Within this time of great uncertainty during the coronavirus pandemic, and its subsequent changes in routines, schooling, employment, and illness, it may seem impossible to find hope and positivity. However, I have been impressed by the strength, kindness, and compassion of not only those I work with in the Department of Pediatrics at Yale, but also the patients and their families for whom I care. I am encouraged by how attuned everyone is to the impact of self-isolation on mental health and overall well-being—from the check-ins with colleagues, to a neighbor inquiring about how I am doing, to the number of local and national news articles normalizing the impact the pandemic has on mental health and discussing strategies to promote resilience. I am heartened by what seems to be a cultural shift and acknowledgement of mental health—which often remains a stigmatized and unspoken topic.
I was recently struck when hearing from a family friend about her self-isolation experience—when asked how she was doing, her response was “better than last time.” And it made me pause, panicked at first that I missed a past world-wide crisis, until I realized that she was referring to the isolation she experienced during her teenage years during cancer treatment. Reflecting on her challenges with chemotherapy, I can see how this is in fact better—self-isolation this time does not include nausea, weakness, fatigue, or mental fog. Additionally, it is not an experience that she has to navigate alone—those within her support group similarly have to learn to manage a new normal. My friend has not been shy about sharing her experience with her cancer diagnosis, nor the impact it has had on her mental health and well-being. But for many, mental health remains a topic often not discussed.
Children and adolescents with chronic health conditions are more likely to suffer from mental health disorders compared to their peers.1-2 Chronic disease impacts all aspects of life and undoubtedly takes a toll on a child and family’s overall well-being and mental health.3-4 However, mental health issues often go unaddressed and most pediatricians do not feel well equipped to address these issues.5-6
Fortunately, a number of studies have demonstrated that even small interventions can make an impact on a child or caregiver’s well-being. It can be as simple as checking in, asking “How are you doing?” and really meaning it.7 And certainly now, as we all struggle with isolation and connectedness, I can see how this statement can make a world of a difference. Empathy, improved communication, and discussion of mental health topics does make a difference, with improved caregiver mental health, decreased stress, and improved satisfaction and trust in medical care.3,8,9 The degree of mental health impairment can be improved, even from one appointment, just by adopting a more patient-centered approach.8,10 These approaches are not demanding nor time-intensive, and they are goals we strive towards as providers. Nevertheless, it can prove difficult to “tune-out” our competing demands, provide undivided attention to our patients and families, and project an empathic, patient-centered approach.
I urge everyone to take a moment during a busy clinic day or inpatient rounds to pause from the medical questions. Perform a check-in and ask your patients and their families “How are you doing?” You may be surprised to hear what they say. You may be touched, as I have been, when patients and caregivers conclude the conversation by checking in with you, in return. I implore you to remember the experience of isolation after this pandemic resolves. Remember that our patients with chronic medical conditions and their families often feel this uncertainty and isolation when navigating their medical diagnoses. Remember, after we return to normal, to keep acknowledging and addressing mental health issues.
Juliann Reardon, MD is a native of Uxbridge, Massachusetts. She received her undergraduate degrees in Chemistry and Women’s and Gender Studies from the Massachusetts Institute of Technology. She received her medical degree from The Warren Alpert Medical School of Brown University. Dr. Reardon completed her pediatric residency training at the University of Massachusetts Medical School and is currently a second-year nephrology fellow at Yale University. Dr. Reardon is committed to medical education, having completed a scholarly concentration in medical education while at Brown and is currently pursuing a Masters in Health Science in Medical Education. As part of her masters, Dr. Reardon is working with the American Board of Pediatrics on The Roadmap Project, a pilot initiative for mental and behavioral health for children with chronic medical conditions, and is developing a mental and behavioral health curriculum for pediatric sub specialty fellows.