Opinion: A buddy system can help doctors and nurses weather the Covid-19 maelstrom

Remember outings in elementary school or at camp? You were probably paired with another kid about your age and size whose hand you held. The buddy system made losing someone much less likely to happen.

It is a timeless technique. It can be used anywhere and anytime. And it works for grownups too, like those on the frontlines of treating people with Covid-19.

Psychological distress and disorder during and after a disaster are very common. The greater the intensity and duration of events in a disaster, the greater the risk of developing serious emotional distress and disorder.


That means frontline health workers, especially doctors and nurses in emergency departments, intensive care units, and what have come to be known as Covid medical wards, are at high risk for serious emotional upheaval from working in these perilous settings. Not only do many of their patients die — often alone — but these clinicians may feel powerless to prevent those deaths, given that we are still learning how to best treat Covid-19 and its complications.

The first surge of Covid-19 created unprecedented physical and mental challenges for these medical professionals. Ironically, they are often the least likely to express their distress, especially doctors, who often avoid caring for themselves as much as they devote themselves to caring for others. They are likely to put on a game face and say everything is “fine,” especially to their service chiefs, hospital leaders, and even their families, sometimes feeling ashamed they haven’t been able to do more for their patients.


Since the start of the pandemic, numerous reports have revealed the depths of distress among attending physicians, medical residents, fellows, and nurses. An article in General Hospital Psychiatry reported high levels of acute stress in these groups, as well as symptoms of depression and anxiety. Those surveyed expressed significant concern about becoming ill themselves or infecting their families; the inability to meet family and home responsibilities; and social distancing from loved ones.

Some hospitals have tried to ease the burden on frontline clinicians by offering wellness videos and online classes, teaching meditation and mindfulness, and offering referral to mental health professionals. Though kind, these offerings have limited adoption and uncertain effectiveness. I heard of one hospital that had arranged for child care, which seems to me to be more useful and needed.

There’s a different approach, commissioned by the CEOs of Massachusetts General Hospital and NewYork-Presbyterian Hospital. Twenty critical care physicians who were daily facing the lash of the pandemic agreed to have private, anonymous video conversations for 10 minutes or longer, once or twice a week, when and where it was convenient, each with a chosen colleague they knew and trusted — essentially a “buddy.”

BongoMedia, where I now work as chief medical officer, was engaged to provide the private, secure platform and guiding questions for these buddy system conversations. The conversations were recorded, scrubbed of all identifying information, then made anonymous by using voice alteration and by substituting each participant’s face with a unique Venetian mask, both of which retained emotional nuance.

These recordings were then qualitatively and quantitatively analyzed by the company’s proprietary software, creating reports for the two hospital CEOs. The aim was to provide the hospitals’ leaders with de-identified analyses of what their doctors (and later nurses) were actually thinking and feeling to better inform their efforts to support their workforces, their greatest assets in caring for Covid-19 patients and their families.

These analyses showed that doctors (and later nurses) reported feeling “overwhelmed…out of control” and “isolated from family and other supports.” They talked about their fear of “becoming sick themselves, infecting their loved ones.” The de-identified recordings between these clinicians provided unfiltered truths they otherwise concealed.

These physician and nurse buddies, at risk of becoming lost in the fog and fear of the coronavirus disaster, helped one another bear feeling powerless, and not to feel alone in their work. That was not the intent of the project, but it is what we witnessed the buddy system do in video after video, though no measures of distress/disorder outcome were generated.

There was no shame. Instead, there was safety, trust, and unanticipated yet powerful peer support. Meeting these essential human needs was not likely to happen in any other way.

The latest Covid-19 surge dwarfs the first in sheer numbers, and its duration may be more protracted due to the emergence of more contagious variants. Vaccine hesitancy may also lengthen the shadow of Covid-19. While doctors and nurses have learned how to better manage the disease, its impact on them continues to be rough beyond words, especially when emergency departments are overwhelmed, all ICU beds are filled, and hospitals are short staffed as health care workers become infected with the virus, or leave for telehealth positions, or quit the profession altogether.

Yet for health care professionals, their duty is unchanged: keep people alive and minimize the gravity of each patient’s illness, especially now that we know Covid-19 can induce a legion of persistent pathologies, including neurological and psychiatric conditions, after the acute illness subsides.

Hospitals across the country can help their caregivers function in a time of coronavirus by offering them a buddy system of private peer support and unfiltered truth-telling. That can be medicinal in countering the grave distress and isolation that health care professionals are experiencing during this unbounded pandemic.

Doctors and nurses want this support, they endorse it. They want to be set up with buddies. To not be alone as they try to stay the course during the unprecedented hell that Covid has wrought. Let’s give them what they want which, it turns out, is what we all need.

Lloyd I. Sederer is a psychiatrist and public health physician, adjunct professor at the Columbia University School of Public Health, chief medical officer of Bongo Media, and former mental health commissioner of New York City, where he led the FEMA-funded efforts to help health care and emergency workers and the wider population cope with the trauma of Sept. 11 and Hurricane Sandy.

Source: STAT