Building mental Health Resilience in health care teams.

Dr. C.V. Alert MB BS, DM, FCCFP.

Family Physician.

 

The term ‘resilience’ primarily reflects the capabilities of a system to absorb and recover from disturbances. Mental health resilience is crucial for effective teamwork in healthcare, and mentally strong doctors are essential for success of any health care system. Mental health resilience is a cornerstone of effective teamwork. Doctors must be able to discuss difficult issues, such as difficult diagnoses, without fear of repercussions. Inaccurate information or hesitation in these areas can have serious consequences. This requires an appropriate health environment, which is not a hypothetical construct but must be created.

Healthcare systems need to focus on both individual coping mechanisms, as well as creating a supportive work environment. Personal wellness means being physically, mentally and spiritually healthy. A healthy lifestyle helps balance all these aspects to achieve wellness. This includes activities like getting adequate sleep, eating healthy, avoiding drinking and smoking, and engaging in physical activity. To cultivate resilience in your life, it's important to apply the principles of the 7 Cs:  competence, confidence, connection, character, contribution coping and control.

On the other hand, lower resilience often stems from taking on (or being forced to take on) too much too fast. If you don't have faith in yourself or your abilities, or faced with an overwhelming situation, you’re less likely to adapt to stressful situations.

Here lies the catch-22 situation, for Caribbean Health professionals. Facing large workloads in under-resources clinics, many health care professionals are forced to take on too many patients, often with little or no support.  Mental health support? Just a rumor, as in many cases there is little recognition of the need to have supportive services, especially mental health services, available to health care professionals. ‘Only the strong survive, the weak fall by the wayside” : if individuals don’t develop personal coping mechanisms, then historically health care systems in the Caribbean are not designed to provide any assistance.

Violence, unfortunately in a prominent feature in many Caribbean islands- in two islands violence appears in the top 5 leading causes of death, and in most Caribbean islands the frequency and severity of violent acts is increasing; local health care providers are often called on to become involved, whether the involvement involves the perpetrator, the victim, family members, or even the security services. In rarer circumstances, the health care provider is himself/herself the victim of a violent act. But where is the support for the health care provider?

Dealing with dying patients and their families is another area of great mental challenge for physicians.

Associations such as the Caribbean College of Family Physicians (CCFP), and other groupings of health care providers, should not only consider advising its members to attend resilience training seminars, but to actually organize such seminars, even inviting other groups of health care professionals to participate.

Resilience training aims to teach how to adapt to stressful or dangerous events. It gives you tools to handle problems that arise on a daily basis. Being more resilient can improve quality of life, increase emotional strength, and lessen stress and worry. Teaching and prioritizing self-care to all family physicians should be also standard practice and supported throughout their careers.

Support must also go beyond workshops. There should be policies that specify adequate staffing targets to minimize exhaustion and burnout. Access to mental health services is also mandatory where family doctors can voluntarily seek psychological support.

Lastly creating a culture of psychological safety and support among peers will also help.

Psychological Safety?

 

Psychological safety is defined as the belief that one can take interpersonal risks without fear of being ridiculed or penalized. It allows team members to:

·         Ask questions without being seen as incompetent

·         Admit mistakes without fearing punishment

·         Raise concerns without being labeled as disruptive

·         Seek help without feeling embarrassed.

 

Psychological Safety benefits.

 

·         Better clinical decisions: Teams where junior doctors and nurses can express concerns without fear of negative consequences make more accurate diagnoses and prevent errors early.

·         Stronger team dynamics: A leader who sees themselves as a listener fosters trust within the team. Those open to feedback often receive critical information in time, preventing undesirable events.

·         Role modeling and sustainable leadership: Leaders who admit their own mistakes create a culture of mutual respect and foster a transparent, learning organization.

·         Error management as an opportunity: Errors are inevitable. What matters is how they are handled. A culture that views mistakes as learning opportunities improves both safety and team innovation. Experienced doctors and leaders who consciously strengthen psychological safety in their teams benefit in the long run through higher employee satisfaction, and improved patient safety.

 

Implementation in Clinical Practice.

 

Implementing psychological safety in healthcare requires action at multiple levels:

 

·         Individual level:

Personal communication skills development

Training in emotional regulation and conflict resolution

Feedback competency building

 

·         Team level:

Daily team reflection huddles

Leadership training at all levels.

Structured handovers with communication standards

Regular team reflection rounds

“Closed-loop communication” to reduce misunderstandings

Anonymous reporting systems for safety issues

 

·         Organizational level:

Regular interdisciplinary case discussions

Standardized communication processes

Speak-up protocols for critical situations

Cross-hierarchy meeting formats

Simulation training to improve error communication

Call to action.

