Dr Volker Hitzeroth, Medicolegal Consultant at Medical Protection, looks at the impact of COVID-19 on the mental health of clinicians

During the past year, our lives have changed almost unrecognisably. The impact of COVID-19 has been significant and ubiquitous. This pandemic has affected healthcare professionals and non-healthcare professionals alike, with everyone having lived through previously unimaginable restrictions, imposed lockdowns, social distancing, limitations to what we may purchase and even where we may travel.

However, the impact has been particularly harrowing for healthcare professionals who were faced with treating the relentless stream of seriously ill patients, whilst at the same time fearing for their own health, wellbeing and lives, in addition to those of their patients, family and friends.

There would be very few practitioners who do not know of any colleagues or friends who have been affected or infected. Sadly, it is not unusual to hear that a family member or colleague has died.

Every practitioner has had to radically and speedily adapt their usual way of practising medicine as new approaches were called for to provide care to their patients in a fast-changing environment.

Whether that has involved continuing to provide care in an overwhelmed system, working in a mismanaged institution, loss of income with subsequent financial hardship or a change to teleconsulting, this meant that both the working environment and the treatment and care of patients has been permanently altered for publicly employed and private practitioners alike.

Additionally, the current socio-economic and socio-political burdens faced by South Africans have posed further challenges to the situation in which healthcare professionals have found themselves over the past many months. No individual or community has been left unaffected and most are still reeling with sadness, suffering, tragedy and loss.

The initial response to COVID-19

Most healthcare professionals were able to adjust to the first COVID-19 wave and its new reality with tenacity and pragmatism.

The initial speed of evolution to practising medicine brought about many uncertainties and understandably raised many concerns and fears amongst the healthcare community. At Medical Protection we were inundated with requests for advice and assistance from colleagues concerned about the use of telemedicine, the medicolegal implications of triage in a resource-deficient environment, as well as the legal consequences of withholding or withdrawing treatment and support for severely ill patients.

Similarly, many colleagues were unexpectedly faced with the prospect of having to declare and notify patient deaths, resulting in uncertainty about the correct process to follow and the medicolegal risks associated with completing such documentation.

At the time of writing this article, early evidence seems to suggest that the second COVID-19 wave is hopefully receding. Yet, clinicians continue to report having to treat patients who are more burdened by the severity of their illness and subsequent complications than they did during the first wave.

Even now the faint and weary whispers of a future third wave are becoming louder and more desperate. Additionally, the current vaccine uncertainties, viral mutations and procurement issues compound the feelings of panic and despair.

Despite the glimmer of light at the end of the tunnel, the current situation remains serious, and both clinicians and healthcare systems appear to be stretched to capacity.

Concurrently, the mental health impact on healthcare practitioners has raged on unabated. While newer and more effective treatments for COVID-19 have become available and vaccines are to be rolled out shortly, colleagues have continued to report symptoms of depression, PTSD, hopelessness and even suicidality. It is for this reason that Medical Protection is continuing its ongoing support for mental wellbeing and psychological health to its members. Medical Protection will, alongside all its other activities to protect and support doctors across the world, continue to host webinars and podcasts about mental health, psychological wellbeing and caring for colleagues. This is alongside the offer of a free, confidential counselling service for members experiencing work-related stress.

What does the future hold?

As healthcare professionals and the public continue to grapple with the pandemic and its consequences, the ongoing concerns regarding practitioner wellbeing will not abate. The pandemic has merely exacerbated an issue that has been with us for a long time, yet seldomly spoken about due to the associated perceived stigma.

Society at large is hopefully realising that doctors, like all other individuals, can also develop mental health issues, particularly given the immense pressure they find themselves under. Unfortunately, it seems to have taken a pandemic of this nature to not only have shed the spotlight firmly on this problem, but also galvanise efforts to support and encourage healthcare professionals to seek help when needed. After all, an impaired healthcare profession is deleterious to all.

Wellbeing and psychological health are not optional add-ons, but critical aspects of living a fulfilling life, in a free and caring society. Belatedly, governments and civil organisations are recognising the need for more support, funding and guidance in order to bolster the organisations advocating for better mental health, support attempts to destigmatise mental illness and provide care for people struggling with psychological distress.

The current situation may seem dire to many, but there are strong indicators that we will persevere and overcome the current difficulties. Our inherent resilience will prevail and facilitate post-traumatic growth, and perhaps even subsequent flourishing.

Current research initiatives in the field of mental wellbeing and psychological health focus on:

1. The neurobiology of happiness and wellbeing

2. Loneliness in an ever more globalised and digital world

3. Happiness, including the factors that contribute and detract from it, as well as how to maximise and nurture it

4. Happiness at work and the role of employers in improving employee’s wellbeing

5. Destigmatising psychological suffering and mental illness

6. Optimisation of happiness across the life cycle and every stage of life

While such initiatives find traction, we are left with the challenge of creating our own hope, joy, and happiness in the current turbulent times. Much has been published, tweeted and blogged in order to assist and guide us in our personal search for wellbeing and contentment. Amongst the most popular suggestions are mindfulness, regular physical exercise, relaxation and breathing exercises, gratitude journals and random acts of kindness. All such recommendations will, alone or in combination, likely contribute to feeling more satisfied, content, and happier.

The difficulty is not in spending 15 minutes meditating or practising yoga. Rather, the real challenge is to recognise that the search for happiness should take priority in our busy lives. Just as we currently prioritise the work that we do to earn an income and raise our children, so we should prioritise the activities that add to our contentment. Without challenging our thoughts, beliefs and actions, we cannot improve our happiness and overall wellbeing. It is only once we are prepared to invest in, and nurture, our common humanity by connecting, sharing and caring that we have embarked on the first step towards happiness.

Further resources relating to medicolegal issues and wellbeing are here. Also see the Medical Protection wellbeing hub for further information about the counselling service and wellbeing app.

This article was originally published in Medical Brief and is republished with permission.