After losing her sister, Dr. Lorna Breen, to suicide in April, Jennifer Feist submitted written testimony last month to a Congressional hearing examining the pandemic’s toll on mental well-being. Ms. Feist has adapted and expanded that testimony for U.S. News in the post below. Together with her husband, Corey Feist, she co-founded the Dr. Lorna Breen Heroes’ Foundation. In the second-half of this post, Mr. Feist, CEO of UVA Physicians Group, shares why they are calling for culture change in health care. Tomorrow, Sen. Tim Kaine, a Virginia Democrat, is introducing legislation with Sen. Todd Young, R-Indiana, Sen. Jack Reed, D-Rhode Island, and Sen. Bill Cassidy, M.D. (R-Louisiana) — the Dr. Lorna Breen Health Care Provider Protection Act — to honor Dr. Breen and prevent suicide and mental health issues among health care professionals amid the COVID-19 pandemic and beyond.
On April 26, 2020, my sister — Dr. Lorna Breen, an emergency room physician — died by suicide at age 49. You may have heard about her on the news. Skimmed the headlines. Seen the TV clips.
There is more to Lorna’s story.
Lorna was head of the emergency department at a hospital in Manhattan, right as the city was being pounded by an onslaught of coronavirus cases. In the span of just three weeks, my sister treated patients with COVID-19, contracted the virus herself, recovered and went back to work. When she returned to the hospital, she was confronted by an overwhelming, relentless number of incredibly sick patients. She and her colleagues worked 24/7 during the peak in New York, with limited personal protective equipment, insufficient supplies, not enough beds, not enough help. Many of her colleagues were out on medical furlough. She told me patients were dying in the waiting rooms and hallways.
There was so much suffering. So much death. So much that couldn’t be done for them, no matter how many hours were being put in nor how much expertise was in the room. Even after 12-hour shifts, my sister and her colleagues would stay on to help. The outbreak didn’t care if it was day or night. There was no timeline. She kept going back, day after day through the prolonged crisis, until she literally could no longer stand.
On April 9, 2020, my sister called me from her Manhattan apartment. Her voice was different. She said she couldn’t get out of her chair. She was nearly catatonic. She had not slept in over a week. At one point, she had even covered two emergency rooms in Manhattan — simultaneously — at locations 5 miles apart.
Lorna answered the call for her city and for her country. And when she became so overworked and despondent that she was unable to move, do you know what she was worried about? Her job. She was worried that she would lose her medical license, or be ostracized by her colleagues because she was suffering burnout due to her work on the front lines of the COVID-19 crisis. She was afraid to get help, even when friends formed a chain to get her out of New York, each driving her from state to state until I could pick her up and take her to an inpatient psychiatric facility for evaluation in our hometown in Virginia, on medical advice. She worried it would end the career she had spent her entire life working for.
My sister had no prior mental health issues (known or suspected), she had no history of depression or anxiety. She was very smart, very funny and had just the right amount of sarcasm. Her drive was something to behold. Raised by my mother, a nurse, and my father, a surgeon, Lorna dreamed as a young girl of being a doctor in Manhattan — and she worked hard to get there. Double-boarded in emergency and internal medicine, Lorna was earning an executive MBA/M.S. in health care leadership to advance her career at the time of her death.
We were born 22 months apart and were close, not just in age. When we were little, we made up a new language and spoke it regularly — relishing our secret, as the only two people who could understand what each other was saying. As an adult, she would often text me in the morning to get my opinion on what she was wearing to work that day, despite being a decisive leader accustomed to making life-or-death calls in crises. She had a rescue cat named Sampson, and was always changing her hairstyle, from long to bob to pixie. She loved Chardonnay, but only if it was oaky. She didn’t care for Pinot Noir — she thought it tasted like jam.
Lorna cursed a lot, but only among friends. She couldn’t understand why people were so obsessed with Instagram but she learned how to use Snapchat so she could keep in touch with our 16-year-old son. Sometimes I tried to convince her to watch Netflix series, but she wouldn’t do it. She thought it was a waste of time. In the free moments she did have, she played cello and salsa danced; she traveled and learned snowboarding. She was a real person, and she was ours. My family’s love for her was infinite.
When Ebola surfaced in New York City and a doctor there became infected in 2014, I remember how worried she was. She was convinced it was going to kill more people. I can’t shake the idea that if, on some molecular level, she knew it would be a pandemic that would kill her. We all knew that she would get COVID-19. When you’re an emergency room physician, you catch stuff. It’s perhaps the cost of doing business. None of us knew how bad it would be, or how her life would end at her own hand.
COVID-19 changed my sister. Emerging research suggests the novel coronavirus may impact the brain and we are anxiously awaiting autopsy results to investigate any possible connection. Regardless of the outcome, I’m writing today because this is not an isolated story of one doctor’s suicide. What happened to Lorna is part of something much bigger. A culture that needs to change.
What I learned after her death is that despite significant progress being made, some medical licensing boards throughout the country still require disclosure by physicians of mental health care, and that seeking mental health care is considered a sign of weakness among many medical professionals.
Well before COVID-19, clinician burnout was being recognized as a national public health crisis, including by the National Academy of Medicine, American Medical Association and other prominent health organizations. The pandemic has placed intense stress on an already strained workforce. This was my sister-in-law Lorna’s experience.