 

Development of psychological safety is a continuous process that requires time, commitment, and resources. A lived culture of mistakes, where employees can communicate openly and without fear, is the key success factor for resilient high-performance teams in medicine and aviation.

 

 

Stress and Mindfulness.

Dr. C.V Alert, MB BS, DM. FCCFP.

Family Physician.

 

“The truth is that stress doesn’t come from your boss, your kids, your spouse, traffic jams, health challenges, or other circumstances. It comes from your thoughts about your circumstances.”
Andrew Bernstein, American Philosopher.

 

Stress is your body and mind’s way of mobilizing you to help you respond successfully to challenges in your environment.  This stress response evolved to keep us safe and healthy. When our cave-dwelling ancestors encountered a tiger, their bodies readied for action to meet the threat. Stress hormones such as cortisol and epinephrine ramp up to provide energy. Breathing quickens, the heart pumps harder, the immune system gears up to be ready to respond to injury. Once the tiger is vanquished and the threat is over, the body returns to a state of rest and restoration.

 

Our fight-or-flight response is still protective today. There are times you must act quickly, for example when a driver cuts in front of you in traffic suddenly. If we didn’t have that system kick on when it needed to, we wouldn’t be here.

 

Chronic Stress.

 

Chronic stress results when what was meant as an occasional emergency response becomes a day-to-day occurrence. Modern life can feel like an endless stream of emergencies: daily bad news, increasing violence in your neighborhood, constantly rising prices, or concern that a hurricane(s) may decide to do a Caribbean island tour, while God is busy with Ukraine and Gaza. Today, many of our stressors often are not life-threatening, like a face to face encounter with a tiger. But it’s still that same biological response. We weren’t designed to be stressed constantly. Biologically, stress a very energy intensive state, and it’s very hard on the body and mind to maintain this high intensity on an ongoing basis.

 

A state of chronic stress takes a heavy toll on the body’s systems. Research has linked chronic stress to a host of physical and mental conditions from high blood pressure to weight gain to digestive problems. In fact, chronic stress is believed to be a major factor in the global (and local) rise in hypertension and its complications, and hypertension is the most prevalent chronic illness. When someone’s hypertension is triggered by chronic stress, in most cases unless we can reduce/eliminate the stress, we won’t be able to control the blood pressure.   Chronic stress actually makes us age faster and shortening our life spans.

 

Chronic stress also has profound consequences for our emotional health.  It can precipitate anxiety, panic attacks, insomnia, and depression. Many adults are aware that stress causes them trouble concentrating, forgetfulness, headaches, or difficulty making decisions.  Your thoughts can become a stressor even in the absence of an outside threat.  In other words, just thinking about ‘something’ can cause you to be ‘stressed out’, and your heart starts to race and your stomach starts to churn.

 

Compounding the problem, we often turn to unhealthy ways of coping. Some people start seeking quick relief by eating more or drinking more or smoking more. These strategies may feel good in the moment, but can cause further damage to our physical and mental health in the immediate to long term.

 

Why doctors can’t diagnose stress?

 

Although stress contributes to various medical issues, diagnosing it is challenging because individuals respond to events in unique ways. For example, imagine a cricket match between Team A and Team B. If the best batsman on Team A gets out quickly, supporters of Team A may feel disappointed, while supporters of Team B may feel elated. The same event—the dismissal of Team A’s best batsman—triggers entirely different reactions among different groups of supporters. This variability in emotional responses makes stress difficult to diagnose, as it is highly subjective and influenced by personal perspectives.

 

 Successful Strategies for Coping with Stress.

 

Escaping forever to a hideaway with no telephones may sound like a tempting solution. But there are other strategies one can employ.  The stress may be here to stay, there is much you can do to boost your resilience.   

 

1.    Take stock of your situation.

 

Press pause and take an honest look at your day-to-day life. If you keep going 24/7/365 at 120 miles an hour, you're never going to get a handle on stress.  Reflect on how you are feeling physically and mentally and identifying the stressors that may be contributing, such as being on your phone constantly or skimping on sleep. Some people don’t want to take stock in this way as it increases their feelings of stress or anxiety. But recognizing your stressors is the first step to being able to do something about them. While you may not be able to eliminate your life’s stressors entirely, reflecting on those aspects you can control and doing something about them can be very helpful. If you are caregiving for an ill loved one, for example, you could ask a friend to do a supermarket run.

 

Taking a hard look at your priorities and then cut back. You may be thinking, ‘I’m doing these 100 things. I’m so important!’ We just take it as a part of modern life. But it’s not sustainable. Ask yourself, if today was the last day of your life, how would you spend your time?”

 

2.    Lean on Others.

 

Make spending time with family and friends a priority. People who have social support cope better Being around people you trust can calm your body and mind, but unfortunately, loneliness is another health crisis that is partially self-inflicted. During the pandemic, rates of anxiety and depression went through the roof and isolation played a huge role.

