandatory stay-at-home order. But that version went away as soon as we began our “recovery phase” in mid-May. By September, it was clear I needed mental health support, and an overdue daily commitment to at least 20 minutes of both meditation and physical exercise. As I focused on breathing, self-awareness and self-control became possible again.
The new normal for me has required more generous listening to what my patient families have experienced, directly or indirectly, as a result of the pandemic and what their greatest concerns are.
So, with winter cases surging, how can we experience and embody optimism as we head into a new year with vaccinations against COVID-19 on the horizon?
The Benefits of Optimism
According to Wikipedia, optimism is “an attitude reflecting a belief or hope that the outcome of some specific endeavor, or outcomes in general, will be positive, favorable, and desirable.” This is usually referred to in psychology as dispositional optimism, and it reflects a belief that future conditions will work out for the best. For this reason, optimism is seen as a trait that fosters resilience in the face of stress (Weiten W, Lloyd M. Psychology Applied to Modern Life: Adjustment in the 21st Century. Belmont, CA: Thomson Wadsworth; 2005).
Optimism is directly tied to psychological and physical well-being and moderately correlates with health (Peterson C, Park N, Kim ES. Can optimism decrease the risk of illness and disease among the elderly? Aging Health. 8:5–8). It has been shown to explain 5–10% of the variation in the likelihood of developing certain health conditions (correlation coefficients between 0.20 and 0.30) (Peterson C, Bossio LM. Optimism and Physical Well-Being. In Chang, EC, ed. Optimism and Pessimism: Implications for Theory, Research, and Practice. Washington, D.C.: American Psychological Association; 2001: 127–145.), specifically cardiovascular disease, stroke, and depression (Kim, ES, Park N, Peterson C. Dispositional optimism protects older adults from stroke: the health and retirement study. Stroke. 2011;42:2855–2859; Giltay EJ, Zitman FG, Kromhout D. Dispositional optimism and the risk of depressive symptoms during 15 years of follow-up: the Zutphen Elderly Study.” J Affect Disord. 2006;91:45–52; Patton GC, Tollit MM, Romaniuk H, et al. A prospective study of the effects of optimism on adolescent health risks. Pediatrics. 2011;127:308–16).
One 30-year study undertaken by Lee and colleagues assessed the overall optimism and longevity of cohorts of men and found a positive correlation between higher optimism levels and exceptional longevity, defined as a lifespan exceeding 85 years (Lee LO, James P, Zevon ES, et al. Optimism is associated with exceptional longevity in 2 epidemiological cohorts of men and women. Proc Natl Acad Sci. 2019;116:18357-18362.) Another study by Aspinwall and Taylor assessed incoming college freshmen on a range of personality factors, such as optimism, self-esteem, and locus of self-control, and found that those who scored high on optimism before entering college were reported to have lower levels of psychological distress and were less stressed, lonely, and depressed than their more pessimistic peers (Scheier MF, Carver CS. Effects of optimism on psychological and physical well-being: theoretical overview and empirical update. Cognit Ther Res. 1992;16:201–228).
In addition, low optimism may help explain the association between caregivers’ anger and a reduced sense of vitality (López J, Romero-Moreno R, Márquez-González M, Losada A. Anger and Health in Dementia Caregivers: Exploring the Mediation Effect of Optimism. Stress Health. 2015;31:158–165). A meta-analysis of optimism supported previous findings that optimism is positively correlated with life satisfaction and psychological and physical well-being, and negatively correlated with depression and anxiety (Alarcon GM, Bowling NA, Khazon S. Great expectations: A meta-analytic examination of optimism and hope.” Pers Individ Differ. 2013;54:821–827). Researchers found that optimists choose healthier lifestyles, are more physically active, consume more fruit, vegetables, and whole-grain bread, and are more moderate in their alcohol consumption.
Sharing Optimism with Patients
Optimism is important for us all now more than ever. I recently listened to the first episode of a new podcast by Bill Gates and Rashida Jones called “Ask Big Questions”. They interviewed Dr. Anthony Fauci, asking him if the pandemic would disappear once vaccines were rolled out. He answered, “Yes, if the vaccine was 99% effective and 99% or more of the population received the vaccine. However, if we anticipate 76-80% effectiveness, with only 75% of the population taking the vaccine, the COVID-19 pandemic won’t disappear.” Dr. Fauci’s message was that whatever happens, every individual must fight and not give up, and get vaccinated.
This pandemic has changed my daily interactions with my patients and families far beyond just washing hands more often and wearing appropriate PPE. The new normal for me has required more generous listening to what my patient families have experienced, directly or indirectly, as a result of the pandemic, and what their greatest concerns are.
