{"id":49654,"date":"2021-02-26T16:48:55","date_gmt":"2021-02-26T15:48:55","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49654"},"modified":"2021-03-05T16:59:04","modified_gmt":"2021-03-05T15:59:04","slug":"learning-from-doctors-with-long-covid","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/02\/26\/learning-from-doctors-with-long-covid\/","title":{"rendered":"Learning from doctors with long covid"},"content":{"rendered":"

When Sarah Burns and Sue Warren<\/strong> started a support group for doctors with long covid, they found a number of people struggling with new experiences, losses, and vulnerabilities<\/p>\n

Long covid has emerged as a serious, yet poorly understood, sequelae of acute covid-19 infection. We do not yet know why some people develop long covid, while others do not, but it appears that rates of long covid are more prevalent in healthcare professionals due to increased exposure to covid-19.1<\/sup> <\/span><\/p>\n

In July 2020, a Facebook support group for medical practitioners affected by and suffering from long covid was set up to provide an opportunity to share experiences. Subsequently, we established a confidential space where doctors could come together for further support, under the auspices of the charity Doctors in Distress. Over 80 doctors, across all grades and specialties, joined the first webinar and were subsequently divided into smaller groups of 10-15 members with experienced facilitators leading each group. Sessions ran for eight weeks, with a final group webinar to share learning.\u00a0\u00a0<\/span><\/p>\n

Common themes emerged, including living with prolonged symptoms, challenges accessing physical healthcare, uncertainty about the pathophysiology and duration of illness, concerns over future fitness to work, loss of personal and professional identities, and the stigma associated with symptoms such as fatigue.<\/span><\/p>\n

Becoming unwell has long been recognised as a challenge to doctors.2,3<\/sup>\u00a0 Having a new, poorly understood disease has made the transition from professional to patient harder and many doctors have struggled with the vulnerability of being \u201con the other side.\u201d While some participants have eventually received diagnoses (for example, autonomic dysfunction, pericarditis, myocarditis, microvascular angina, pulmonary embolism, and neuropathy), several have not and feel dismissed by their clinical colleagues. For many, the most important factor was feeling heard by other clinicians.<\/span><\/p>\n

Loss (including the inability to work and professional identity) was a pervasive theme, although given how central work is to doctors this is hardly surprising.4<\/sup> Doctors described intense feelings of failure and guilt for leaving colleagues with increased workloads and not personally contributing to the \u201cfight against covid.\u201d This self-stigmatisation and shame is common among sick doctors.5,6<\/sup>\u00a0<\/span><\/p>\n

The diffuse nature and severity of symptoms has led some to question whether they would be able to return to working as a doctor again. Neurocognitive dysfunction is a common symptom of long covid and is in sharp contrast to the high function essential for managing the complexities of medical work, which doctors will have been used to pre-covid. Other symptoms, including exertional chest pain, shortness of breath, and severe fatigue, have pervaded and limited every aspect of life. These doctors\u2019 worlds have shrunk and changed considerably.\u00a0<\/span><\/p>\n

Many felt angry that they had, almost certainly, contracted covid-19 in their workplaces, but now felt abandoned or even penalised by colleagues\u2014a small but not insignificant number have been asked to leave roles due to prolonged sick leave.<\/span><\/p>\n

While long covid has many physical presentations, this is not to dismiss its psychological manifestations. For some, mental illness has been obvious: depression, anxiety, and post-traumatic stress disorder. Fear that their treating clinicians would attribute physical symptoms to their understandable psychological distress is a common concern. The <\/span>Doctors In Distress<\/span><\/i> groups were the only place some could talk freely about their experiences, losses, and vulnerabilities, and reach a deeper understanding. The therapeutic power of belonging to a group, being able to share experiences, receive support, and provide hope have been described as universal features of groups in different settings.7<\/sup><\/span><\/p>\n

Moving forward\u00a0<\/b><\/p>\n

Participants realised they needed to find other ways to help healing. Disappointingly, medicine (despite all its technological advances) seems unable to provide all the answers. Participants in the groups recognised improvement is likely to occur with the passing of time, but this means accepting and making space for self-care, rather than constantly striving to perform.<\/span><\/p>\n

