Working in a caring profession, practitioners supporting older patients are used to putting others first. This responsible, challenging work demands both mental and physical wellness. But the Covid pandemic has been an extremely stressful time for health professionals, and its impact means that many could be feeling overwhelmed and at the point of burnout.

Even during the best of times, working in healthcare can be challenging. According to the Medical Protection Society (MPS) in its paper Breaking the burnout cycle: keeping doctors and patients safe, “predisposing factors for burnout are often related to job demands such as workload, time pressure, and long hours without sufficient time to rest and recover”.

These challenges have been intensified by the pandemic and are taking their toll on the mental health and wellbeing of healthcare professionals. The Royal College of Physicians’ latest survey of members found that almost a fifth (19%) said they have sought informal mental health support during the pandemic, and 10% said they had sought formal mental health support from either their employer, GP or external services.

While a third of respondents reported feeling supported (35%) and determined (37%), the majority of doctors (64%) felt tired or exhausted, and many were worried (48%).

Burnout made worse by pandemic

Professor Andrew Goddard, president of the Royal College of Physicians, says he is “extremely concerned about the mental health of frontline doctors, who may be suffering from burnout and a feeling of not being valued”.

The BMA’s covid-19 tracker survey from October 2020 found that almost half (44%) of doctor survey respondents said that their levels of stress, anxiety, and emotional distress had got worse since the pandemic began.

Claire Goodwin-Fee, founder and CEO of Frontline19 - which delivers free psychological support to keyworkers – says there are more cases of burnout during the pandemic because  it has been an “assault on every sense – physically, mentally and spiritually”.

“Practitioners are feeling burnt out trying to cope with home and family issues as well as the sheer volume of work,” she says.

Dr Jennifer Burns, president of the British Geriatric Society, and a consultant physician at Glasgow Royal Infirmary, says constantly dealing with emotional trauma of the waves of Covid-19, and the peak numbers of patients admitted to hospital with the virus is “a huge challenge”.

Added to those pressures she says that winter is always a tougher time for the NHS when admissions go up, that patients are presenting with deteriorating chronic conditions during the second wave who went undiagnosed and untreated during the first one, and that practitioners’ leave has been cancelled.

Since the start of the pandemic she says geriatricians have played “a substantial part in looking after high numbers of extremely poorly older people”. Care has been complex, sometimes palliative, while support has been required not only for patients but families caring, and often grieving, at a distance. For those working in the specialty “it’s a very stressful time”, she says.

“The volume of cases has become exhausting. And that’s what you see on the faces of a lot of doctors and nurses at the moment – exhaustion.”

Signs and symptoms of burnout in healthcare professionals

“A constant sense of physical exhaustion” is one of the symptoms of burnout to be aware of, says Catherine Gallacher, a BACP senior credited counsellor and former nurse, currently working in the NHS supporting health professionals with Covid and burnout.

Not being able to sleep, loss of appetite and irritability, feeling tearful or overwhelmed are also signs that someone might be reaching the point of burnout. Physical signs of burnout include stomach problems, headaches, and general aches and pains. 

Emotionally practitioners may be feeling that “you can’t deliver the same level of care to patients as you would do normally”, says Dr Burns. This ‘emotional exhaustion’ she says can lead to health professionals avoiding situations where they know they are going to need to use their emotional reserves, such as feeling less inclined to talk to patients’ families. And when colleagues stop coming to team meetings or debriefs this can be a cause for concern, she explains.

Dangers to ‘ploughing on’ when you have burnout

Ignoring the signs of burnout and simply ‘ploughing on’ can be detrimental to a person’s wellbeing. “The first impact of burnout is almost always on the individual’s mental health, which can significantly deteriorate and manifest itself as depression and anxiety,” says Dr Burns.

By ignoring the signs and carrying on, practitioners not only put themselves at risk, but also their patients, as the long term effects of burnout “can even lead to dangerous practice”, warns Ms Goodwin-Fee.

 

Burnout: possible signs

  • Low mood/sadness
  • Fatigue, lethargy, difficulty sleeping, interrupted sleep
  • Feeling close to tears
  • Sense of helplessness
  • Feeling isolated
  • Anxiety/panic attacks
  • Anger/irritability
  • Headaches, backache, stomach problems

 

 

Ways to prevent and manage burnout

“Burnout doesn’t go away on its own, so you need to seek help,” says Ms Gallacher.  “I always say to people that it’s a strength not a weakness to be able to say when you’re struggling.”

