If two months ago someone would have told me where we are today, I would have never believed them. Businesses are shuttered, surgeries canceled and postponed indefinitely, standard-of-care medical treatments being suspended or delayed, people attending important medical appointments and learning life-changing information without the support of a loved one. It is stunning how much has changed and how quickly we\u2019ve all had to adapt to life in the time of Covid-19.<\/p>\n\n\n\n
At Genetic Support Foundation we\u2019ve met with\npatients through both telehealth and in-person visits for a few years now, and\nuntil a month ago I had a pretty even balance of time with patients whom I met\nvia video and those I saw face-to-face in a clinic setting. In mid-March, as we\nall became more aware of the insidious manner in which this virus could spread\nthrough unsuspecting, asymptomatic carriers, we became concerned that many of\nour genetic counselors were traveling to see patients at multiple different\nsites. I was especially concerned given that many people at these clinics were\nin vulnerable populations and at greater risk for serious complications,\nincluding cancer patients and pregnant women. <\/p>\n\n\n\n
We quickly adjusted with our partner clinics to bring as much of our services to telehealth as possible to minimize contact and hopefully decrease risk for our patients. We have been flexible, and still see some patients in the clinic when needed to coordinate their care in a timely way. In these cases, we are taking all precautions to keep everyone safe–wearing masks, keeping a distance, lots of handwashing, and sanitizing of our spaces. I\u2019m grateful we were able to make this transition so smoothly, building on our past experience, and for a brief moment it seemed that we would be able to maintain some normalcy in our day-to-day work by continuing to connect with patients. Some days, these circumstances wear us down and make those connections more difficult, but I know it will not always be this way. Finding normalcy in some moments now doesn\u2019t mean that this will be a new normal.<\/p>\n\n\n\n
Just as the Covid-19 crisis began unfolding in\nmy home state of Washington in February, I attended the Texas Society of\nGenetic Counselors annual education conference where I had the opportunity to\nhear Krista Redlinger-Grosse, PhD, genetic counselor and psychologist, give a\ntalk on burnout and compassion fatigue in genetic counseling. During the talk\nDr. Redlinger-Grosse compared genetic counseling to crisis counseling. I had\nnever considered this, and this point resonated with me. As genetic counselors\nwe often speak with patients who are in crisis. Perhaps they just learned they\nhave cancer, or that their baby may have a serious medical concern, or maybe\nthey have just learned that a life-altering disease runs in the family. Our\ndays as genetic counselors can be a series of stressful conversations with\npeople whose lives are being turned upside down. Dr. Redlinger-Grosse pointed\nout that the nature of our work and some of our frequent personality\ncharacteristics as genetic counselors (perfectionism, trait anxiety, low\nexternal locus of control) can increase the risk of burnout.<\/p>\n\n\n\n
Despite my many years of working as a genetic counselor I can truly say that I don\u2019t often identify a feeling of burn out. I love my work as a genetic counselor and find the time I spend with patients to be incredibly grounding, even when the encounters are intense and stressful. I have described to my colleagues that genetic counseling is like my meditation–even when faced with the most chaotic of personal circumstances, once I am face-to-face with a patient, all other thoughts and worries disappear for a time and I am able to focus only on that person I am working with and their situation. I think this is the case because I derive a lot of personal satisfaction from work in which I feel I can help others. I also feel that genetic counseling, like all caring professions, gives an opportunity to practice empathy–to see the world through the eyes of another. <\/p>\n\n\n\n
Genetic counseling in this time of Covid-19 is\nchallenging me in new ways. Honestly, it is a struggle to see how genetic\ncounseling fits into the larger picture of healthcare for our patients at this\ntime of crisis. To give an example, people often use information from genetic\ncounseling and genetic testing to guide their surgical decisions when diagnosed\nwith cancer, including breast and colon cancer. A few weeks ago, a patient of\nmine received a call shortly after her appointment with me that her breast\ncancer surgery was canceled, as it was not deemed urgent\/emergent and would be\nrescheduled at some time in the future. I\u2019ve also had more conversations lately\nabout whether genetic test results would change surgical plans at this\ntime. <\/p>\n\n\n\n
