As pediatricians seek to end race bias in care, a caution on parent burnout
While the nation’s pediatricians have announced an important, high-minded goal of eliminating racial bias in the medical treatment of children, working parents and other full-time caregivers for kids need a different kind of help, too, for a growing, serious problem — burnout.
These seemingly different issues share a common discovery point, rooted in challenges made large by the coronavirus pandemic and the recent unrest over social injustices experienced by communities of color, news media reports say.
Medical practitioners of various kinds, including kids’ specialists, have been forced to reexamine their consciences and beliefs even before but especially after the 2020 death in police custody of George Floyd, the AP reported. For pediatricians and their important practice group, this led to a medical reckoning, valuable to all patients but especially those of color:
“The American Academy of Pediatrics said it is putting all its guidance under the microscope to eliminate ‘race-based’ medicine and resulting health disparities. A re-examination of AAP treatment recommendations that began before George Floyd’s 2020 death and intensified after it has doctors concerned that black youngsters have been undertreated and overlooked, said Dr. Joseph Wright, lead author of the new policy and chief health equity officer at the University of Maryland’s medical system. The influential academy has begun purging outdated advice. It is committing to scrutinizing its ‘entire catalog,’ including guidelines, educational materials, textbooks and newsletter articles, Wright said. We are really being much more rigorous about the ways in which we assess risk for disease and health outcomes,’ Wright said. ‘We do have to hold ourselves accountable in that way. It’s going to require a heavy lift.’”
The group, besides issuing a strong and public commitment to an anti-racist course, already has started to make changes, the news service reported:
“[The AAP] ‘retired’ a guideline calculation based on the unproven idea that black children faced lower risks than white kids for urinary infections. A review had shown that the strongest risk factors were prior urinary infections and fevers lasting more than 48 hours, not race, Wright said. A revision to its newborn jaundice guidance — which currently suggests certain races have higher and lower risks — is planned for this summer …”
The pediatricians have joined with other medical professionals in calling for an end to biases in practice and a greater emphasis on evidence-based medicine, the AP reported, noting:
“In recent years, other major doctor groups including the American Medical Association have made similar pledges. They are spurred in part by civil rights and social justice movements, but also by science showing the strong roles that social conditions, genetics and other biological factors play in determining health.”
The challenge of overstressed parents
The pandemic, of course, has put huge economic and household stresses on working parents and other fulltime caregivers of children who already were getting crushed by societal inequities, the New York Times reported, noting that researchers from the Ohio State University nursing school have found these circumstances put these people at high risk of burnout:
“For two years, working parents in America have been running on fumes, hammered by the stress of remote schooling, day care closures, economic instability, and social isolation. Now, a new report says that 66% of working parents meet the criteria for parental burnout — a nonclinical term that means they are so exhausted by the pressure of caring for their children, they feel they have nothing left to give. The report … by researchers with Ohio State University … is based on an online survey of 1,285 working parents that was conducted between January 2021 and April 2021. It gives a snapshot of a different time when America was deep in pandemic lockdowns. But its authors believe parental burnout is here to stay, because working parents don’t have enough practical, structural supports to overcome the relentless stress, which isn’t abating. Any parent can experience burnout, but the new report focuses on working parents, who, the researchers believe, are at particular risk for exhaustion.”
The newspaper described the risks posed by the extreme demands with which too many parents must cope:
“Parental burnout isn’t a clinical diagnosis that would end up in anyone’s medical chart, but many psychologists recognize it as a subtype of burnout — a work-related phenomenon now recognized as a syndrome by the World Health Organization. (It is not included in the DSM-5, often called the “bible” of psychiatry in the United States.) ‘As with burnout, parental burnout is defined as physical, emotional and mental exhaustion due to the ongoing demands of caring for one’s children,’ said Dr. Jennifer Yen, a psychiatrist at UTHealth Houston. Of course, raising children is demanding in all those ways, which makes it difficult to draw a clear line between normal periods of stress and burnout. Dr. Yen said parents should be on the lookout for signs like fatigue, irritability, changes in sleep, appetite and mood, or aches and pains. What sets parental burnout apart is how severe those symptoms are, as well as how much they affect daily functioning.”
The experts, besides offering a practical scale that parents can use to understand their own conditions better, offer ways to help deal with what can be an overwhelming concern, the New York Times reported:
“[P]arents facing mild burnout may be able to make immediate changes that will prevent more severe exhaustion. Find small ways to ask for help, the researchers say. If you are able, ask a family member or neighbor to pitch in with childcare, even if it’s just to give you a short break. If you’re responsible for getting your children to and from school, activities and play dates, find others to carpool with so you aren’t running yourself ragged.
“The report found that 68% of working moms say they’re burned out compared with 42% of working dads, so it may be especially important for women to take breaks and ask for help — though that may not be simple or easy. Stressed-out parents may also find it helpful to tap into a sense of quiet and calm by practicing mindfulness. Research shows that mindfulness can help reduce parental stress, which may in turn help improve children’s psychological outcomes. It can be as simple as intentionally feeling the bottom of your foot on the floor and taking a deep breath, Ms. Kripke said. But breathing alone won’t solve this. Parents with more serious burnout should reach out to a primary care practitioner or mental health provider immediately. They can screen for issues like anxiety and depression.”
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
It is unacceptable for patients of color, especially our kids in whom our future rests, to experience racism and other biases in their care. As I’ve written before, for African Americans, relentless health inequities require urgent redress.
Our country also must improve its own prospects for the future by investing more in working families today, especially as so many of them continue to bear the brunt of the pandemic’s economic pain. The stress of managing a job, especially if it does not allow remote work, as well as meeting even heavier family responsibilities can be nightmarish. It is hard to fathom why, in the wealthiest nation in the world where the rich grow even more fabulously wealthy by the minute, workers that we once described as “essential” can earn fairer wages, as well as childcare help, sick leave, family time, real vacations, and other job benefits that most other industrialized nations provide.
Prevention can be so much cheaper and more effective in health care, and we cannot ignore how we spend trillions of dollars annually in this area, wastefully, even as we ignore social support programs and efforts to increase economic equity that would keep so many Americans from grievous injury and illness.
We have much work to do to really level the playing field and to provide the healthy, bountiful lives that so many of us cherish as fundamentals of achieving the American dream.