Burnout, mental exhaustion, stress -- people are seeking relief as pandemic drags on

[00:00:00] Host Amber Smith: From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." As we approach the end of the second year of the pandemic, if you're feeling mentally exhausted, you're definitely not alone. Here with me to talk about what's happening is Dr. Kaushal Nanavati. He's Upstate's assistant dean of wellness and the medical director of integrative medicine and survivorship, and also an assistant professor of family medicine.

[00:00:25] Host Amber Smith: Thank you for making time for this talk, Dr. Nanavati.

[00:00:28] Kaushal Nanavati, MD: Amber, I'm glad to be back.

[00:00:30] Host Amber Smith: Well, a record number of Americans are quitting their jobs. There's a labor shortage that seems to be impacting all industries. So I want to ask you about the root cause of this turmoil. Do you think this mass exodus is because of the pandemic?

[00:00:47] Kaushal Nanavati, MD: You know, honestly, it's a multifactorial thing. So, I mean, this question that you're posing, a little different than some of the past conversations we've had, and there are economic theories and political theories and all that; the specialists of those talk about that. But in terms of health, wellness, well-being, mental health, there are so many factors, many of which were present before the pandemic but have been magnified or exacerbated by the pandemic.

[00:01:11] Kaushal Nanavati, MD: And so, what we've noticed, with surveys that have been done by multiple organizations that do these things, there's increased anxiety, there's decreased enthusiasm for work, lack of motivation or decreased motivation, rather, reduced focus at work, increased sense of depression, people feeling more isolation and kind of less of a network of support.

[00:01:33] Kaushal Nanavati, MD: Even insomnia, lack of sleep, right, and sleep disturbance. And a lot of this is fueled by what's happened during this time frame, which, you know, employees have felt economic uncertainty, right? People that have to deal with, family members at home who might be recovering. I give the example of teachers, often, who are possibly parents, so they've got kids at home or trying to do homeschooling while the teacher may have to be at school. And what a difficult task, right? And then the administrators that have to try to -- become like a no-win situation, and so that makes it difficult at multiple levels. Both the employee, the employer, have their own unique stressors that they're both dealing with .

[00:02:14] Host Amber Smith: Well, some economists and social scientists are suggesting something more existential. They're saying that this rise of remote work may have permanently altered the way we think about our lives and the world.

[00:02:26] Host Amber Smith: What are you hearing from your patients or your colleagues or the medical students you teach?

[00:02:31] Kaushal Nanavati, MD: So I think it's been multifactorial. , I would say that there are some who have thrived with the flexibility that they've been able to have; working from home has worked out for some people, learning online has worked out for some people, but not everybody is comfortable with that.

[00:02:49] Kaushal Nanavati, MD: And there are people who by nature, thrive in social situations, being around people, and for them to be suddenly in front of a computer, one screen or two screens or three screens, and having no physical engagement, no social engagement with other people, that's led to increased anxiety, depression, and frankly speaking, when you suddenly tell people, you know, you can work from home, companies start to sell buildings or divest of physical space. That can be very scary because that actually sometimes creates economic uncertainty for people. You know, am I going to have a job? Is my job really that necessary if it's not there? Are they going to hire out or outsource what I'm doing? For students, you know, when you think about college students, even high school students and medical students, when you have classes that require a hands-on that are now being done online. The classic example is you know anatomy, anatomy right?

[00:03:44] Kaushal Nanavati, MD: Learning things that supposed to be hands-on -- lab science classes, classes that require group engagement. Being on a screen isn't the same as connecting in person, right? I'm a person who loves to take a board and start writing stuff and mapping things out for people. And it's harder to do on a screen.

[00:04:01] Kaushal Nanavati, MD: There are technologies that are evolving as a result. And I think that's some of the gain that we will get is the technological evolution that this has kind of forced upon us in some ways, and actually engendered, will shift things for the long term, for sure. You think about telemedicine and telehealth, remote patient monitoring and health care. And some of these things are advances that should allow us to manage population health better in the future, once we get better at utilizing them and figure out models that actually make them viable, you know, both economically and from the health perspective.

[00:04:37] Host Amber Smith: With all of what's been happening, some people are leaving their jobs or retiring early, because they're just mentally exhausted, or they're burned out, and I think health care workers are among those with the highest reported cases of burnout, so can we talk about some of the reasons for that? Is it all the fault of the pandemic, or is there something more?

