If you’ve been feeling surrounded by more angry people lately, you are not alone. As the initial intensity of preparing for the COVID-19 pandemic and the associated enthusiasm and adrenaline settles, I am also noticing a rise in anger. In the past week, I have been approached by five hospitals across the country to help deal with conflicts. Surgeons are angry in the OR because it is taking longer to prepare, set up the OR, and don PPE. Colleagues are angry with peers who fear exposure to the virus and are resisting return to work. Physicians are angry because the new schedule appears to favour the scheduler and their friends.
There seems to be more tension as frustrations turns into anger, as if people are “fraying at the edges.” To some extent, anger is normal, natural, and perhaps even necessary. However, it is not always helpful or healthy. Top
Understanding the anger
There are many reasons why people are feeling angry during the current pandemic. It helps to understand that physicians may be experiencing any or all of the following.
Grief — Anger is a normal stage in grieving. Because of COVID-19, we have experienced many losses: loss of normalcy, control, routines, workflow, finances, valued activities, our health or that of loved ones, the ability to see friends and family, travel. And the losses continue, with no firm end in sight.
Burnout — Before the pandemic, the level of burnout among physicians was already high, and it is likely exacerbated now as physicians are working under heightened stress for longer periods. This can appear as irritability, negativity, cynicism.
Fatigue — Our threshold has changed: we are tired, have less reserves, are less patient and tolerant, and are more reactive.
Underlying emotions — Anger is usually a secondary response caused by underlying fear, uncertainty, or concern, all of which are common features of our current situation.
Resentment — Physicians are feeling anger or indignation as a result of unfair treatment. Some feel unsupported or unprotected, when lacking personal protective equipment, and unvalued. Others feel it is unfair that they cannot work and are not getting paid, while colleagues are working or others are not working but still getting paid.
Rescue triangle — This triangle describes movement between the roles of rescuer, victim, and persecutor, and back. Physicians are classic rescuers, jumping in to fix things and feeling guilty if they do not. However, over time, they start to feel victimized and resentful, and this can lead to anger, blaming, and criticism as persecutor.
Displacement — Bright people use intellectual defenses, such as displacement, to protect themselves from unpleasant feelings, subconsciously transferring emotions such as anger from the original source to other people or situations. Top
Managing your anger
Although anger is an understandable response to the pandemic, too much is damaging and disruptive to you and those around you. Use my ABCs — allow, burn, calm — to settle down.
Allow your feelings.
o Understand where they might be coming from.
o Give yourself permission to be angry. Studies show that 20 minutes is long enough to feel emotions, process them, and let them go.
o Express feelings safely, by “venting” to a trusted person or privately writing them out.
o Try the four-letter technique. Write a letter (that you will not send) to whomever you are angry at to let out your feelings. When the feelings bubble up again, write a second letter as if you had not written the first, then a third and fourth as needed. Remember, these are not letters that you will ever send.
o Resist the urge to express your anger on social media.
Burn off the energy. Do some physical activity or exercise.
Calm yourself with a restorative activity, such as deep breathing, visualization, mindfulness meditation, active or passive relaxation, gratitude, positivity, and spirituality. Top
Managing the anger of others
As a leader, people come to you to share how they feel and to seek your help when they are frustrated or angry. The following tips may help you approach this situation effectively.
Expect it. Normalize it. Allow it.
Be respectful and compassionate.
Listen actively. People want, and deserve, to be heard.
Try to understand their perspective without judging. You do not know their situation or what they are going through.
Do not take it personally or become defensive. This is not about you. The fact that they are telling you means that you have been successful in creating a safe space for them to do so.
Understand there is a difference between being medically safe and feeling psychologically safe.
Focus on needs, not solutions. Look for the hidden need and understand what the person is trying to gain or avoid.
Use the 4As1 to de-escalate the situation:
Agree with what you can; find a fact that is true or agree that they are feeling.
Acknowledge the impact of this on them.
Apologize for the situation they are experiencing.
Act with compassion to help address the underlying issues or need.
Share the ABCs that have helped you remain calm.
As leaders, the ability to manage our anger and that of others, master our responses, and lead in a thoughtful and balanced manner helps our team feel supported and secure and creates a culture of safety that is especially critical during this time of uncertainty.
1. Gautam M. Dealing with anger: the four As. Can J Physician Leadersh 2015:1(4):10-2.
Mamta Gautam, MD, MBA, FRCPC, CCPE, CPE is an Ottawa-based psychiatrist, with special expertise in Physician Health and Physician Leadership. She is a member of the Department of Psychiatry, University of Ottawa, Ottawa; CEO of PEAK MD Inc; Chair of the OMA Burnout Task Force, and a Board member of CSPL.