Being connected and sharing our journey is the antidote for isolation, fear, anxiety, and depression.
As always, I addressed the otolaryngology complaints, did a thorough exam, scheduled surgery when indicated, and empowered patient families through evidenced-based information and education. But so many children ceased receiving critical therapy services this year, including OT, PT, speech, feeding, and ABA, and trach- and ventilator-dependent children have had fewer home nursing and/or durable medical equipment supplies. Many parents and caretakers faced unemployment and/or lost their housing. In Florida, the AARP reported that 157,353 grandparents are responsible for their grandchildren who live with them; of those, in 51,606 (32.8%) households, the parents are not present. I’ve become very concerned about public distrust and opting out of the vaccine once it’s available—I’ve never met so many anti-vaccinating parents as I have during these last seven years working in Florida.
I’ve seen more epistaxis and tinnitus this year compared to the past 20 years. How ironic that in Florida, most parents have a humidifier but never use it—after all, Florida is so humid! Yet, we’re indoors with the air conditioning on 24/7, all year long. As the pandemic forced millions to spend more time indoors, plus fires throughout the West, climate change, and dry air from indoor living, for millions of children already taking daily antihistamine and nasal fluticasone for presumed allergies/stuffy nose—all of this is likely why I’ve seen more children with epistaxis.
There have also been more tinnitus visits, especially in adolescents who all have normal audiograms. Perhaps it’s related to the hours of wearing AirPods and headphones for virtual school, and then socialization with friends and gaming. The pandemic will likely have a negative impact far greater than we realize that may be subtle or invisible now.
My conversations during every office and OR encounter now include asking how patient families have fared with the pandemic, and a natural dialogue immediately follows. Without getting political or making them uncomfortable, discussion of current infection numbers, the most up-to-date scientific progress, and key questions “hot off the press” have become the norm. I ask if a child is going to school virtually, in person, or in some hybrid version. I ask about their birthday and holiday plans, limitations when it comes to sports, and their greatest challenges. Every encounter is a time when I can remind everyone about the benefits of going outside whenever possible and engaging in some physical activities every day. Sharing my reality and vulnerability with them, acknowledging theirs, and connecting more deeply than I was trained to do with patients has given me a sense of optimism in terms of how we can move forward together despite all these challenges.
Sharing Optimism with Colleagues and Family
The pandemic has also changed my focus when it comes to my team, my colleagues, and my own family. Choosing optimism and self-care to achieve well-being might have been optional pre-pandemic, but now I see them as our own life- and career-saving “vaccination” against any and all pandemics.
Being connected and sharing our journey is the antidote for isolation, fear, anxiety, and depression. With my colleagues and members of our division, I found myself always first asking how they were doing mentally, and how they were managing the challenges faced by us all—child and elder care, virtual school, testing positive for COVID-19—while still showing up to work every day. We can best be optimistic if we’re connected as a division, a department, as subspecialties in our societies, academy, a medical center campus, an offices team, and geographical and spiritual communities.
When opportunities come up, I openly discuss what we physicians believe in and practice above and beyond the CDC guidelines, and the critical importance of getting the vaccine once it’s available to minimize morbidity and mortality. I proudly participated in a Mandarin language version of our Nemours Children’s Health System public service announcement video on why everyone must get the flu shot—and get it early. I find myself sharing that plea in my neighborhood with everyone, including our 14-year-old daughter Claire’s classmates’ parents.
At home, while my family experienced the joy of more family time as we minimized socialization with others, we had plenty of tense conversations about my own exposure and risk, and conflicts on whether Claire was spending too much time socializing on electronic devices, with a mother who could often be judgmental and critical. (We’re lucky—my husband started a new job in August with the ability to work remotely, and so he juggled work and driving duties for Claire’s school and a truncated varsity golf season.)
So, despite a year that I’ve called the fastest and slowest of my life, I’ve realized that every patient encounter is an opportunity to change our culture to reduce burnout, increase well-being, and improve our relationships at home. We can do so by no longer representing ourselves as the “perfect” version of humans who have zero vulnerabilities. For those privileged to witness and listen to such vulnerability, conversations create a new culture of peer support that allows us to spread optimism and confidence. But we can’t do enough unless we care for ourselves first.
As I re-read that January 2020 article on individual self-care actions and micro-actions, they are still relevant today—perhaps more than ever. Be well, be optimistic, be grateful, be kind, and be compassionate to yourself first. If you do, you’ll become an endless source of optimism and healing for others.
Dr. Wei is division chief of pediatric otolaryngology/audiology at Nemours Children’s Hospital and director of the Resident and Faculty Wellbeing Program at Nemours Children’s. She is also an associate editor on the ENTtoday editorial advisory board.