[00:04:58] Kaushal Nanavati, MD: So one, actually two, out of 10 Americans, or about 20% or one in five Americans, however you want to say the numbers, had anxiety, depression/mental illness, even before the pandemic. Now, with a pandemic that's been magnified, and what many people have realized is that, you know what, distress just isn't worth it for my health. I just read an article about a couple who basically retired, but had enough in their savings where they didn't necessarily jump onto collecting Social Security. They're going to use up some of their retirement and wait to collect Social Security until they're older, because then they get a higher absolute amount in their Social Security. So people are getting creative in what they're doing.

[00:05:40] Kaushal Nanavati, MD: For employers, it's a very difficult thing. And in health care it's a big problem because to replace an experienced employee who has a skill set is not only very expensive, it's time consuming. And in that time frame, when you don't have someone to fill the gap, at the end of the day, that can impact patient care, right? Community care and the health of entire population. Plus the people that are left behind now have a greater burden to manage, so it's a huge stressor. In fact, for employers, one of the things that they've talked about is, for them, the mental and emotional health of employees and the physical health of employees is actually a much higher factor for them than some other things that people might think of naturally, simply because when employees are anxious or depressed, their functional ability goes down.

[00:06:34] Kaushal Nanavati, MD: We know that things like lighting affect it, we've talked about that before, but at the same time, you think about the mood, the tone, you know, the attitude, and one person who is burnt out or depressed or anxious at work can impact the entire team, especially in health care, where we're so intimately connected in the work that we do in caring for the lives that we're privileged to care for.

[00:06:56] Host Amber Smith: You're listening to Upstate's "HealthLink on Air." I'm your host, Amber Smith, talking with Dr. Kaushal Nanavati about the collective level of mental exhaustion in America as we're wrapping up the second year of the pandemic. Dr. Nanavati is Upstate's assistant dean of wellness, so he's focused on what can be done to improve the situation, especially among healthcare workers.

[00:07:16] Host Amber Smith: Now, Dr. Nanavati, you and I have talked before about ways that individuals can cope during stressful times, but this feels like more than that. Because even some of the most well-adjusted, mentally balanced people are leaving careers because of working conditions. So how do we as a nation fix this?

[00:07:36] Kaushal Nanavati, MD: So I think this is a big, big point, and it's not just a nation; it's a global issue, in terms of what we've come to focus on society, when we talk about efficiency, we talk about things like resilience, we talk about performance measures and all of those things, and recently I had a chance to speak in front of a group of finance folks, and even in their industry, you know, stress, anxiety, burnout, those were really high, and so when we think about it, think about wellness as what a system offers for its employees or for the people in its charge, so that they can actually have greater sense of well-being, and well-being is what people do for themselves. So when we think about well-being, and we've talked about this, and we'll continue to talk about this, talk about the core four: nutrition, physical exercise, stress management, spiritual wellness.

[00:08:25] Kaushal Nanavati, MD: Now there are eight domains of wellness that incorporate everything from finance, social, emotional, occupational, environmental factors, nutrition and physical factors, etc. But the reality is, as systems, we really have to think about what is it that we're offering for the people that work for us, that we care for, and some of the most important things when we think about it are flexibility, right? So that we meet people where they are. Life is a dynamic. It's not a static. And a lot of companies have fixed benefits packages and fixed plans in place, but people's lives change, right? And during this pandemic, it really became evident that not everybody has the same needs, and not everybody has the same stressors. Some people needed time to take care of loved ones at home, right? Other people had the flexibility to actually offer more time at work, and so they could benefit from that extra time. Others started to just not take care of their mental, emotional, nutritional, physical health, and for them, a robust employee assistance program, is something that could not only be "Oh, if I have a mental health problem, I can call them." The reality is an employee assistance program should be able to help with setting up things like child care, right? Finding resources, whether it's mental health or financial health or physical health and offering those things that become a comprehensive and that can flex with what a person needs so that people can adjust and adapt to their life and the company adjusts with them. That's embracing the relationship with the employee vs. dictating or directing the relationship. And as we start to do that, we start to realize that it's a relationship, right? And a relationship is stronger, it's like a ladder. The two posts are held together by the rungs: communication, trust, honesty, flexibility, right? Compassion, love, all of those things, and more, are qualities that bring that relationship together. It has to be done from both sides. And so employees have to recognize the stressors that employers are facing right now, just to keep the doors open. And that employers have to recognize that employees coming in every day are bringing in a greater burden than that's been in the past.

