Struggle and strain

COVID-19 has placed doctors under unimaginable pressure, with many reporting heightened stress, finds a BMA survey. Tim Tonkin reports from the front line

Location: UK
Last reviewed: 1 June 2020

‘I don’t think I realised how stressful it was directly until I wasn’t sleeping, and bursting into tears in the car and when saying goodbye to my kids on the way to work.’

‘I feel I have aged over the past three months, with variable levels of anxiety and stress, it’s been a rollercoaster of emotions, whilst trying to run a practice and protect my staff.’

‘I have never experienced this much stress in my whole career of 15 years.’

These heartfelt and brutally honest confessions as to the physical and mental demands being borne by doctors leading the fight against COVID-19, reveal the extent to which the pandemic has tested the mental resilience and wellbeing of NHS staff throughout the UK.

A recent BMA COVID-19 tracker survey found that 41 per cent of doctors were suffering with depression, anxiety, stress, burnout, emotional distress or another mental health condition relating to or made worse by their work, with 29 per cent saying this had got worse during the pandemic.

‘Dealing with the impact of COVID-19 on my mental health has been tough,’ one junior doctor told the survey.

‘The support from friends, family and the general public has been incredible but, at times, being labelled a “hero” has made it difficult to admit that I have struggled.

‘The prolonged uncertainty is still ongoing and not knowing what is happening week to week is very tough to deal with. With the added stress of not seeing friends and family and not being able to turn to my usual sport to de-stress is becoming increasingly more challenging.

‘I struggle to sleep at times and on my days off it can be difficult to forget about work. Work is so busy that it’s almost impossible to find the time to attend any of the well-being sessions.’

Emotional toll

As of 29 May there have been 269,000 confirmed cases of COVID-19 and 37,837 deaths resulting from the virus in the UK.

While the emotional effect of any death is most acute for the loved ones of those who have lost their lives, the drawn-out and ever-increasing human tragedy wrought by the virus has unquestionably taken a huge emotional toll on doctors and other frontline healthcare professionals.

‘I think as doctors we want to be able fix people and make them better,’ a West Midlands junior doctor told the survey.

‘Working on a COVID ward where all the patients are frail and elderly, and the majority of them dying and there being nothing we can do, has seriously impacted on my teams and my own mental health.’

‘During the early period the work felt extreme beyond anything we’ve seen before,’ explained another junior doctor based in London.

‘At times it felt completely relentless without an end in sight. The most traumatic part was the stress on patients, and even more so, their relatives.’

Family risk

As of 29 May, a total of 29 doctors who had been actively serving in the NHS are confirmed to have died as result of the virus.

Of this total 27 were from BAME (black, Asian or minority ethnic) backgrounds and all but one was male.

One east midlands-based junior doctor told the survey that while she accepted the risks to her own health, the prospect of her family being infected as a result of her work was an incredible emotional burden.

‘I feel like I am more concerned for my family members and even though they support me fully, it feels like I am opening them to risk unwillingly.

‘It does feel like I’ve signed up for the army and that I may get injured on the way and I don’t mind that. I signed up to be a doctor well before COVID when HIV, hepatitis and TB were feared.

‘But my family didn’t choose this career path, I feel like I’ve forced the risk on them and I can’t get away from the guilt. Any time a family member coughs or looks unwell I worry that I am responsible.’

‘During COVID my anxiety about my own health and the health of my family has increased,’ admitted a junior doctor from North East England.

‘I worry that I will cause my family members to become ill, or that I will become ill and have nobody to take care of my toddler, as we have no direct family nearby to help.’

Long-term challenges

As well as dealing with the immediate pressures of the pandemic, such as meeting an increased patient demand while faced with inadequate resources, and concerns about risks to personal and family members’ health, many doctors are already worrying about what challenges they might face further down the line.

‘This has been a time of huge challenge and uncertainty,’ explained one GP from north-west England.

‘GPs have had to drastically change the way we work and consult and have been worried about risks to ourselves, staff, patients and our own family and friends.

‘There will be mental health issues for some considerable time after this pandemic passes, and dealing with the recovery phase is likely to be more demanding than the main part of the curve.’

‘Each phase [of the pandemic] has brought different stresses and strains,’ a London-based consultant said.

‘The urgency to reconfigure at the beginning was a time full of adrenaline and anxiety of what was to come. Then the exhaustion of working all hours and not being able to sleep.

‘Now the burnout that makes it hard to keep going and to have the energy to plan recovery or for a second wave. Plus all the worry you hold for yourself and your family. A rollercoaster with no end in sight.’

Steadfast support

In light of the mental and emotional pressures being faced by the medical profession, the BMA has sought to do all it can to provide timely and accessible practical support.

This includes the launch of a 24-hour COVID-19 emergency line, allowing doctors to receive specialist advice or guidance from BMA advisers on matters relating to the pandemic such as concerns about PPE and work-place risk assessments.

The BMA is also calling for more support for doctors suffering with poor mental health and wellbeing and has set out 10 recommendations which should be considered as part of a comprehensive strategy

In a message sent on 29 May to all members, BMA council chair Chaand Nagpaul reiterated that no matter how long the effects of the pandemic were felt, the association would remain steadfast in supporting doctors across all parts of the NHS.

He said: ‘The BMA exists as a professional association and trade union to look after you so that you can look after your patients.

‘We will continue to stand with you throughout the course of this pandemic, and to fight your corner in the days, weeks, months and years ahead.’

The BMA’s emergency line can be reached on 0300 123 1233, with additional support via webchat or by contacting [email protected]