When a disaster occurs, psychological problems often appear months or even years after the event is over. Perhaps only then will people notice the problems of mental health and think about the impact of disasters on individuals and society.
Just last month, Director of Peking University Sixth Hospital and Academician of the Chinese Academy of Sciences Lu Lin mentioned in the "Academician's Lecture" that the impact of the new crown epidemic on human psychology will last for at least 20 years.
The natural perspective of attention is directed to the public, and medical staff on the front line of the epidemic are considered to be invincible in work, or their psychological tension is placed behind the public.
On May 29, 2022, Lu Lin mentioned in an online forum that after an online sampling survey of 50,000 residents, it was found that during the COVID-19 epidemic, the probability of medical staff, infected people and general population suffering from PTSD (post-traumatic stress disorder) was 26.9%, 23.8% and 19.3% respectively.
Long-term continuous working hours, high-intensity and stressful work requirements, closed living environment, etc. are all reasons for the occupational fatigue of medical workers.
On March 14, 2022, the epidemic in Shanghai became increasingly severe. The medical and psychological care hotline initiated by the Shanghai Medical Union and hosted by Shufu EAP (Employment Psychological Assistance Project) was launched. This is one of the earliest and continuously opened psychological hotlines in Shanghai during this epidemic.
Through this hotline, psychological counselor Qin Hai clearly felt the changes in the psychological state of Shanghai residents. Since then, he has been constantly committed to paying attention to medical mental health and realizing that this is a systematic problem.
In the wave of marketization, public hospitals have become more and more like modern enterprises, enjoying financial appropriations on the one hand, and requiring their own profits and losses on the other hand. In the pursuit of performance, the number of patients and surgery must be oriented, while in terms of employment, the number of staff is getting smaller and smaller, and more are contract workers. This makes medical liquidity more common, just like a group of "workers" who have changed jobs and increased their salary among major Internet companies.
On September 14, Qin Hai posted a message on WeChat Moments: I visited the hospital for investigation in the past two days and felt the helplessness and sadness of the three A. Once upon a time, hospitals had long become "big factories", but they did not necessarily have psychological counseling for employees. Moreover, it is not appropriate for our hospital's psychology department to undertake this part of the task.
Previously, Qin Hai was the vice chairman and secretary of the Youth League Committee of Shanghai Chest Hospital. After saying goodbye to the public hospital where he worked for 10 years, he joined Renji Medical Management Company in 2004. In 2015, he founded a personal psychological counseling studio.
During the three months of the epidemic in Shanghai, Qin Hai's team contacted nearly 400 medical workers in total, providing one-to-one psychological counseling to more than 70 individuals. It was found that many of these medical workers were irritable, and they felt more anxious and depressed than ordinary people.
Through these calls and visits, Qin Hai clearly saw the backlog of emotions and the huge systemic problems behind them. From hospital staff to indirect observers, Qin Hai began to think from different perspectives what profound impact the current environment has had on doctors, and what can our modern hospitals do?
The following is Qin Hai's oral statement:
A continuously extended medical psychological hotline
On March 13, I received a call. After putting down the call, I began to do a plan for psychological crisis intervention for Shanghai medical staff. Six hours later, a psychological hotline team was successfully formed.
The one who called me was He Yuan, executive vice chairman of the Shanghai Medical Union. Based on last year's experience in fighting the epidemic, He Yuan knew that the medical workers in the temporary cabin still had a large amount of psychological care needs. She hoped that the medical staff who supported the fight against the epidemic in Shanghai would receive more support. Therefore, this psychological care hotline for medical care came into being.
20 consultants came from 11 places, each of whom was on duty for 3 hours a day, and the other end of the line was connected to the Shanghai Fangcai Hospital. The person who called the hotline was medical staff and their families who were closed in the Fangcai.The hotline numbers of
were sent to various hospitals and medical teams through the Shanghai trade union system, but the ringtone did not ring once in the first few days.
We later realized a problem - it took about 7 hours for medical staff to go from putting on protective clothing to taking off their clothes. Only when they take off their protective suits and return to their residence can they think of their family, themselves, and the strong and bad experiences in their hearts.
