What is being done to look after doctors during covid-19 and beyond?

Covid-19 has brought disruption, uncertainty, and pressure for doctors. In the first wave we were at least galvanised by feelings of community and pulling together. But it is different now.

The second wave has brought new challenges. As the caseload of sick patients accumulates, doctors are concerned about patients whose care has been postponed as well as “missing” patients—those who don’t present at all. 

In October 2020, we concluded phase one of a Scotland-wide study on doctors’ wellbeing, funded by the Chief Scientist’s Office (Scotland).  

We interviewed and received longitudinal audio-diaries from over 100 doctors across Scotland. The data crosscut the first wave and the start of the second (June-October 2020) to form the first national level evidence base regarding doctors’ experiences during the pandemic. It has allowed us to identify priorities and develop empirically informed wellbeing interventions.

Unsurprisingly, covid-19 has magnified existing challenges to doctors’ wellbeing, across all sectors and grades. 

The doctors we studied experienced many changes at work, at home and in their educational contexts, which have impacted on all aspects of their lives.  

GPs as a group are usually reluctant to participate in this sort of study. However, a significant proportion took part in ours. They reported finding the new working practices and reduced direct patient contact during the pandemic highly challenging.  

Hospital doctors too highlighted significant changes to their working practices and patient pathways, as well as increased complexity of decision-making. The cancellation of elective work and the effect this has on patients has exacerbated concerns. 

Trainees also reported disruption in their educational and training environments (e.g. redeployment, cancellation of rotations and exams) and faced continued pressure in meeting curricular milestones.

Doctors across all career grades spoke of uncertainty about the future and told us they felt burnout, stressed, and anxious.

However, they also reported poor access to both formal and informal support, along with a perceived stigma around their use. 

From our findings it appears that NHS employers have failed to demonstrate how much staff are valued and appreciated, especially senior doctors, who feel responsibility for trainees and other colleagues as well as patients.  

The lack of being valued is amplified by the perceived removal of rest and relaxation spaces and catering which had been provided early in the pandemic. 

Doctors also report reduced access to informal psychological support, after those delivering it returned to their “normal jobs” and receiving less communication from senior managers.  

Different doctors have different needs when it comes to accessing support, which means that a range of interventions will be required.  

However, key priorities should include institutional support for doctors; supporting psychological safety; and supporting physical safety.  

We urge for the reinstatement of rest and relaxation spaces where they have been removed and making access easier where they have not.

There is clearly a need to support doctors in pandemics. It is interesting that government plans for such events miss this component.  

There is now potential for one legacy of covid-19 to be lasting support for doctors. Healthcare staff are people who should be valued, cherished and supported through difficult times. Is that too much to ask?

Peter W Johnston on behalf of the SMERC Scottish Doctors’ Wellbeing Study.

PWJ is the Interim Director the Scottish Medical Education Research Consortium (SMERC) comprising the Universities of Aberdeen, Dundee, Edinburgh, Glasgow, St Andrews and NHS Education for Scotland.

The SMERC Scottish Doctors’ Wellbeing Study has representation from the Universities of Aberdeen (K Gibson Smith, KA Walker), Dundee (L Gordon, GA Scanlan), Edinburgh (G Aitken), Glasgow (L Pope), St Andrews (P Cairns, JE Cecil, KB Cunningham, A Laidlaw, TR Tooman) and NHS Education for Scotland (J Ferguson, PW Johnston, J Wakeling).

Funding for the Study is from the Chief Scientists Office (Scotland) and NHS Education for Scotland.

Competing interests: none declared.