Approximately 400 physicians die each year by suicide in the U.S. — more than twice the rate of the general population. Doctors, particularly women, appear to have the highest suicide rate of any U.S. profession, and emergency medicine, Lorna’s area, has one of the highest suicide rates of all medical specialties. A 2019 survey of more than 15,000 physicians found that about 40% are wary of seeking formal mental health treatment, while 12% said they’d consider it but only in secret. Imagine a job where you felt your professional stature could be at risk for seeing a marriage counselor. Or having postpartum depression. Or seasonal affective disorder.
“Physicians are routinely exposed to tragedy and death resulting in occupationally induced anxiety, depression, and PTSD. Yet doctors receive no routine on-the-job support. Instead, they risk punishment when asking for help,” writes Dr. Pamela Wible, a family doctor in Oregon. She published a paper on the subject last year in the journal Qualitative Research in Medicine and Healthcare, which ran a special issue on physician mental health. “State boards, hospitals, and insurance companies interrogate doctors about their mental health, read their confidential medical records, and then deny health plan participation, medical liability coverage, hospital privileges, and state licensure.”
I have worked in health care for over 20 years, dedicating the last decade almost exclusively to supporting physicians and addressing burnout. Yet, there remains a dark secret in medicine: a cultural stigma that is hard to eliminate among physicians. It dictates that the caregiver not ask for care; that taking a break, admitting fatigue or asking for help is inappropriate. The indoctrination begins early during the rigorous days of medical education and training. This stigma is reinforced by legislation, licensing, credentialing and hospital privileging. This stigma weighed heavily on Lorna , and we believe it was a significant factor in her suicide.
This paradigm must end. We have gone too far. We have asked too much. The system is broken.
We have established the Dr. Lorna Breen Heroes’ Foundation, a nonprofit dedicated to protecting the well-being of physicians and health care workers everywhere. We are working across the health care industry, with national associations, health systems, and both the state and federal governments to bring resources to clinicians who are desperately in need of help.
A Call to Action
To the Health Care Industry
We ask that health care organizations develop real strategies to address the root causes of burnout — be they longstanding issues like electronic medical record inefficiencies or more recent challenges stemming from the pandemic. It’s time to do more to promote the well-being of health care workers and improve their access to mental health services, not only during the current public health emergency but long after.
To the Federal and State Governments
We encourage the federal government to fund programs and support comprehensive legislation addressing clinician burnout and wellness, including during early medical training. We ask state governments to recognize they hold the key to alleviating a major element that reinforces stigma — the medical licensing process. Dr. Wimble’s recent paper compared medical licensing applications across the country, and identified the most physician-friendly states for mental health.
The Federation of State Medical Boards made sweeping recommendations designed to help curb doctors’ reluctance to seek mental health treatment in a 2018 policy statement. The group encouraged state medical boards to review their “licensure (and renewal) applications and evaluate whether it is necessary to include probing questions about a physician applicant’s mental health, addiction, or substance use.”
We’d like to see this momentum continue, with all states limiting questions about mental health to conditions that currently impair clinicians’ ability to perform their job. As Dr. Esther Choo, an emergency physician and professor of emergency medicine, wrote in a recent Op-Ed for the Washington Post: Many prominent organizations including the American Psychiatric Association and American Medical Association “have advocated against using past mental health diagnosis and treatment as a means of assessing fitness for work. As of 2018, however, 32 state medical boards and 22 nursing boards continue to ask mental health questions on licensing forms that are inconsistent with the Americans with Disabilities Act.”
While these figures don’t capture the strides that have since been made, our work to combat these obstacles — real and perceived — must continue as the pandemic rages on and providers are still suffering. In addition, we ask that states adopt the model legislation enacted by the Virginia legislature in 2020 to develop confidential support programs for providers. Other states have taken similar action, giving providers more avenues to seek the help they need.
To the Clinicians
Lorna was the toughest of the tough. This can happen to anyone and the tide can turn in the blink of an eye. Please take time for yourselves and take care of each other. Encourage your colleagues to take a break and make it “OK” to sit down. Talk to your peers. Dr. Humayun Chaudhry, President and CEO of the Federation of State Medical Boards, says a misperception persists that doctors could lose their license for simply getting mental health care, noting there are support programs available and opportunities to pause licenses and re-enter the workforce after getting help if needed.
To Health Care Rating Agencies
We ask that ratings agencies like U.S. News and World Report start incorporating clinician well-being and the work environment into their rankings, using well-established industry measures. This could have a seismic impact, improving not only burnout but the patient-quality outcomes measured in these rankings. The U.S. News Best Hospitals edition has just published today; we would like to see next year’s rankings take the lead on this.
To the General Public
We ask you to recognize that every one of us will need health care at some time in our lives. Our health care workforce has been carrying an incredible burden for all of us — especially during this prolonged pandemic — and they deserve to be of sound body and mind. When clinicians are unwell, it may impact the quality of care you or a loved one receives.
Please join our community and support our clinicians and their families by following us on social media @drlornabreenheroesfoundation (Instagram), @drbreenheroes (Twitter) and Dr. Lorna Breen Heroes Foundation (Facebook). Share your stories and ideas on how we can help.
Mother Teresa once said, “I alone cannot change the world. But I can cast a stone across the waters to create many ripples.” Lorna’s death has cast a stone, and we will continue to fight for a cause that was so important to her and to change the paradigm that was, in the end, her undoing.
If you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK).
More from U.S. News
Our Family’s Tragedy: Dr. Lorna Breen Is the Canary in the Coal Mine originally appeared on usnews.com
Update 07/30/20: This story has been updated to include all of the senators who introduced the Dr. Lorna Breen Health Care Provider Protection Act.