Dr. Mammen, Feist: Simone Biles' courageous actions will have lasting effect on medical profession, more


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It sometimes takes a professional athlete to bring attention to a lesser-known cause and make it relevant to the nation. Simone Biles’ courageous decision this week to withdraw from the Tokyo Olympics has brought the mental health of athletes to the world’s center stage. It is about time we eliminate the stigma of admitting our mental health needs.  

Few of us know the singular dedication, focused time, effort, and investment it takes to develop into an elite athlete. This doesn’t only include technical abilities, physical skills, stamina, and endurance, but a level of concentration, focus, and mental toughness hinging on a belief in oneself and their preparation to get through the most grueling of challenges and fiercest competitors. 

It would seem a reasonable expectation that together, both the Olympians and the association overseeing the competition would recognize the central importance of performance and positive outcomes of the primary goal – to compete and win competitions, to propel the sport of gymnastics even further, and to serve as a role model of a true athlete. 

As an emergency physician, I, Dr. Mammen, know what it means to dedicate years in study, more in training, and the bulk of your life to honing your craft, building your knowledge, and approaching your career with focus and dedication. 

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Emergency physicians, in particular, don’t often ask for help. We are trained and taught to push through any barrier or limitation for the sake of our patients. 

Watching what Biles endured in 24 hours illustrates some of the deepest fears that arise when we express our mental health needs. 

This substantiated consternation in seeking help is just what plagued Dr. Lorna Breen, a celebrated emergency medicine physician at New York-Presbyterian Allen Hospital who treated patients on the front line in the early weeks of the COVID outbreak in New York.

Emergency room doctor Lorna Breen

Emergency room doctor Lorna Breen

The culture of medicine has long been recognized as one where human capital and the strength of the workforce is a foregone conclusion rather than one that is cultivated and protected. 

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Consequently, and as COVID further highlighted, many try unsuccessfully to navigate it alone. They ultimately suffer in silence due to fear of being shamed for asking for help, having clinical competence and “strength” questioned, or being kept from the work we all cherish due to regulatory issues with our medical licenses or hospital privileges. 

While it takes profound courage and unwavering dedication to show vulnerability, it is the fear of being punished for perceived weakness that keeps us silent. 

Tragically, Dr. Breen felt she couldn’t carve out the time and space needed for mental health respite. 

We are all plagued by the mantra “just keep swimming.”

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Breen, sister-in-law of J. Corey Feist, faced the unrelenting deluge of sick and suffering people and families as COVID-19 ravaged New York City in a time when little about the virus was known, and the country was largely unprepared for a pandemic. 

Priya E. Mammen MD, MPH is an emergency physician, public health specialist, Senior Fellow at the Lindy Institute at Drexel University for Urban Innovation and a Trustee, of the College of Physicians of Philadelphia. 

Priya E. Mammen MD, MPH is an emergency physician, public health specialist, Senior Fellow at the Lindy Institute at Drexel University for Urban Innovation and a Trustee, of the College of Physicians of Philadelphia. 
(Courtesy of the author)

She subsequently contracted the virus herself and returned to an even more overwhelming, relentless number of sick patients. 

Like many frontline workers today, Breen was overworked and exhausted. But mostly, she was worried about losing her medical license or becoming ostracized by her colleagues because she was mentally suffering due to her work on the pandemic’s front lines. Lorna died by suicide on April 26, 2020.

Mental health and wellness are fundamental to each of us doing our jobs to the best of our abilities. Few would question a physical injury or an obvious external defect in setting boundaries, as Biles tried to do. Mental wellness aligns knowledge, training, skills, clarity of thought, and mental health to do our jobs at the highest caliber and for a sustained long term.

It is worth protecting. 

While Olympic competitions are one of public consumption and span far beyond the bounds of the arena, the ire and shaming from some quarters that befell Biles after her announcement this week illustrates the deep stigma that persists towards mental health. However, this situation also foretells the growing courage from individuals to put their wellness foremost and the support from peers and colleagues, where supervisors, leaders, and systems might fail. The support from Biles’ biggest sponsors also remains undeterred. 

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Fortunately for physicians and other health care professionals, there is similar hope on the horizon in the form of the Dr. Lorna Breen Health Care Provider Protection Act, which aims to reduce and prevent suicide, burnout, and the behavioral health conditions impacting our health care workforce. 

J. Corey Feist is the brother-in-law of Dr. Lorna Breen, chief executive officer of the University of Virginia Physicians Group, and co-founder of the Dr. Lorna Breen Heroes' Foundation.

J. Corey Feist is the brother-in-law of Dr. Lorna Breen, chief executive officer of the University of Virginia Physicians Group, and co-founder of the Dr. Lorna Breen Heroes’ Foundation.
(Dr. Lorna Breen Foundation)

This first of its kind legislation has passed the committee phase in the Senate and is on its way to full passage on the Senate floor. The Lorna Breen Act is an excellent first step in recognizing the mental health toll faced by health care professionals–and a step forward in addressing mental health in our country. 

In an act of bravery and recognition of the importance of her own well-being, rather than succumbing to external pressures, Biles withdrew from the group competition finals because she was afraid she would be injured if she continued in a rattled state of mind. 

Just last month, star athlete Naomi Osaka withdrew from the French Open and declared she would take time away from tennis and her career. 

So, too, have many physicians in the wake of COVID and the ever-increasing demands on our abilities and a singular focus on the financial outputs of our work rather than the technical skill and emotional presence required in caring for others. 

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On Wednesday, Biles announced she will not compete in the individual all-around phase of the Olympics. Through her self-awareness, intention, and actions, Biles has shown all of us that caring for herself in the face of penalty and public derision can lead to meaningful changes that impact her career. 

Even more, it could mean improvements for those beside her and those coming behind her. 

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Lorna Breen, her legacy, and the continued efforts of the foundation in her name, strive to do the same. 

The groundswell of support from the populace and peers is undeniable. It’s time for leaders and regulatory bodies to follow. 

 J. Corey Feist is Dr. Lorna Breen’s brother-in-law, chief executive officer of the University of Virginia Physicians Group, and co-founder of the Dr. Lorna Breen Heroes’ Foundation.

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