Promoting Social Connection during COVID-19
Special Issue: AAEM Tales of COVID-19
Author: Al'ai Alvarez, MD FAAEM; Dr. Aneesha Dhargalkar, MD FAAEM; Carole Levy, MD MPH FAAEM; and Robert Lam, MD FAAEM
The COVID-19 pandemic has led to the implementation of social distancing, which has led to a decreased patient volume from non-COVID-19 related complaints. Along with canceled hospital elective surgeries and other major sources of revenue for the hospital, many emergency departments (ED) across the country, outside of New York City, the major hub of the pandemic in the United States, have implemented reduced staffing. Furthermore, some physicians are not working due to increased health risks, adding to the decreasing frequency of clinicians interacting with each other at work. We simply are not seeing each other in person as much as we used to. In-person department meetings have also been rapidly converted into remote meetings, further exacerbating this loss of physical contact among clinicians in the workplace.
With all the emotions that come with dealing with this global pandemic – fear, anxiety, grief, frustrations, and a clear sense of lack of control – physical distancing and the feelings of isolation add to the moral distress that clinicians experience.
Left unaddressed, the literature suggests loneliness and isolation in medicine lead to decreased productivity, burnout, depression, and other mental health disorders, physician suicide and is even a risk factor for death.1-5 Loneliness and social network size have even been linked to immune response as well as greater psychological stress, poorer sleep, and elevations in circulating levels of cortisol.6 A promising study of isolated senior citizens demonstrated that the use of SkypeTM for video chat had half the probability of depressive symptoms.7 Another study showed that an emotional connectedness similarly to in-person interactions could be achieved with video chat.8
In the time of social distancing, embracing technology as a tool to use with traditional strategies may promote teamwork, build community, and optimize use of positive psychology to enhance social connection.
We propose the following ways of combating isolation during the physical distancing restrictions of the COVID-19 pandemic:
Reinforce Purpose and Meaning
- Celebrate together with colleagues when COVID patients recover and when they are discharged from the hospital.
- Utilize journaling. Keep a log of each shift along with the thoughts and emotions of the day.
- Be detectives for random acts of kindness. Pause and recognize whenever you see goodness happening around you.
Support and Improve Clinician Team
- Send funny memes or words of encouragement. Be careful about patient information when messaging a group via a personal mobile. ContextTM is a HIPAA compliant app that you can use via cell phone or computer for chats.
- Virtual cocktail hours can be beneficial for those who normally enjoy reveling in a post-work beverage with their friend or coworkers.
- Playing online games as a group can be a nice way to socialize from a distance. Host an online game night, dance party, or escape room experience.
- Jackbox (https://www.jackboxgames.com) has a variety of games and you can make a trivia quiz for the group.
- Crowd Purr (https://www.crowdpurr.com/live-crowd-trivia.html)
- Mario Kart tour can be played multiplayer (https://mariokarttour.com/en-US).
- Animal Crossing can be played multiplayer (https://www.nintendo.com/games/detail/animal-crossing-new-horizons-switch).
- Lead with optimism.
- As physicians, we are the team leader and we set the tone for the work environment. How we show up for work ultimately affects how the day will go for the entire team. Inspire.
- Lead with appreciation and gratitude.
- Highlight aspects of our work so that you can show appreciation and gratitude to your team and your leaders.
- Continue to celebrate life events and other things that reinforce the cohesiveness of the team.
- Make time for a formal or informal debrief at the end of each shift.
- Check-in with your colleagues.
- Consider using a modified three good things platform.
- Focus on the positive things that happened during the shift.
- Send postcards. There’s something uplifting about receiving a personal note from someone in the mail.
Encourage Connection to our Shared Humanity
- Create a wall of post-it notes or memes in the break room or office space with encouraging messages or funny memes.
- Post notes of encouragement from the community.
- Bring in photos from home to post on the walls of the break room or office of the family, including fur babies. Include pictures from past social events.
