Wednesday Apr 15, 2020
Unease During Pandemic Offers a Lesson in Understanding
I recently screened myself for anxiety using the Generalized Anxiety Disorder 7-item scale.(www.integration.samhsa.gov) I scored higher than I ever have before.
For reference, I've used this scale on myself before I took board exams, before National Resident Matching Program results were released when I was a fourth-year medical student and when I was feeling pretty overwhelmed during an international rotation. I know that my current state of anxiety is directly related to the burgeoning number of COVID-19 cases in my community, the number of cars I still see on the street, the people I see coughing without masks and the limited number of ventilators we have in our small town.
My anxiety is warranted, but I had a thought strike me yesterday during one of our daily COVID-19 task force meetings.
This is what anxiety feels like all the time.
This is a short post because I want to communicate a simple idea: The fear, sense of powerlessness and worry that grips health care professionals as we face this growing crisis is an opportunity to learn what our patients who suffer from anxiety experience daily -- pandemic or not.
I trust family medicine physicians to be empathetic, kind and thoughtful when dealing with any illness. However, we all know that if we have personal experience with something, like an ICU stay, we come away with a profound understanding of what it feels like to be on the other side of the stethoscope.
I feel that with the looming menace of COVID-19, we can have at least a glimpse of what it feels like to have something akin to the profound, persistent and pernicious anxiety associated with generalized anxiety disorder.
I cannot fall asleep easily these days because my mind is racing. I worry about every passing face-to-face interaction and am hypervigilant about my actions and those of others. I have intrusive thoughts about worst-case scenarios. I feel that no matter what I do, things will get worse, and that I as an individual have only a tiny amount of agency in the face of an onrushing tidal wave.
I have dread.
I know that there is good reason to feel this way, and I also know that, as a lover of public health, I have agency and will make a difference. However, I also can imagine what it would feel like to have these worries without a "good reason," or to have seemingly no agency to make a difference. It would feel orders of magnitude worse. All the things that I can do to resolve my anxiety are frequently unavailable to those without resources, stability or community.
I've known how debilitating anxiety can be, but now, experiencing a sliver for myself, I feel that I have a better understanding. I hope that I can bring that understanding to my future interactions, both during this pandemic when anxiety is likely to be worse for everyone and long after it ends. When it does end, I will remember that as we return to our baseline levels of anxiety, for some people, the "baseline" is still pretty difficult to deal with.
Stewart Decker, M.D., is a family physician practicing in southern Oregon. He focuses on the intersection of public health and primary care.
Posted at 02:22PM Apr 15, 2020 by Stewart Decker, M.D.