Post-COVID trauma on the healthcare frontline

Jolyon Attwooll

12/11/2021 4:54:58 PM

Half of healthcare workers in an international study reported having PTSD symptoms due to COVID. Has the pandemic had a similar impact on Australian GPs? 

Close up of masked healthcare worker.
The COVID-19 pandemic has had a profound impact on healthcare workers all over the world.

A new survey has found that more than one in every two Canadian healthcare workers showed symptoms of post-traumatic stress disorder (PTSD) after working during the pandemic.
The study, which was run among healthcare workers in Toronto, found 50.2% of all those who took part recorded moderate or severe scores for symptoms of PTSD.
There were also high rates of anxiety (24.6%) and depression (31.5%) among the 3852 respondents, who included nurses, non-clinical staff, allied health staff and doctors.  
A more basic online poll run last month by newsGP produced similar findings, with more than half of the respondents reporting their mental health had been ‘greatly affected’, to the point where some had to take time off work. A further 32% said their mental health had been ‘somewhat’ affected.
Dr Michael Bonning is the medical director at the Inner West GP-led respiratory clinic in Balmain, Sydney. While he recognises the situation in Australia has differed markedly from many other places, he says the impact has still been profound.
‘We haven’t had the absolute carnage in the health system that has been seen in many other countries overseas,’ Dr Bonning told newsGP.
‘We have not experienced the mortality and huge clinical pressure on our health system from COVID, [but] we have seen the displacement of a normal way of life, which has affected the mental health of both our patients and ourselves.’
He cited protracted lockdowns and the huge changes to the way general practices have run in Australia as some of the challenging factors – as well as dealing with high levels of community uncertainty.
‘There have been many well documented cases of verbal abuse from very [upset] individuals whose contact is with our reception team,’ Dr Bonning said.
‘There are lots of real points of distress, even if our levels of COVID are relatively low by world standards.’
The requirement to bulk bill has also had an impact.
‘COVID has fundamentally changed our health system, and how we have operated. We have worked harder and longer,’ he said.
‘We’ve always done it under the under the spectre of a COVID-positive patient walking into our practice or respiratory clinic and potentially causing us to become exposed in a way that could bring us both financial and real health risks.’
The Canadian study, published this week in the open-access journal PLOS ONE, also compared the reaction of workers during the SARS pandemic with their response to the current pandemic.
While the study authors concluded that working during the SARS outbreak had no overall impact on the psychological distress seen during COVID-19, they said the results underlined the importance of managing mental health fallout in healthcare workers.
‘These findings have significant implications for staff wellness, the prevention of burnout and promotion and maintenance of staff retention – all of which are ongoing challenges in this current and in future pandemics,’ they wrote.
‘Our findings provide guidance for healthcare systems seeking to provide appropriate, targeted, and timely support to healthcare workers, especially those at greater risk, in order to promote individual wellness and a healthy workforce.’
According to Dr Bonning, recognising the signs of mental fatigue and feeling able to take steps to address it is a key aspect of reducing mental trauma on healthcare workers, including GPs.
‘People with burnout may identify it in themselves or may identify some of the traits but there is too much associated stigma,’ he said.
‘Having compassion fatigue, having true loss of joy in your work, are really clear signs that like everyone else, a GP is human.
‘Doctor’s health services across the states and territories are very important for people to know about, and [it is very important] for them to continue to be well resourced.’
A member of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), Dr Bonning said GPs have adapted well to the circumstances but need more ongoing support to cope.
‘General practice has shown itself to be the Swiss Army knife for problem-solving in the Australian healthcare system,’ he said.
‘I think that needs both recognition and financial support and resourcing. That will take some of the pressure off general practice.’
However, he warns that the impacts on GPs and primary care overall are likely to be seen for some time ahead.
‘[It is] highly likely we still have to deal with a future where we have many missed diagnoses, and where the financial and psychological family trauma that exists in that community will continue to percolate through general practice for years to come,’ he said.
‘It’s going to end quietly, but it’s not going to end for a long time.
‘The sequelae of issues in our community that have been shown by COVID will continue to affect healthcare, whether it’s for years or even a decade.’
Mental health guidance
The RACGP has published a fact sheet on self-care and mental health for GPs, which suggests the following 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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Dr Morven Isla Crane   13/11/2021 8:07:40 AM

I’m very fortunate to work in a practice who can see the importance of wellbeing of staff. I don’t think I would have completed my training if it weren’t for the wonderful supervisors and mentors I have within my workplace. The list of ideas at the end of the article is so important. Having burned out already while working in a another specialty during a previous career incarnation, I can attest to these being all of the changes I have had to make to perform at my best in medicine.