- Pin photos of yourself to your PPE suit to humanize you to your staff and patients.
- Exercise and encourage self-compassion – treat yourself like you would treat a treasured friend.
- Do the 36 Questions with friends.
- With a group, have each friend respond to the question, then go on to the next one.
Personal Improvement / Professional Development
- Start a book club to create a shared narrative. Make it an excuse to meet monthly.
- Start a virtual journal club or work on ABEM MOC articles together
- Create an online band; rehearse songs together. Here's a beautiful example from Italy
Helping Others Has a Double Beneficial Effect
Reaching out to others right now will not only help others but it helps the helper: Helping others increases happiness and our own well-being.
- Give blood if you are able. Convalescent plasma programs for clinicians that recover from COVID-19 can be a life-saving gift.
- Be a battle buddy. A battle buddy is a fellow peer and colleague. The goal is to have two clinicians partner together to support one another.
- Organize a PPE drive. Here is an example of medical students participating in #PPEdrive.
Our work in the ED, and medicine, in general, can be isolating with or without the COVID-19 pandemic. With social distancing, we can continue to physically isolate ourselves, while maintaining social connections. You can start now. Take a moment to reach out to someone. Go ahead. Text a friend and share a moment of gratitude.
- Heinrich, Liesl M., and Eleonora Gullone. "The clinical significance of loneliness: A literature review." Clinical psychology review 26.6 (2006): 695-718.
- )Cacioppo, John T., et al. "Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses." Psychology and aging 21.1 (2006): 140
- Stravynski, Ariel, and Richard Boyer. "Loneliness in relation to suicide ideation and parasuicide: A population-wide study." Suicide and life-threatening behavior 31.1 (2001): 32-40.
- Seppala, Emma, and Marissa King. "Burnout at work isn’t just about exhaustion. It’s also about loneliness." Harvard Business Review 29 (2017).
- Holt-Lunstad, Julianne, et al. "Loneliness and social isolation as risk factors for mortality: a meta-analytic review." Perspectives on psychological science 10.2 (2015): 227-237.
- Pressman, Sarah D., et al. "Loneliness, social network size, and immune response to influenza vaccination in college freshmen." Health Psychology 24.3 (2005): 297.
- Teo, Alan R., Sheila Markwardt, and Ladson Hinton. "Using Skype to beat the blues: Longitudinal data from a national representative sample." The American Journal of Geriatric Psychiatry 27.3 (2019): 254-262.
- Sherman, Lauren E., Minas Michikyan, and Patricia M. Greenfield. "The effects of text, audio, video, and in-person communication on bonding between friends." Cyberpsychology: Journal of psychosocial research on cyberspace 7.2 (2013).
- University of Washington Department of Science of Social Connection http://depts.washington.edu/uwcssc/content/staying-connected-during-covid-19
- Staying connected — at a distance (University of Washington News) https://www.washington.edu/news/2020/03/12/staying-connected-at-a-distance
- Why You Shouldn’t Give Up on Virtual Happy Hours (Seattle Met) https://www.seattlemet.com/coronavirus/2020/04/why-you-shouldn-t-give-up-on-virtual-happy-hours
- Peer Support Program Strives to Ease Distress during Pandemic
American Medical Association, April 14, 2020
- 5 Resources Built to Provide Emotional Support In Times of Crisis
- Peer Support Program Strives to Ease Distress during Pandemic
- Peer Support
PeerRxMed - Free peer to peer program for physicians and others working in health care to provide support, connection, and encouragement. https://www.peerrxmed.com
AAEM Tales of COVID-19
AAEM wants you to have a forum to share your thoughts, emotions, opinions, and stories related to the COVID-19 pandemic. Thank you for sharing your ideas with other members so we can get through this crisis together. We will continue to share new stories weekly online and then all stories will appear in the print version of the July/August issue of Common Sense. Submissions are now closed for this special feature.