Before he became a family medicine physician, Mark Greenawald was in the U.S. Navy — a military man groomed to keep his emotions close to the chest.
That all changed early on in his medical career after this pivotal experience.
Dr. Mark Greenawald
When I was about five years into practice, I was doing obstetrics as part of my medical practice. And I had a patient who was in the midst of what appeared to be a normal labor and delivery.
Things went bad really fast, and she ended up dying — she ended up bleeding to death. And that happened right in front of me. And the baby who was born alive was neurologically devastated. And that was probably the turning point for me in realizing that this is just not normal.
And in retrospect, people say that within a week, I was back trying to just normalize that as just kind of ‘Here’s what I learned from that, and we’re ready to move on.’ But that wasn’t true. And behind the scenes, I was really struggling emotionally. And I didn’t know what to do with that.
So, it took me a year — literally a year — until I finally reached out for help. And that happened serendipitously because the actual story was my wife and I were going away on vacation and for an anniversary trip. And I got pulled over for my only speeding ticket that I’ve ever received in my life. And as the police officer was walking away from the car, I just started weeping. I had no idea where it was coming from — I just started weeping. And my wife said, ‘you know, basically, it’s just a speeding ticket. Like, you know, it’s not a big deal.’ And I said ‘that’s not what this is about at all. And told her that for the last year, not a day had gone by that I didn’t walk around with just this giant lump in my throat and just was not doing well.’
Nobody knew. I was able to put on airs that nobody had a clue that that was going on. And so, my wife, who is a physician as well, said, ‘You need help.’ And I said ‘No, I think I just need a good cry, and I’ll be better.’ And she said, ‘No, you need help.’ And so I ended up going and seeing a therapist. And it was amazing.
And so it was really back then that I started becoming a lot more interested and involved in what can we do to begin to talk about what I like to refer to as the conspiracy of silence around not talking about the challenges of healthcare. Again, healthcare is an incredible field, and I’m really feel privileged to be part of it. And yet, we have this underlying culture of silence. And we just don’t talk about these things that we know are emotionally scarring.
Mark says that, traditionally, physicians don’t take care of themselves in the same way they do patients.
Dr. Mark Greenawald
There is a stigma around mental health. Even as we would say, to our patients, ‘Absolutely, it’s fine to go see a therapist, this is really important, or to take medication for depression or anxiety.’ There’s a little voice in the back of our head saying, ‘But I’d never do that — that’s for people who are weak.” It’s not anything that anybody ever said to me. But there’s kind of a sub-conversation in many ways in healthcare, it’s called the hidden curriculum.
I have seen people and I’ve talked to many people who have literally been told, ‘Maybe you just don’t have what it takes to be in health care.’ And when you think about all the sacrifices that people have made to get there, the last thing that they would ever do is to think about walking away from that. And now that’s changed over time and people have done that. But certainly back in the times when I was training, that just didn’t happen.
Mark has spent a lot of his career trying to facilitate that change. And one of the big ways he’s done that is by developing a platform called PeerRxMed — which pairs health care workers together for regular well-being check-ins. It gives frontline workers someone to talk to, who isn’t a friend or family member, but who is someone who shares their experiences and can be a sort of neutral party to hear out their issues and stressors.
Dr. Mark Greenawald
The seeds for PeerRx were really planted in both my military training, but even before that, I grew up in the YMCA, and the YMCA swimming programs, and you never swam without a buddy, you just didn’t do it.
Literally the tagline for PeerRxMed is no one cares alone.
And so the structure is a very simple one where I send out an email once a week — that’s called the ‘buddy check nudge’ — and in it is a very brief email that just says here’s some things I’ve been thinking about this week. When you check in with your PeerRx partner, besides just checking in, here are two prompts that you may want to think about. And then I have a blog that I’ve started that kind of expands on whatever I’ve been thinking about that week. And so my encouragement to them is literally check in. It’s as easy as checking in for 90 seconds — you can just text somebody and say, ‘Checking in, how you doing? I’m struggling with this this week…’ Email, phone call, whatever that is. And then if something’s going on, pick up the phone or hop on a call or video or whatever, just to check in.
I designed it so that physicians who were very famous for saying, ‘I don’t have time for anything,’ I tried to design it in a way that it would be really hard to, with any kind of integrity, say ‘I don’t have 90 seconds to check in with somebody.’ Like, that would be ridiculous.
We have a website that went live a year ago and it’s really organically been amazing how it’s grown.
While health worker burnout and stress aren’t new, the pandemic has made things worse. A September 2020 study from Mental Health America found that 93 percent of health workers were feeling stress. More than three-quarters felt exhausted or burnt out.
Dr. Mark Greenawald
The other thing that people are talking about a lot more is post-traumatic stress disorder. People who are working on Covid units right now, I mean, the things they’re seeing most of them could never have fathomed, particularly if you’re in the ICUs, and things like that in the emergency departments. We’ve seen some of that on TV, but that’s just not happening in just, you know, New York City or Chicago — it’s happening all over the country.
I’ve talked to people who’ve said, ‘I’ve had more people die in a week, than sometimes I’ve had die in a month or even a year.’ And they’re dying alone in many cases. You have to be pretty cold-hearted to not have that crush your heart and crush your soul.
I think we’re going to experience a lot more of that once people clear their heads and say, ‘What just happened?’ It’s also bringing up pre-Covid traumas that we never talked about before that all of a sudden we’re starting to say, you know, ‘What about those traumas?’
I think that we are going to talk about clinician mental health and emotional health in a way that we never had before. It kind of happens generationally, that we destigmatize it a little bit more and a little bit more. And my hope is maybe this time around, it will become one of those things that not only do we talk about, but we even say, ‘We assume that you’re struggling, you know, so we’re going to assume that and it’s almost like, prove to us that you’re not.’ I know that’s kind of radical, but the idea of saying how are we checking in on people in a very deliberate fashion, rather than waiting for them to crash?
My hope certainly is, as somebody who’s helping to lead this conversation, is that we’ll be talking about it in a different way. And if we do that, then we take it a step in the right direction, because that conspiracy of silence is devastating in many ways.
For iPondr, I’m Cody Nelson.
Audio story edited by Annie Sinsabaugh
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