In the pre-pandemic world, many women diagnosed\nwith breast cancer may elect to undergo a bilateral mastectomy rather than a\nlumpectomy if they carry a mutation in a gene such as BRCA1 or BRCA2 that puts\nthem at high risk for a second breast cancer. These days we have another\nvariable to factor into surgical decision-making. Given that a bigger surgery\nincreases the risk for complications, and means more time recovering in the\nhospital, many are concerned that this could increase Covid-19 infection risk\ntoo. Not to mention, people are not allowed to have visitors in hospitals in\nmost parts of the country, so a bigger surgery means more time apart from loved\nones. Additionally those who learn now that they are at an increased risk for\ncancer due to an inherited mutation may have additional anxiety, as they will\nbe stuck with this information in a holding pattern, unable to access cancer\nscreenings or undergo risk-reducing surgeries. <\/p>\n\n\n\n
Covid-19 is affecting prenatal genetic care as\nwell. In some of the clinics where we support genetic counseling services, we\nare seeing an uptick in the number of diagnostic tests performed, such as\namniocentesis. One of our genetic counselors speculated that perhaps people\nwere drawn to these tests that could offer more certainty, at a time in life\nwhen everything else feels so very uncertain. On the flip side, we are seeing\npeople who once planned on diagnostic testing now forgoing it due to concerns\nof transmitting a virus should they be infected and not yet know. And most\nprenatal clinics are also not allowing visitors – this means women are having\ntheir ultrasound, undergoing amniocentesis, and receiving life-alternating news\nabout a prenatal diagnosis, all without their partner. As genetic counselors we\nare more and more frequently meeting with patients on the other end of a video\nscreen where we cannot pass the tissue box or offer a hug.<\/p>\n\n\n\n
Of course, there are some bright spots as well.\nIt is wonderful to be able to share news of a negative result for a familial\nmutation. It can be such welcome news to patients who can now cross hereditary\ncancer risk off their list of worries – I have found these phone calls often\nbring tears of relief. To be able to patch in an expectant father to a video\nconference when he can\u2019t join his partner at the clinic, and to be able to\nshare information and encouragement, is a wonderful use of the technology and\nhelps keep us all connected<\/p>\n\n\n\n
It all feels more than we can bear sometimes.\nOur patients are definitely under more stress than usual as all of us <\/em>are\nin crisis and are separated from so many of the things that we commonly rely on\nfor support and comfort. The circumstances we as genetic counselors find\nourselves in at this time also increase our personal stress. Our lack of\ncontrol in how we help our patients may decrease satisfaction with our role and\ncould lead to greater compassion fatigue. <\/p>\n\n\n\n A powerful quote by Jim Rohn I jotted down during the talk at the TSGC, \u201cThe greatest gift you can give somebody is your own personal development. I used to say, \u2018If you will take care of me, I will take care of you. Now I say, I will take care of me for you, if you will take care of you for me.\u2019\u201d <\/p>\n\n\n\n This is advice we should all live by and could be especially helpful at this time. As best we can through this crisis, let us keep caring for ourselves so we can continue to care for others. <\/p>\n\n\n\n Dr. Redlinger-Grosse shared this self care wheel<\/a> which may be a helpful\nexercise. She also shared this Professional Quality\nof Life Test<\/a> which is a tool that ultimately provides scores\nin three areas: 1) Compassion Satisfaction, 2) Burnout and 3) Secondary\nTraumatic Stress as related to your work. This may be a useful assessment for\nany of us to take right now and maybe again over time to check the pulse of how\nwe are doing emotionally at work and in our lives. <\/p>\n","protected":false},"excerpt":{"rendered":" If two months ago someone would have told me where we are today, I would have never believed them. Businesses are shuttered, surgeries canceled and postponed indefinitely, standard-of-care medical treatments being suspended or delayed, people attending important medical appointments and learning life-changing information without the support of a loved one. It is stunning how much …<\/p>\n