 

‘Mindfulness’ is a type of meditation in which you focus on being intensely aware of what you're sensing and feeling in a particular moment, without interpretation or judgment. Practicing mindfulness involves breathing methods, guided imagery, and other practices to relax the body and mind and help reduce stress. Mindfulness meditation has been shown to offer a host of stress-busting benefits, from lowering blood pressure to easing anxiety. With regular practice, you can become less reactive. You’re able to sit back a bit, take a breath, and contemplate before you shoot back a reply to that distressing email. Another effective go-to: deep breaths. Simply closing your eyes and inhaling and exhaling five deep breaths can have an immediate stress-relieving effect.

To see benefits from meditation, experts suggest you aim for at least 10 minutes each day. However, each person responds differently, so try longer meditation periods if 10 minutes don't seem to make any difference for you. If you find this difficult, try meditating several shorter times throughout the day.

4. Practice Good Self-Care.

 

Stress saps your mental and physical resources, so good self-care can help you be more resilient. Prioritize sleep. Turn off your phone, listen to relaxing music, and take a bath, so your body knows it's time to rest.

 

Make regular exercise a priority. That doesn’t mean you have to have a full-out sweat session every day. Walking can be great exercise. Some of my patients use a step counter (pedometer), often on their smart phones. You can slowly increase your goal by 500 steps every few days. Other exercises that are particularly restorative for body and mind include swimming, yoga and tai chi, and there’s support for spending time in nature – stop and smell the roses- to reduce stress as well.

 

A healthy diet can also help you combat the toll of stress. That can start with eating more mindfully. Eat with a focused mind. Chew their food down to a liquid before they swallow. Once you really connect with your food, you tend to want to eat more nutritiously.

 

5.    Seek Help.

 

Sometimes, despite such efforts, we reach a state of complete overwhelm. Seeking professional help from your doctor or a mental health specialist can be an empowering step toward coping better.

 

“Doing what matters in times of stress. An illustrated guide. Adapted for the Caribbean” is a booklet produces by WHO/PAHO, is available for free on line, and offers simple advice about dealing with stress, and is particularly useful for persons who fear the stigma of being labeled ‘mental case’.

 

6.     Laugh more.

A good sense of humor can't cure all ailments. But it can help you feel better. When you laugh, it lightens your mental load. It also causes positive physical changes in the body. Laughter fires up and then cools down your stress response. So read some jokes, tell some jokes, watch a comedy or hang out with your funny friends. Did you hear about the man who walked into a bar and said “Ouch”? Well, it was an iron bar.

 

Minimizing the chronic stress of daily life as much as possible can support your overall health. Engaging in activities that support self-care may help reduce stress and anxiety. These can include getting more exercise, mindfulness practices, getting adequate sleep. and eating a well-balanced diet. By prioritizing mindfulness and self-care, we create space for calm, growth, and resilience.

 

 

Artificial Intelligence (AI) in Medicine. Many positives, some negatives, but can we benefit?

Dr. C.V. Alert, MB BS, DM. FCCFP.

Family Physician.

Artificial Intelligence (AI) is a rapidly evolving field of computer science that aims to create machines that can perform tasks that typically require human intelligence. AI in medicine and healthcare is rapidly transforming the field by enhancing diagnostics, treatment plans, and patient care. AI algorithms can analyze medical data to identify patterns and insights that may be missed by humans, leading to earlier and more accurate diagnoses, personalized treatment strategies, and improved patient outcomes. 

 

Here are some areas in which AI is being used to improve healthcare:

 

1.    Diagnosis of complex cases.

 

Very recently, it was announced that a new AI tool (from Microsoft) can diagnose complex illnesses more accurately than most doctors. This AI tool blends the strengths of both generalists and specialists. Most doctors either have a broad base of knowledge (e.g. family physicians) or deep expertise in a particular field (e.g. specialists), but this AI combines both. In testing, this new tool correctly solved over 80 percent of the specifically selected challenging cases, compared to just 20 percent by human doctors. Even more impressive, it managed to do so while ordering fewer tests, suggesting a more efficient and cost-effective approach to diagnosis.

 

The system’s ability to update its diagnosis in real time, as more data is added, means it can adapt quickly and provide up-to-date recommendations. This is a big deal, especially in complex cases where every detail counts. Researchers say the AI’s clinical reasoning skills are beyond what any single doctor can offer, thanks to its ability to process vast amounts of information from different medical fields at once.

 

Despite these promising results, Microsoft is claiming that this is a pathway to ‘medical superintelligence’, but is not positioning this AI tool as a replacement for doctors, at least, not yet. The tool is still being tested in real clinical settings to see how it performs outside of controlled experiments. Safety checks and clinical validation are ongoing, and the company says it will only move forward with broader use once these hurdles are cleared. Stay tuned.

