WATERTOWN — With decreasing coronavirus transmission levels in the area and loosened pandemic restrictions, focus has shifted to reflecting on the negative impacts of COVID-19 and some unexpected silver linings.
One such silver lining has been an increased focus on mental health. Now, the goal is to continue this progress and education surrounding mental health, as well as physical health, and equipping people with tools to safeguard both and make it easier to seek help.
For National Doctors’ Day, celebrated each year on March 30, three local medical professionals reflected on the effects of the COVID-19 pandemic, ways to safeguard physical and mental health and the importance of focusing on the entirety of a person when it comes to treating them.
Dr. Jill M. Laureano-Surber, the family medicine specialist of Family Medicine of Northern New York, is a trained doctor of osteopathy, a branch of medical practice that emphasizes treating the whole person.
“Everything comes into play with disease patterns and our body’s ability to heal itself is optimized if we are healthy mentally, physically, spiritually,” she said.
A theology major during her undergraduate studies, Dr. Laureano-Surber focused a lot on medical ethics and said she believes people’s spirituality impacts their care. While she said patients don’t need to hear about her spirituality because it shouldn’t be something that influences doctor-patient choices, she makes sure that she understands theirs.
“Sometimes you might be talking to them about anxiety or depression, and I’m talking about medication, and if you don’t understand their spiritual beliefs they might not take your medication because they have a certain viewpoint about it that you don’t quite understand,” she said. “I guess it comes more into play if I notice that there’s resistance there, I kind of know how to delve into asking them what their thoughts are about that.”
Dr. Laureano-Surber said that now there’s less resistance to treatment for anxiety and depression because people seem to be at their wit’s end after the hardships of the pandemic.
With many people struggling mentally during the pandemic, if practitioners did not take mental health into account, things would be missed during a visit, Dr. Laureano-Surber said. In a pre-pandemic year, she’d have conversations regarding mental health with about 50% of patients during visits. That number has risen to around 90% now.
According to Christina M. O’Neil, director of Mental Health Services at Samaritan Medical Center, COVID-19 has impacted mental health significantly.
“I think our society has changed and people are more attuned to the different stresses and anxieties that are out there,” she said. “Whether or not it’s a direct link, I definitely think COVID has contributed.”
Mrs. O’Neil said those in her field have always believed mental health should not be stigmatized, that it should get the same attention as physical health. One positive from the COVID-19 pandemic is that it helped normalize mental health conversations.
Years ago, Samaritan started integrating behavioral health practitioners into its primary care clinics. Now there are three satellite locations for primary care and on-site referral options for behavioral health.
An important part of furthering mental health conversations is education so people can recognize common warning signs too commonly brushed off. Anxiety and depression warning signs can include sleep disturbance, difficulty with motivation, difficulty at work, agitation and irritability, and an overall sense of feeling overwhelmed — especially if those reflect changes in a person’s life.
“Nobody should feel ashamed for seeking help,” Mrs. O’Neil said. “You don’t have to be worried about this label of being mentally ill just because you go to counseling — that’s something that really everybody could benefit from at some point in their life. We get a lot of professional people who really don’t want anyone to know because what would people think? Those kinds of things and the better we can get as a society at breaking down those barriers, I think the better we all will be.”
Sometimes Dr. Laureano-Surber will bring patients back more frequently than she typically would because she knows they need the human interaction. She said that while she’s not licensed to do therapy, she can listen and be a sounding board. Dr. Laureano-Surber speaks with her patients about things they can do to help their mental health, like getting outside. With sometimes dismal north country weather, she makes sure patients’ vitamin D levels are appropriate and said most people in the region need to take vitamin D supplements to account for lack of sunshine. She also talks to patients about yoga, meditation, exercise, getting enough sleep and eating right — “basically all the things that you don’t want to do when you’re feeling depressed,” she said.
“Sometimes we self-medicate in the wrong way — people are definitely drinking more alcohol than they should,” Dr. Laureano-Surber said. “I always tell them that I can only do so much, this has to be a two-way street in order to get you feeling better. You’re gonna have to participate in making yourself feel better, and when you’re depressed it’s a little bit of a vicious cycle because you want to isolate, eat a bunch of junk, drink more.”
An important thing for patients to remember, Dr. Laureano-Surber said, is to make separate appointments if they feel like they’re struggling mentally.
“Those things deserve their own separate visit in my opinion,” she said. “Sometimes people think of it as a secondary thing, but it’s just as important as their high blood pressure.”
With his family medicine specialty, Dr. R. Brian Shambo of the Beaver River Health Clinic takes care of the whole family. Having grown up in Copenhagen and familiar with the area, he said knowing details about patients, such as where they’re from and their family life, can be beneficial for later treatment.
“The whole idea behind what we were taught as family physicians is that we would be the first point of contact for everything and we would know a little bit about everything,” Dr. Shambo said. “So we can take care of most things, and then know the right place to send the things we can’t take care of.”
Dr. Shambo said most illnesses don’t affect a single organ system in a person’s body, that things are often connected. In particular, the brain is affected by many things. Drinking alcohol or your father having Alzheimer’s disease, for example, factor into illnesses and impact the brain.
“My friends at the cardiologist probably wouldn’t like to hear me say this, but you can’t look at somebody as a heart,” Dr. Shambo said. “You can’t take care of somebody’s heart without considering all the other parts too; they’re all connected, they work together.”
One way people can protect their physical health is exercise, which is more important than many realize, Dr. Shambo said, in addition to avoiding excess, especially food and substances like alcohol, cigarettes and other recreational drugs.
Dr. Shambo said that during the pandemic, many people gained weight and exercised less. He said it’s important to maintain a relatively healthy diet, but that it doesn’t have to be strict as long as people aren’t spending too much time on the sofa eating junk food, which he called a “recipe for disaster.”
Of equal importance to a healthy body is a healthy mind, so Dr. Shambo encourages patients to keep their minds active and get a proper amount of sleep regularly. He admitted that while he tries to do these things in his own life, he’s not always good at it.
According to Dr. Laureano-Surber, it can be hard for doctors to treat the whole patient simply because there can be so many medical problems to tackle and not enough time in one visit — it’s always a juggling act. Sometimes multiple visits are required to focus on different issues. Another difficulty for doctors, especially during the pandemic, has been care of themselves along with their patients. What the pandemic has especially highlighted for medical professionals is the need to practice what they preach.
The COVID-19 pandemic put even more demand on already overstretched health systems, testing health care workers’ limits and taking a toll on their own health and well-being.
“I think physicians as a whole and health care providers right now are also struggling, so we have to make sure we’re doing all the things too,” Dr. Laureano-Surber said. “I would say I’m guilty of not exercising much during COVID and I am usually somebody who exercises very regularly. I usually play competitive soccer, but I haven’t done that in two years because I haven’t felt safe doing it. There are things that we do that we haven’t been able to do just like patients, so that’s challenging too.”
Dr. Laureano-Surber said she takes care of a lot of physicians in her practice at Family Medicine of Northern New York and has conversations with them often, telling them they have to make sure they’re taking care of themselves because by nature, they may give to the detriment of themselves.
“As we get back to our normal life a little bit here, I think all of us are starting to do some of the things that we normally do. I just took my first vacation in a year with my family,” Dr. Laureano-Surber said. “It’s important for us as doctors to take care of ourselves too, because it’s very hard to take care of other people if you’re not taking care of yourself.”