Broken and exhausted

The BMA has conducted the largest survey of frontline doctors during the COVID-19 crisis thus far – with more than 16,000 respondents. Peter Blackburn reports what the findings tell us about the effect of the crisis on workload, staff wellbeing and patient care

Location: UK
Published: Tuesday 12 May 2020

‘I feel terrified that I will lose colleagues, friends or family. I am worried that I could become unwell myself and potentially infect my other patients… I worry about the impact of this trauma on the mental health of our profession.’

Those few words, from one doctor working on the front line of the COVID-19 crisis, illustrate the stress and strain of daily working life in this frightening new world.

Doctors sharing their experience with the BMA’s COVID-19 portal speak of ‘toxic cultures’ in their workplaces, ‘overwhelming anxiety’ and feeling ‘unsafe and undervalued’.

And these are far from isolated anecdotes.

Unsustainable working patterns

Many of us aren’t used to several patients dying in a working day

Dr McKeown

‘There has been very little rest – people just work and then try to go to sleep, and this has been their existence for weeks.’

Dr McKeown adds: ‘This is all going to be crucial planning as part of the Government’s exit strategies – we are going to have to work on sharing out rest and enabling people to take a proper break. We know people were already working under pressure and now they are even more emotionally and physically exhausted. And we need to be talking about a week or two off – three days is just not a proper break.’

Unhealthy environment

The survey also found that redeployment of staff – which for many was not voluntary –  is causing issues: 35 per cent of those redeployed say they were not given inductions, 32 per cent have not received training, 17 per cent feel they are working outside their area of competence and 74 per cent don’t know how long their new arrangements will last. Some doctors say they felt ‘bullied’ into changing job plans and working arrangements.

This could hardly be a less healthy working environment. It is perhaps as unsurprising as it is frightening that nearly a third of doctors (30 per cent) are more stressed and burned out than before the pandemic.

One emergency care doctor said they felt ‘dispensable’ – and described ‘hating every moment of work’, feeling ‘unsafe and undervalued’. They described their working environment simply as ‘dangerous’.

Another said: ‘Feeling unsupported and unsafe at the front line.’

There has been very little rest – people just work and then try to go to sleep

Dr McKeown

For Dr McKeown one of the most ‘exhausting’ and worrying parts of working life under the COVID-19 crisis has been dealing with death in such great quantity.

‘It is a great concern for the service – this has just been exhausting for people,’ she says. ‘There are a few very special doctors in the world who choose to do palliative care and things like that but many of us aren’t used to several patients dying in a working day, and that’s a huge thing for people. It has been very difficult.’

At a time like this support services could hardly be more vital – but 22 per cent of doctors feel they do not have access to the help that they need.

Dr McKeown says it is crucial that doctors are not made to feel guilty for leaving holes in service provision if they need time away from work – and urges regulators and NHS leaders to step back from buzzwords like ‘resilience’ when talking about staff under extreme strain.

She says: ‘Doctors may need to be given proper time off from working – not just occupational health while they continue the job. They need to be given permission to have time away and have therapy or find head space to get back to work. Burnout is absolutely horrible – some people never get back to work and it is absolutely crucial we take this seriously.’

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Collateral damage

Ultimately, this is not just a huge problem in the present – but is storing up trauma and tragedy for the future.

It is the future that many doctors are worrying about. When asked which areas were most concerning them, respondents said the upcoming demand from patients and future working arrangements.

One doctor said they worried about ‘collateral damage’ and the future impact on services of missed diagnoses of cancer or illnesses like sepsis not being treated. He said: ‘There is a real sense of patients sparing the NHS for non-COVID issues.’

While the UK may be slowly passing the first peak of this crisis, a great deal of damage has already been done and there are many serious decisions still required. This significant survey shows doctors’ wellbeing – and the realistic capabilities of the service and its staff – must be placed at the heart of any plans made. 

This article is taken from the May 2020 issue of The Doctor magazine

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