[00:10:36] Kaushal Nanavati, MD: And when the pandemic ends, these problems were here before. If we have the wisdom to learn from this, what will happen is, we will adapt to a new world with new rules of engagement, right? Which are different than what they were before the. And when we do that, I think we'll be able to come out of it in a healthier way.

[00:10:56] Kaushal Nanavati, MD: Hopefully, that's the goal. And not every industry will come out the same, not every organization will come out the same, not every person will come out the same, but what we can do, and especially representing an institution, is be open, meet people where they are, learn their life story first, because then we get context and perspective for each employee. And that's how an institution can support them.

[00:11:22] Host Amber Smith: And what you're talking about, I think, can apply to every company or business, but I'm feeling like in health care, we have to heal the healers first, right? Because they're the ones we turn to, to take care of us. Are there specific fixes being talked about in health care?

[00:11:39] Kaushal Nanavati, MD: So, I think, as I mentioned earlier, if you look at health care, it's a broad spectrum, right? Nurses, health care providers, front desk staff, complimentary providers, you know, and all those in health care, administrators, as well. Teachers, faculty, students and patients all have a different perspective on this and different needs.

[00:12:01] Kaushal Nanavati, MD: And the most important thing I think that any health care organization can do is, continue to gauge their employees. I think managers during times of stress and distress should create a more regular and consistent connection with their employees to actually connect, to learn where they are.

[00:12:20] Kaushal Nanavati, MD: Because if we make assumptions, employers underestimate the degree of distress that employees feel and have felt during this pandemic -- surveys have showed that again and again. And so employers are missing the mark when employers start to give messages out of positivity, and without acknowledging the stress and distress that their employees are feeling, I think the first place is to meet people where they are to acknowledge what the reality is.

[00:12:46] Kaushal Nanavati, MD: And the fact that the administrators and bosses are feeling it too, vs., you know, the boss comes in and says, "Hey, listen, you guys are doing great. Keep going." It's a matter of saying, "Look, I'm stressed too. This is an unpredictable public health crisis. I don't say unprecedented because different eras have had different things, but definitely unpredictable.

[00:13:04] Kaushal Nanavati, MD: And in that sense, "We're all in this boat, and I don't have an answer, but together we can come up with one" is a more realistic perspective than to say, "You know what? Keep going," because that can be overwhelming when somebody who doesn't feel like they're seen and acknowledged, and that can be very stressful for people.

[00:13:22] Host Amber Smith: It's been stressful. It's been traumatic. It's been a long two years. I understand that trauma can impact people long term. And the pandemic has certainly been traumatic for many people. How do you think this is likely to affect us in the decades ahead?

[00:13:36] Kaushal Nanavati, MD: I think it reinforces the message that is time-tested, which is to focus on the fundamentals -- right? -- for each individual and as systems coming back and focusing on the fundamentals. So for any company and any health system -- right? -- its greatest asset are the people that make it. And so they really have to think about that, and then the customer base is just as strong an asset, so they have to think about communication there and being real. And for individuals focusing on the fundamentals is recognizing that you have to take care of your own health. You know, I had a lady recently came to me with a lot of stress and she talked about the fact that, "You know what, I'm just completely burnt out and drained of energy because I'm caring for so many things and juggling so many balls."

[00:14:21] Kaushal Nanavati, MD: And I say, you know, it's interesting. The human heart is a giver. It gives all day long, keeps on giving, but it's figured something out. It's got these coronary arteries, so every time it pumps, it feeds itself first, so it can keep going. And so for people to recognize that we have to do what is necessary to take care of our own health.

[00:14:39] Kaushal Nanavati, MD: And for each of us is different, right? For some people, nutrition, some people exercise, some people, stress management, mindfulness, some people, getting better sleep, you know, refocusing on what they value and prioritize. I think this pandemic has really helped a lot of people recognize that the things that were priorities before aren't necessarily the things that are the immutables and the fundamentals. And so, hopefully, through this pandemic, people will focus on the fundamentals that mattered the most and recognize that the meaningful relationships in their life are the things that oftentimes provide for sustained happiness, more so than other factors that they may have valued before.

[00:15:19] Host Amber Smith: Well, I appreciate you making time to talk with us about this. My guest has been Dr. Kaushal Nanavati, he's the assistant dean of wellness at Upstate and also the medical director of integrative medicine and survivorship and an assistant professor of family medicine. I'm Amber Smith for Upstate's "HealthLink on Air."