For this reason, the hotline has extended the service time from 9 pm to 12 pm. Sure enough, the phone calls came one after another.
As the time for the epidemic lockdown in Shanghai extends, the name of the hotline is constantly shortening. At first, this hotline was called "Shanghai Anti-epidemic Medical Care Hotline". After being brought into the square cabin, some volunteers and citizens in the square cabin will also come to ask for help - slowly, these citizens pass the number to their relatives and friends outside the square cabin.
I simply cancelled the word "medical care" and changed it to "Shanghai Anti-epidemic Psychological Care Hotline" - From this moment, my consultants and I heard the voices of countless most ordinary residents in Shanghai.
Everything seems to be out of reach. On the poster of this psychological hotline, the deadline of the hotline has changed again and again.
Psychological consultation is more about emotions, but at the beginning, the hotline received real problems. For example, if the medication is not available, the supplies are short of, and the positive patients who live with them are not transferred.
Some medical staff have underlying diseases and need to be equipped with insulin and asthma drugs for a long time, but because they were temporarily assigned to collect nucleic acids, there were insufficient medications for their own use, and they were immersed in anxiety every day.
I began to realize that in order to solve the psychological anxiety of callers, I essentially need to help solve the real problems.
helps with medicine dispensing, first aid phone number, group buying channels, public welfare organization contact information... These channels establish a connection between inside and outside the cabin and reality.
intensive nucleic acid collection and more than one month's lockdown period make many medical staff have no time to deal with their feelings.
In mid-April, our team conducted a psychological state assessment of the medical and nursing group. He found that a considerable proportion of medical and nursing care had shown symptoms of severe anxiety and severe depression, with moderate and severe anxiety being 15% and 9% respectively, and moderate and severe depression being 21% and 10% respectively.
Some are tired, separated from family, and invisible despair.
A nurse from in the community health service center was emotional on the phone. She started staying in the hospital since early March, and took a bus to remote old towns and villages in the early morning, and then walked to residents' homes to collect nucleic acid. Her boyfriend is a medical staff member. The two have not seen each other for a long time and their parents cannot take care of them.
"Do you know? We are so hard now, we are exhausted." She cried and said that she wanted to go home, but I don't know how to comfort her.
There are also many centralized isolation points, square hospital , and medical staff from medical institutions. The colleagues around them were infected one after another, and they were worried that they might be infected. Some medical staff will feel guilty and blame themselves - because they fall down, other colleagues will be busier; some even feel embarrassed and self-examination, not knowing which link is the problem.
"I want to resign"
"If there is another epidemic, I may choose to resign." A nurse told me that this was her second time entering a temporary hospital.
This nurse has developed somatosimistic symptoms: patients with high fever in the ward, coughing one after another, and masks with blurred water vapor exhaled in front of her may make her feel difficult to breathe, rapid heartbeat, and gastrointestinal discomfort. She always worried that there were insufficient protective measures.
I reminded her that the actual protective measures were not really as fragile as she imagined. Perhaps the inner anxiety amplified the unsafe factors in the environment, and then helped her analyze whether other factors caused the anxiety of inner emotions.
After professional training, when facing a high-pressure working environment, they may choose to debug themselves to actively adapt to the environment. However, for some workers, the situation is likely to be that their internal trauma has not been repaired and they continue to work.
Many times medical staff do not feel that they can be cared for and supported, so they will not actively call the hotline for help. Many of them have reached a state of collapse.
This cycle is repeated. Once too much pressure is accumulated in the heart, a small point may eventually lead to an emotional outburst.
For example, a nurse infected with COVID-19 moved into an isolation hotel and found mold spots on her chopsticks while eating. This is a simple little thing in life, and in a closed environment, it brought her so much dissatisfaction that she began to doubt whether the treatment of quarantined people was generally treated. In fact, maybe there is something wrong with this pair of chopsticks. If her request was listened to at the beginning and someone would give her some comfort, maybe her mood would be calmed down soon.
In order to have a more subtle insight into the psychological state of medical care, we decided to join eight medical care work groups. At first I just observed silently, but later I started sending some posters with psychological knowledge in the group every day, or a music for relaxation and healing, or a mindfulness meditation video. These trivial tasks keep us with the health care.