Many are going through a period of loss for their old self. With acceptance, facilitated by belonging to the group, some gave themselves permission to be truly self-compassionate, which, not unexpectedly, has resulted in improved self-care and subsequent improvement in their physical health.\u00a0\u00a0<\/span><\/p>\n

None of these doctors expected to have these sequelae to acute covid. They have become sufferers of a new, complex disease, and yet in this process of recovery (helped by the group) they have grown in their understanding of what true caring means\u2014the value of kindness and true self-compassion and the importance of feeling heard.\u00a0\u00a0<\/span><\/p>\n

Almost all described that the process of becoming unwell has changed them, not only as people, but also as doctors. Not being heard themselves, they pledged to listen more closely to their patients, be more open minded about symptoms that do not fit a clearly recognised pattern, have a deeper understanding of the impact of disability and chronic illness, and be kinder both to themselves and their colleagues and patients.<\/span><\/p>\n

Some have also used their experience to escape stressed NHS workplaces and explore other opportunities. Others have made long planned changes in their personal lives\u2014<\/span>getting dogs, exploring artistic talents, making more time for simple pleasures.<\/span><\/p>\n

These doctors have learnt from long covid. We can learn from these doctors too.\u00a0\u00a0<\/span><\/p>\n

Sarah Burns<\/strong> is a GP based in Southampton, who had long covid. She was a co-founder of the UK doctors #longcovid Facebook group and put the proposal for these groups to Clare Gerada.<\/span><\/em><\/p>\n

Sue Warren<\/strong> is a locum GP (and ex-partner) in Dorset and also works for Practitioner Health and Wessex Professional Support and Wellbeing Unit. She is an appraiser and Wessex LMC rep and was a facilitator for the Doctors in Distress long covid support group.<\/span><\/em><\/p>\n

Competing interests<\/strong>: none declared.<\/p>\n

With thanks to Clare Gerada for leading this programme and her support with this article. Many thanks to “Doctors in Distress” for funding and delivering the free support accessed by these doctors. Themes discussed in this article can be explored further in <\/span>Gerada G. (Ed) 2020. Beneath the White Coat: Doctors, Their Minds and Mental Health<\/em>.<\/span><\/p>\n

References:<\/strong><\/p>\n

    \n
  1. Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo C-G, Ma W, et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health<\/em>\u00a02020 Sep 1;5(9):e475\u201383.\u00a0<\/span><\/li>\n
  2. McKevitt C, Morgan M. Anomalous patients: the experiences of doctors with an illness. Sociol Health Illn<\/em>\u00a01997;19(5):644\u201367.\u00a0<\/span><\/li>\n
  3. Thompson W, Cupples M, Sibbett C, Skan D, Bradley T. Challengers of culture, conscious and contract to general practitioners\u2019 care of their own health: qualitative study. BMJ<\/em> 2001;323:728.\u00a0<\/span><\/li>\n
  4. Gerada C. Work is central to doctors\u2019 identity, and those unable to work need support. BMJ<\/em> 2016;353:i2014.\u00a0<\/span><\/li>\n
  5. Henderson M, Brooks SK, Busso L del, Chalder T, Harvey SB, Hotopf M, et al. Shame! Self-stigmatisation as an obstacle to sick doctors returning to work: a qualitative study. BMJ Open<\/em> 2012 Jan 1;2(5):e001776.\u00a0<\/span><\/li>\n
  6. Miles S. Addressing shame: What role does shame play in the formation of a modern medical professional identity? Br J Psychiatry Bull<\/em> 2020;44(1):1\u20135.\u00a0<\/span><\/li>\n
  7. Yalom I, Leszcz M. The Therapeutic Factors. In: The theory and practice of group psychotherapy<\/em>. 5th ed. Basic Books; 2005. p. 1\u20132.\u00a0<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    When Sarah Burns and Sue Warren started a support group for doctors with long covid, they found a number of people struggling with new experiences, losses, and vulnerabilities […]<\/p>\n

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