There are many solutions available to help prevent and manage burnout. Mindfulness/meditation apps, such as Headspace, Calm and Ten Percent Happier can be downloaded to help manage stress.

Support is essential to preventing and dealing with burnout. It can help practitioners to share their difficulties, not only with families and friends, but with each other, finding ways to stay connected with people who can support them, even during lockdown. “Sometimes just a discussion with a peer about something that’s troubled you and getting that support can be really helpful,” says Dr Burns.

Professional bodies are also at hand to offer support to practitioners, for example, the BMA, RCP and British Geriatrics Society continue to support members and highlight the need for support from employers, particularly given the work pressures resulting from the pandemic.

Taking time for self-care outside work is an important way of tackling burnout. Simple steps that practitioners advise but may neglect to practice themselves include: taking regular breaks from work, exercise, cutting out or down on alcohol, sugar and caffeine, eating well, and doing something creative outside work are ways to self-care, reduce stress and boost wellbeing.

To help prevent burnout Ms Goodwin-Fee recommends looking at your sleep hygiene, which includes keeping laptops and mobile phones outside the bedroom, taking a daily break from technology, that computers stay shut after working hours, and if possible, going to bed at the same time every night to get into a sleep routine.

Dr Burns says it's important to be "kind to yourself”. “If you’ve had a bad day, take a moment at the end of the day to process what has gone well. Accept that you have to be self-aware,” she says.

Self-awareness is crucial to seeking help

Self-awareness is a vital to preventing burnout, which means knowing yourself well enough to recognise if and when it’s time to seek help from a healthcare professional.  Practitioners can contact the British Association for Counselling and Psychotherapy to access an independent and credible counsellor. Talking therapies, such as counselling, can help get to the heart of people’s problems and concerns, and offer strategies to managing stress and anxiety.

“Counselling gives you a safe space to help you reflect and what’s manageable and doable, it gives a different perspective, and there’s no judgements,” says

Practitioners can seek medical help from their own doctor, and/or contact an occupational health service. And they can ask their employer if they offer any support. Some trusts, for example, offer an Employee Assisted Programme (EAP) to staff. This is an employer-paid scheme that allows employees to contact an independent adviser on a confidential basis to discuss any issue that is troubling them, causing stress or interfering with effective job performance or attendance.

Dr Burns says employers have a role in signposting support and that “most trusts have done this quite extensively over pandemic”. “Making it much easier for doctors and other healthcare workers to get formal psychological support has allowed people to accept that it’s normal not to be ok, and seeking out help doesn’t feel as much of a stigma,” she says.

Longer term action

As well as individuals taking action to safeguard their mental wellbeing, longer term action is needed to address NHS workforce issues, Dr Burns believes. For those involved in older people’s care, that means making sure there are adequate numbers of people working in this area so that patients have access to a good range of services. Action is also required so that health professionals have the ability to recharge through, say, study leave and that students, junior doctors and other team members are supported as they progress their careers.

While this is a “really challenging time for geriatricians”, going forward Dr Burns says “we need to see a brighter future. And if doctors and nurses, who have worked so hard, are suffering with their mental health, then they need to be given support”.

The sooner that health professionals seek that help the better says Ms Gallacher. “Don’t delay, get the help with burnout that you need. And don’t be so hard on yourself, or feel your letting people down. Everybody struggles sometimes. It’s only human, especially given what’s going on just now,” she says.

And to those who are struggling, feeling isolated, and in need of help but not wanting to acknowledge this, Ms Goodwin-Fee says it’s important to remember that, “even if  you’re done the same job for years, what’s happening is unprecedented. It’s an assault in many ways on the layers of being that we share. We’re all in survival mode. You’re not on your own.”


Advice and support

BMA: Counselling and peer support for doctors and medical students

Royal College of Physicians: Mental health and wellbeing resources

NHS Practitioner Health: a free, confidential NHS service for doctors and dentists across England with mental illness and addiction problems, who are working or looking to return to clinical practice.

Frontline19: Free independent, confidential service delivering psychological support to keyworkers

Doctors in Distress: Aims to raise awareness of doctors’ wellbeing and prevent suicide among health professionals

British Association for Counselling and Psychotherapy

Mind: mental health charity, information and support


 Kathy Oxtoby is a medical journalist