Some medical workers will take the initiative to establish contact when they see the information of psychological counselors in the group, or respond to the counselors in the group, "Today's song is quite nice, thank you", "I feel warm when I see this picture." When we distributed psychological research questionnaires, some medical staff would ask the consultant privately: "The result I made is 'serious', what should I do?"
psychological counseling that was unable to be carried out due to objective reasons during the Shanghai epidemic, was standardized and improved when Shanghai medical staff assisted the Hainan epidemic.
At the end of June, the epidemic in Shanghai had just subsided and the epidemic in Hainan began to ferment. While giving an online lecture to the medical staff who aided Hainan Fangcai, I designed a small game to let them paint freely on white paper, showing the "people in the rain" that they thought in their minds at this moment.
In a painting, the raindrops are very big, but the umbrella is even bigger. This umbrella is supported by two people and is very strong. This means that the author is calm and composed in his heart. Although there are great challenges from the outside world, the team of these two people is enough to deal with such challenges. In another painting, under dense raindrops, a person was walking without carrying any rain gear, and was completely wet from head to toe.
Obviously, the latter is in a worse situation and needs to focus on the author's recent situation. Free association projective training similar to this kind of free association can help a person better understand his heart. We can analyze the current pressure of medical care based on multi-dimensional angles such as the environment in which the person is in, the state of the person, and the relationship between the person and the environment.
During the consultation, I roughly summarized the impact of the epidemic on mental health into two categories, either numbly and endure to suppress myself, or directly choose to give up.
If you have medical staff, you will say directly that you want to escape from the medical circle and quit. Some may also want to leave the front line and return to the second and third lines, even if you work in the community hospital .
Although for public hospitals in Beijing, Shanghai and Guangzhou, they are not worried about talent loss, the junior high school can always attract talents continuously, so the management will regard this flow as a normal phenomenon; but every expert's resignation will increase the cost burden of the hospital.
Hospitals such as large factories
Generally speaking, medical work is a very stable choice, at least in my nearly thirty years of experience. But now, the stability of medical staff in hospitals is also declining.
Now, hospitals have entered the era of large branches, and the number and size of the hospital have become a symbol of demonstrating the strength of the hospital.
Reviewed at the end of the last century, the hospital space was small.In the past, I have heard of two academicians using a desk together. The medical treatment environment is so compact that it is "made in a snail shell", but it also invisibly narrows the doctor's sense of distance.
With the continuous development of hospital reform, the scale of Chinese hospitals has reached an unprecedented scale. Whether it is building space, luggage affiliation or management level , the former independent small hospitals have gradually disappeared into history and have been replaced by large group hospitals that integrate and integrate. Some junior high school headquarters located in downtown may not be as good as a branch of a municipal-level hospital.
The hospital is growing in size, but the scope of workplace interactions among medical staff is gradually shrinking.
In the past, in a hospital, there were five or six hundred employees, and at least they could be familiar with each other; but now in public hospitals, there are thousands of employees, and employees can only recognize the director, secretary and other leaders, and then the director of the department line and colleagues in the same department.
The division of labor in public hospitals continues to develop in a refined manner, becoming like the Internet giants we are talking about now. Perhaps every employee is doing small things under the huge hospital system, and the loss of one or two personnel has a very subtle impact on the operation of the entire huge machine.
The hospital has grown, which means that the people inside are smaller and more difficult to be cared for. If we used to put home visits and one-on-one talks, it seemed a bit "out of time".
The epidemic has changed the working status of medical care, and this impact will continue until the post-epidemic era. When you put on protective clothing, medical staff became "medical soldiers"; when you take off protective clothing, medical staff is still an ordinary person.
Whether there is an epidemic or not, continuous high-intensity work has always been the norm for medical staff. This may be one of the reasons why some medical staff are always "unwilling to" rest and have no time to seek help.
Even if the hospital provides the opportunity to adjust medical care, few people respond. Some medical workers seem to have lost a "brake" to remind themselves to rest in the next round of work. They have no time to stop and give themselves a space for healing and rest. "If I rest, who will take my job?"