 

 

 

2.    Personalized Treatment Plans:

 

AI can analyze patient data to predict individual responses to different treatments, allowing for the development of more targeted and effective treatment plans. AI-powered tools can also help optimize medication dosages, minimizing side effects and maximizing therapeutic benefits. 

 

On the other hand, many of the ‘newer’ classes of medications, like the monoclonal antibody treatments for a wide variety of diseases, many newer anti-cancer drugs, and the new classes of anti-obesity medications, are outside the price range of many Caribbean patients and most Caribbean National Drug Formularies, so we are unlikely to see any of these medications in the near future, or at least until patents run out, and/or effective and affordable generics become available.

 

3.    Disease Prevention and Management:

 

AI can analyze population health data to identify individuals at risk for certain diseases, enabling proactive interventions and preventive measures. AI can also help manage chronic diseases by providing personalized recommendations for lifestyle changes and medication adherence. 

 

On the other hand, there seems to be limited ability and enthusiasm, if not resources, for Caribbean Ministries of Health (+ Wellness) to generate and analyze data on local populations, At a regional level, the World Health Organization (WHO) and the Pan American Health Organization (PAHO) Caribbean countries are linked with Latin American countries, but the populations of tiny islands are dwarfed by the millions of persons in Central and South America with whom we share little apart for geographic closeness. It seems likely that Caribbean islands will need to develop Caribbean-specific AI algorithms, but it is unknown whether any concrete steps have been taken or contemplated in this regard.

 

4.    Ethical Considerations and Challenges:

 

While AI offers tremendous potential, it is crucial to address ethical considerations related to data privacy, bias in algorithms, and the potential for job displacement. It is also important to ensure that AI is used responsibly and ethically in healthcare, with proper oversight and regulation. Again this is an area in which Caribbean specific algorithms may be needed. Clear oversight and regulations would be needed to ensure ethical use of AI in healthcare.

 

To most independent observers, it would seem that many Caribbean islands are experiencing a mental health pandemic, although this has not been officially recognized. The triggers for this include both violence and drugs, often interconnected, and harsh financial conditions which impact on employment opportunities and even education. While AI is being used to develop tools to assist in mental health diagnosis, treatment and ongoing support, and can assist in scenarios where mental health professionals are in short supply, as we have here, again Caribbean specific (or even island specific?) algorithms will need to be developed before we can use these technology advances to improve health care.

 

AI companions that combine conversational AI, cognitive behavioral therapy (CBT), and mood tracking are used to support users’ mental wellness. The best of them simulate real conversations, prioritize user privacy, and deliver interventions grounded in psychological research. However, they are not a substitute for a mental health therapist, especially in severe cases.

 

But there is a possible downside to all of this new technology. AI programs can be configured to routinely answer health queries with false information that appears authoritative, complete with fake citations from real medical journals. Without better internal safeguards, widely used AI tools can be easily deployed to churn out dangerous health misinformation at high volumes. If a technology is vulnerable to misuse, malicious actors will inevitably attempt to exploit it - whether for financial gain or to cause harm,

There are many areas in medicine where AI is likely to make, and is already making, significant valuable contributions.  These include areas like the development of new drugs, where AI can analyze vast amounts of data at record speeds. The discovery and production of a variety of vaccines against Covid-19, for example, fall in this category. AI will be here when the next infectious disease pandemic arises. AI can automate some tasks, potentially alleviating the burden on healthcare professionals and helping to address workforce shortages. Robotic systems can assist surgeons with complex procedures, improving precision and minimizing invasiveness. AI can analyze medical images (like X-rays, CT Scans and MRIs) with greater accuracy and speed than humans, aiding in earlier disease detection. By automating tasks and analyzing data, AI can minimize human errors in diagnosis and treatment, leading to safer and more effective care. By improving accuracy, efficiency, and resource allocation, AI can help reduce healthcare costs and address workforce shortages 

Finally, AI can be used to train healthcare professionals and enhance patient education.

 

Like any other tool, whether AI can be a blessing, or a curse, depends on the use to which it is put, or if it is put to use at all.  There is no doubt that, in the ‘real world’, AI is being increasingly used to improve global health. The question is, do we wish to advance Caribbean health care services, and the health of our people? In the Caribbean we have rapidly rising health costs, yet decreasing population health.  The gap between the population’s need for health care, and the ability of the health services to supply this care, seems to be widening.  At least AI seems to provide one avenue for us to adopt a new business model: ‘business as usual’ is not working. AI should be used to complement human intelligence, but is not likely to be useful in situations where human intelligence seems to have run out of ideas.