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COVID strain taking a major toll on GPs
New poll findings suggest the majority of practitioners’ mental health has been greatly impacted by the pandemic, with one GP saying it has ‘tipped us over’.
More than 50% of respondents to a newsGP weekly poll reported that their mental health has been greatly affected by the pandemic, to the point where some had to take time off work.
Dr Amy Imms knows what it’s like to struggle with mental health firsthand.
She first confronted the realities of burnout while undertaking medical training, first among colleagues and patients, and later personally.
‘I find it a very sad thing,’ Dr Imms told newsGP.
‘We’ve got all these incredible doctors who are working in an under-resourced system and trying to do their best, and really struggling with that.’
These systemic challenges have only gotten worse during the COVID-19 pandemic.
A poll run by newsGP ahead of Mental Health Week found that out of 1465 respondents, 38% reported that working as a GP during the pandemic had ‘greatly’ affected their mental health, 34% said it ‘somewhat’ had, and 13% said it had led them to take time off work.
Melbourne GP and Chair of RACGP Specific Interests Psychological Medicine, Dr Cathy Andronis told newsGP she was surprised the numbers weren’t higher.
‘The pandemic has tipped us over,’ she said.
‘Adjusting to new numbers, adjusting to new ways of practising, adjusting to everybody’s distress, spending hours and hours reading the new COVID rules and having them change again and again to get to the stage where we are now, where we feel like we’re fighting people to get vaccinated.
‘It’s affecting us at a very personal level.’
Early this year in May, nearly half of all respondents (48%) to a poll run by newsGP ranked avoiding burnout as their main priority over the next 12 months.
Dr Imms, founder of The Burnout Project, says burnout can present differently for everyone, but the most common signs include:
- a sense of fatigue and/or dread when going to work
- interpersonal relationship difficulties, such as conflict with others, feelings of cynicism, or having trouble showing empathy towards others
- feelings of inefficacy, ie feelings of underperforming or underachieving.
While there can be a stigma within the profession when it comes to acknowledging mental health, Dr Imms says it is vital to confide in someone, whether that be a family member, friend or professional.
‘We did a bit of informal research a few years ago and it was really disheartening; the vast majority of people who’ve been burnt out have not told anybody, ever,’ she said.
‘So we’ve got a group of high achieving, very intelligent, resilient people who really can cope with a lot and they know that they can [often] get away with pushing through, and so they do.’
Dr Imms says it can also be a good idea to seek professional help, and
find what self-care strategies work best for them.
‘[Even if] you’re a GP who does this kind of stuff with your own patients every day and are really good at it, you’re not good at assessing yourself,’ she said.
‘For everybody, it’s a bit of a process of experimenting and figuring out what works for them … to help their own mental wellbeing.
‘The other side is looking at the workplace if that’s what it is that’s caused them to burn out – although it’s not just work is it? It’s always a combination of things; people have got stressors at home and lots of things that pile up.
‘So it’s looking at all of those things and then looking at what can actually be changed so that this doesn’t happen again and so that they can recover well from it and be in a place where they can continue long and fulfilling careers in general practice.’
Dr Andronis says more emphasis needs to be placed on the social determinates of mental health, to better understand and address systemic issues – many of which she says predate the pandemic.
‘We work too much, we work too hard, we see too many people, we see too many people too quickly – and why do we do that? The way the Medicare system is structured with fee for service and with
predominance of bulk billing,’ she said.
‘We often concentrate very much with doctors on talking about biological and psychological factors – get some exercise, sleep well, keep healthy, have your own doctor – and they’re really vital.
‘But the social structures of the system that we work in have really pushed doctors so that psychologically they blame themselves for things that are really happening externally.’
While GPs are a central part of the pandemic response in driving vaccination numbers up, Dr Andronis also fears for GPs in the aftermath, with likely increasing presentations of long COVID and consequences of delayed health checks.
‘I think our risk of burnout is really, really high,’ she said.
‘How often have we heard the answer to a question by a politician: “speak to your GP” – and that’s an appropriate thing to do. But at the same time, we have to stand back and reflect on our own capacities, our own mental health … rather than just blaming ourselves when we don’t achieve unrealistic goals or expectations.
‘My advice to doctors would be recognise and validate yourself for the amount of work that you’ve already done. We are going to be in high demand, so set realistic expectations on ourselves and patients about how much we can manage.
‘We have to be careful to pace ourselves, support each other, take time out and really prioritise our own personal needs and prioritise the needs of our patients according to what needs to be managed urgently … so we don’t burn out and give up.’
An RACGP fact sheet on self-care and mental health for GPs suggests considering the following self-care strategies:
- Not taking work home, where possible
- Scheduling regular breaks
- Being realistic with time and avoiding overcommitting
- Developing and maintaining healthy therapeutic boundaries
- Debriefing with colleagues regularly
- Demanding a good work–life balance (and not seeing this as a sign of weakness)
- Maintaining a healthy, balanced diet
- Scheduling regular physical activity
- Practising good sleep habits
- Practising mindfulness
- Participating in activities that bring personal joy
- Making your relationships a priority and enjoying time with family and friends
- Maintaining connection with culture, country and community
- Establishing a relationship with an independent GP to assist you to manage your own health.
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