There is nowhere to put doctors and patients
For patients, the development of hospitals is more reflected in the intelligence of various devices when seeing a doctor. From registration, consultation, examination, and prescription of medicine, the entire medical treatment process data is circulated online in the backend, saving quite complicated manpower and reducing communication and interaction between people.
Nowadays, hospitals have less promotion of humanistic care, but are more promoting efficiency.
A medical expert can reach more than 100 numbers in one morning, with 3 or 4 graduate students helping each other, and the actual meeting time of a patient and the doctor is only one or two minutes. The doctor's vision is more about the cases on the computer, as if electronic information and checklists are more real than those in front of him.
Under the requirements of various indicators, with the assistance of smart medical care, the hospital's efficiency is getting higher and higher. The hospital has become a factory that operates at high speed for 24 hours and constantly absorbs and vomits patients. After the treatment is completed, the patient is allowed to leave the factory and returns to the factory for repair from time to time.
But is such a hospital friendly to everyone in it?
is not the case for the elderly at least. Many elderly people still adhere to the traditional medical treatment model and will only take out their medical insurance cards at the hospital registration window, but know nothing about online appointment registration models such as WeChat public accounts. Although these technologies facilitate young people, for the elderly who are visiting the hospital alone, when they go to the physical hospital to register, they are far behind those who make online appointments.
Intelligent technology is not always friendly to young people. A young girl who came to consult me once broke down because of this. The trigger point of her emotions was that she didn't know how to get her X-ray in such an intelligent hospital.For the hospital, if you don’t ask for a movie, the hospital will assume that you don’t need it anymore, which becomes an electronic file of the hospital. When she was in the clinic, no one mentioned this. Later, she went to many places and could not find a place to take the film. It was difficult to explain her condition when she visited other hospitals.
Many times, machines replace labor, but it is far from reaching the point where they can provide patients with answers to all questions.
I remember more than 20 years ago, the staff at the hospital's drug dispensing office could even remember the name and price of the drugs at that time and handed them to the patients through hand. But this incident is unimaginable today. First of all, the richness of various types of drugs has exceeded the scope that people can remember, and the number of patients coming to the hospital for treatment has also increased the complexity of this matter exponentially.
Any employee in the hospital has an emotional labor orientation. Whether it is security or finance, everyone may have face-to-face contact with patients entering the hospital, and the sense of strangeness, confusion or anxiety that patients may have may be transmitted to employees in the hospital through this communication.
On the one hand, it is the increasingly strict hospital KPI assessment system and the ever-accelerating hospital operation speed with the support of intelligent technology; on the other hand, it is the highly sensitive doctor-patient relationship and rigorous rules and regulations. This high-tension and high-pressure working environment will inevitably cause a person's career tension.
There is one thing that still impressed me. Around 2000, a young nurse from the Chest Hospital said she was feeling sick after work at night. After examination, she found a lump in her stomach. The nurse, who was only 22 years old, was already in the advanced stage of gastric cancer and was believed to have a maximum of two months.
This nurse's family is not well off. As the secretary of the Youth League Committee, I organized the fundraising and raised more than 17,000 yuan for her family. In order to fulfill the nurse's wish, we also arranged for her and her sisters to go to Nanjing for a three-day trip. It's just because she said she wanted to watch Undersea World in Nanjing once. After returning from this trip, she never left the hospital ward.
Looking back now, I am still glad that the hospital did something worthwhile for this young nurse and her family, but today, this "subtle care for specific people" is gradually declining.
After the Wenchuan earthquake in 2008, psychological crisis intervention began to mature gradually in the country. Qian Ying, director of the Office of the Clinical Psychology Center of Peking University's Sixth Hospital, introduced that after the fire in Karamay, Xinjiang in 1994, the country sent psychological experts to provide assistance for the first time, which was the beginning of China's post-disaster psychological crisis intervention.
The epidemic has promoted the popularization of psychological crisis intervention, and now all provinces and cities have established professional teams.
But this is not far from enough. In addition to the hospitals need to strengthen their awareness of caring for employees, we also need more professional psychological counselors to do some common sense popular science work to help more medical staff and even ordinary people get rid of their shame for psychological problems and give employees more care.
Chen Xin, Wang Yuhui | Written by
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