key: cord-0885161-3o19ugbw
authors: Fessell, David; Garver, Kim; Lexa, Frank
title: Navigating “Down Time” During COVID-19
date: 2020-04-15
journal: Acad Radiol
DOI: 10.1016/j.acra.2020.04.006
sha: 6c52dc9b3d6d948efd401b05dd79f859bc58891d
doc_id: 885161
cord_uid: 3o19ugbw

nan

Navigating "Down Time" During COVID-19 David Fessell , MD, Kim Garver, MD, Frank Lexa, MD/MBA I n an effort to slow the spread of the corona virus, many elective medical procedures, including screening imaging studies have been postponed. As a result, the volume of cases in radiology departments has dramatically decreased. While some radiologists may be extra-busy supporting the new "schooling at home" status of their children, and others may now have extra duties caring for an elderly parent without their usual support, many radiologists now have increased down time. Being "radiologically idle," at least in the shortterm, may very well stimulate a desire for meaningful contribution, especially given the increasing volumes of patients infected with COVID-19 and the massive changes in our country and our world. While radiologists may be called upon in various ways as the situation evolves, what positive things can be done with this down time?

While it is tempting to be "all in" for others-helping, serving, monitoring the news-it is essential to take care of oneself. This is part of the Declaration of Geneva that many of us pledged to uphold when we graduated from medical school-"I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard" (1). If we are run down and do not have energy we cannot help others. The reminder given on every airline flight is trueÀput your own oxygen mask on firstÀso that you will be able to help others. Positive daily routines can be very helpful in stressful times including setting goals, exercising, maintaining a healthy diet, getting enough sleep, as well as connecting with others. Tracking one's goals helps to provide a sense of progress and accomplishment and for high power professionals is particularly important when their work structure is disrupted. Limiting news and world events updates to specifically scheduled times (perhaps when one is exercising and can burn off the stress) can limit the stressful inputs and promote coping.

A number of quick and simple micropractices for wellness have been described, including a personal "wellness checkin" during handwashing (2) . Developing healthy routines, constructive habits, and a structure for one's day is grounding and can elevate energy levels by decreasing decision fatigue. Focusing on those things in our zone of control is empowering and calming (3) . Regular reminders of our personal values-those which provide meaning and purpose in our lives-help to ground us. Such things can include spirituality, religion, meditation, service, and family ties. Sharing these deeper values-those which bring greater meaning to our lives-can also be a very meaningful and lasting way to connect with others, especially now, in the face of constant change.

The current crisis can give rise to a variety of feelings in those who are at home rather than engaged in their normal activities at the hospital, clinic, or imaging center. Such feelings can include inadequacy, uselessness, guilt for not doing more "clinically relevant" activities, perhaps even mixed with occasional feelings of relief that one is not currently on the "front lines" in the emergency room or ICU. Loss naturally stimulates feelings of grief and mourning. Uncertainty naturally stimulates anxiety. It may feel as though we are increasingly hijacked by unexpected emotions including frustration and sadness. Naming our feelings, allowing them to be present, and letting them flow through us helps to complete the natural process of navigating traumatic events (3, 4) . Such selfcare, including our emotional and mental health, is essential. Self-care is not self-indulgent-it allows us to support those who rely on us. Social media may be helpful to some, but can heighten fear and worsen depression in others. On-line talks with mentors, colleagues, coaches, spiritual advisors, and mental health professionals are supportive forms of communication and all can be helpful. A regular journaling practice, including what one is grateful for, can also have a positive effect on our well-being (2, 4) .

A primary consideration is how best to support our families. Challenging times can be a time of pulling together and of building resiliency and inner strength. It can be a time of deepening the connection with one's partner. Many find it helpful to track one's "check-ins" with family members who are not living with you. Family members are often living across the country and having such a system to know one is regularly checking in can ease our minds. Preparing oneself before such calls-by centering and calming ourselves, bringing some positive or encouraging news (dramatically fewer cases in China, progress on a vaccine, etc.) can be helpful. Expecting stress, anxiety, and worry from those on the other end of the call allows us to prepare and bring more support. By providing a listening ear, a bit of hope, and a connection to meaning and purpose, we can deepen the family bonds that help sustain us all.

What can we do in our local communities? Across the country there is a shortage of blood since regularly scheduled blood drives have been canceled. Many agencies, including the Red Cross, and America's Blood Centers are in dire need of blood and take appointments to align with social distancing (5) . One can donate money to local food banks to help support the rising numbers of unemployed. Putting a reminder on one's calendar to assess which agencies have needs and to donate to them can help provide a source of continual contribution. Hosting zoom coffee chats, happy hours, and birthday parties with family, friends, and colleagues helps all engender feelings of connection and a sense of belonging. Such events can be an occasion to sharing coping strategies, jokes, and gratitude, as well as concerns and fears.

With normal radiology work massively decreased, this can be a time for tackling tasks that are otherwise on your back burner such as mandatory continuing medical education (CME) credits. Have you been planning to learn more about AI, or a new development in your specialty? Many journals offer CME for engaging with articles, and there are many other on-line sources for radiology CME credits. One may be able to do maintenance of certification work as well. Can you give lectures on-line to your trainees, or prepare that lecture you have scheduled at a fall conference? A recent publication outlined many helpful tips for giving web-based lectures to residents (6) . This can be an especially productive time to complete research papers and write the next grant. It may feel difficult at first to try and focus on such work, given all that is happening in the world. It can also be very satisfying to have a meaningful project on which to focus.

The future is uncertain but it is not unreasonable to expect less conference or professional development time when the COVID-19 pandemic is over. There may be a post COVID-19 surge in radiology work. Doing all that one can do now is prudent and helpful from a psychological standpoint as well. Asking oneself, "How can I be more productive at home," can be a helpful question. Beginning to think, at least in broad terms, about potential scenarios and the associated business plan needed for navigating them, may also be helpful. The Radiology Leadership Institute among other organizations has on-line content which can be of value, especially given the enormous change that is still evolving.

Depending on one's available time and interests, this down time can be a gift-a time for learning and developing new skills. Many of us have accumulated books we have not read, or ideas for the book we have always wanted to write. This can be a time to develop new hobbies such as learning to play the piano or an instrument, drawing, painting, organizing family photos or documenting a family history. Perhaps this is a gift of time for cleaning or organizing those often neglected areas like basements and garages. Such activities are defined, do-able, and help build a sense of accomplishment and agency.

This challenging time can also be an opportunity for deep reflection and a personal check-in. Where am I in my life? Before COVID-19, was I heading in the direction that truly aligns with my values and purpose? Has COVID-19 changed my priorities, values, or the way I wish to spend my time going forward? Thinking 2À5 years from now can be a helpful exercise-where do I want to be, and what can I do now that will help me get there?

While we may not currently be able to contribute in our normal ways as radiologists, there is still much to be done, for our families, communities, practices, and for ourselves. Focusing on what we can do, and making progress will serve us well. We cannot know what the future will bring, but we can do our best to make progressÀday by day, breath by breath. Share your strategies, successes, and failures. We are in this together. We are navigating this challenge, and we will thrive again.

COVID-19 and beyond: micro-practices for burnout prevention and wellness

That discomfort you're feeling is grief. HBR, 3-23-20

Understanding your emotions, HBR

WSJ blood drive: Available at

Web-based conferencing: what radiology educators need to know