Doctors’ wellbeing: self care during the covid-19 pandemic

During a period of increased stress and uncertainty it is more important than ever for NHS staff to look after themselves, say Michael Farquhar and Shreena Unadkat

In February 2019, Health Education England published the Pearson Report looking at the mental wellbeing of NHS staff.

It asked “Who cares for the people who care for the nation’s health?”, and stated “We must improve the way in which we look after ourselves and our colleagues, so they are better placed to meet the needs of patients.”

That reflects a growing consensus, from the General Medical Council, the Royal Colleges, the British Medical Association and others, that protecting the wellbeing of NHS staff is essential.

However, the NHS, already under chronic strain, is about to be put under almost unimaginable additional pressure, as we respond to a global public health challenge of a magnitude not seen for generations.

The seeming paradox that rapidly emerges is that the more pressured things become, the more important, not less, it is to pay attention to the wellbeing of NHS staff. 

The coronavirus pandemic will almost certainly be a marathon, not a sprint. To continue to deliver the best possible care for its duration, we must support our staff from the very beginning. Looking after ourselves and our colleagues has never been more important; we must give ourselves permission to change “the patient is always first” narrative to “the patient always … but not always first.” 

When pressure and demand are high, when NHS staff feel they need to stretch to extreme levels to cope, it can seem impossible to stop and take a break. But they are not superhuman.

Pushed to their limits NHS staff, like everyone, become fatigued and performance drops off. If breaks are not taken consistently, we run the risk of staff being broken. NHS staff are incredibly resilient, however they are in danger of believing that “resilience” means never showing you are tired or stressed. 

We must emphasise that regular rest and breaks are “recharges”—the essential re-powering up to enable us to continue to function at our best—and must be clearly modelled and supported by senior leaders. Most of us start to feel anxious as soon as our phones dip their battery charge into the red, and start seeking out sockets to recharge, but we don’t always apply the same principles to ourselves. 

If we exhaust ourselves sprinting in the first mile of the marathon, the remaining miles will be all the harder. Stress is a normal human experience which indicates when something needs to change. A better strategy for long term psychological wellbeing is being able to allow yourself to stop. 

Paying attention to signs of physiological hyperarousal is a good starting point, as our bodies often indicate that we need to stop long before we admit that we are struggling. Online brief “body scan” exercises are freely available and can help staff to pause and build awareness of mind and body. 

When stressed, sleep becomes more difficult. The temptation is to see sleep as a luxury, not an essential. Supporting NHS staff to be able to get the best sleep they can while responding to the pandemic is critical, because sleep is essential for physical and mental health. Crucially, when we are sleep deprived, our immune systems can function less well, increasing our chances of becoming symptomatic on viral exposure in the first place. 

Prioritising quality sleep will be difficult in the months ahead. Some simple tips on this can be found here.

We can also look after each other by compassionately witnessing and acknowledging the daily experience of working through a global health crisis. This is an ever evolving situation, and many people have a sense of “unreality” at the moment. Having other people match our experience is grounding and helps us to make sense of what is happening, which is important for longer term emotional processing.

Being kind to ourselves, and to those around us, is essential. 

Many trusts are mobilising their psychological therapists to help frontline staff manage through this time. Staff should check with local psychology leads and occupational health to see what is available. 

When the pandemic is over, and we return to some sense of “normal” again, we will need an even more vigorous discussion about what safe staffing, safe resources, and a safe model of care really mean in the modern NHS. 

Our ability to cope with extraordinary demands, like a viral pandemic, depends on our staff having resources and reserves to draw on. We have been drawing on those reserves for a very long time now. 

As Michael West said, on publication of the GMC’s “Caring for doctors, caring for patients” report last year, “We can’t simply go on the way we are, loading more responsibility onto doctors already struggling to cope. Where workloads are excessive, patient care suffers.

Guidance about managing fatigue can be found:

Shreena Unadkat is a clinical psychologist who specialises in physical health across the lifespan, with a specific focus on helping families and systems adjust to diagnosis. She is currently working in the Sleep Medicine Department at the Evelina London Children’s Hospital.

Michael Farquhar is a consultant in sleep medicine at Evelina London Children’s Hospital. He has a particular interest in the impact of shiftwork on sleep, sleep deprivation and fatigue in NHS staff.