Mental health of doctors in COVID times

A panel discussion with two doctors who cared for COVID-19 patients and a mental health expert sheds light on the struggles of medical practitioners, their reluctance to seek help, and overarching expectations of resilience that have led to an overwhelming situation.

“There is definitely a sense of loss and hurt, but you have to do what you have to do,” said Dr. Mona Kulpati, Pediatrician at Rainbow Children’s Hospital, New Delhi, speaking at a virtual panel discussion organised by Health Analytics Asia on the mental health of doctors during the pandemic.

Medical professionals have been on their toes for more than a year now, doing their best to strengthen the fight against COVID-19. The persistent struggle has led to both physical and mental stress. We asked doctors how they have been dealing with the pandemic, the challenges, the burnout, looming fear of getting infected and even carrying the infection back to their families.

Dr. Shimna Azeez, Public Health Worker and social media activist from Kerala and Dr. Vandana Shetty, a Consultant Psychiatrist at Mind-Body Clinic, Bengaluru, who has also worked at NIMHANS, were unanimous in their observation that the pandemic has placed doctors in an unfamiliar situation. And there has been no time for doctors to really understand their emotional response to it!

Challenges galore

Doctors have witnessed unprecedented gloom and loss of lives since the outbreak of the pandemic and at the same time, been subjected to the discomfort of living inside PPE kits for hours and painful societal discrimination. “We couldn’t use the restroom or eat on time, especially during the initial months, but we got accustomed to it later. People were afraid in the beginning, they would sit at a distance. As we were in PPE, we had to literally shout and ask them questions about their symptoms,” recalled Dr. Azeez.  

“I have heard people saying, ‘she is a doctor and could be corona positive, let’s move away from her’,” confided the doctor who found the situation to be emotionally draining and stressful, especially when she was away from her family for days on end. 

Dr. Kulpati outlined factors responsible for the psychological stress and how the situation is different while dealing with children, a vulnerable group. “With children, when a doctor is associated with a chronic illness and when you don’t have better news – diagnosis like COVID, or saying that the treatment isn’t working – no matter how clinical the approach is, it does become personal and it impacts us,” she said.  

Long hours at work, almost non-existent sleep, work pressure and poor empathy of colleagues and superiors are some of the key factors that impact the mental health of doctors.  Although data across the world shows that mental health issues are prevalent in the doctor community and the spectrum is wide, Dr. Kulpati reasons that “mental health itself is a topic of stigma and mental health of doctors is an unreal notion as we don’t talk about it”. 

Mind over matter

“Doctors are trained not to focus on their emotional response and to be clinical right from the early days of medical training. They are told to be resilient, to be strong and to be the one who gives hope,” noted Dr. Shetty. Such training works well in a normal scenario, but it can backfire in a prolonged crisis situation. When healthcare workers are dealing with strong emotions and they don’t know what to do with it, there is a problem. And that needs to be addressed.  

“There is nothing called ‘switch off’ mode. I haven’t ‘switched off’ for about one and a half years now,” admitted Dr. Azeez. “But it’s time to accept mental health issues like other physical health issues and seek access to care and support,” maintained Dr. Shetty.

The implication of being at the forefront, the amount of uncertainty, and increasing level of stress is taking a toll on the mental health of medical professionals. “Eventually they feel that it is professional inadequacy – which it isn’t – but that’s just how the training has been over the years,” said Dr. Shetty.  

To ensure that healthcare professionals are not silently getting gripped in the gloom surrounding them, the panel highlighted the need for changes at structural levels. Changes have to take place at multiple levels for building a better community and a more conducive civil society.

The road ahead

While policy and structural changes are the need of the hour, there are many steps that can be taken at an organisational and family level to ensure that the mental health of doctors is taken care of. “Support from families and co-workers and a strong support system is what they need the most,” said Dr. Shetty. “The level of acceptance has to come in and help-seeking behaviour is something which doctors have to normalise as help-seeking is often stigmatised,” she added. 

The participants in the panel pointed out how there are specific helplines for healthcare workers. They also agreed on the importance of senior doctors and colleagues extending support to junior staff members, particularly in these tough times. 

“At the level of hospitals, junior doctors are at the forefront and the experience and training is less than a senior doctor, so they are more vulnerable. Preventive measures like doing regular check-ins, group discussions and upscaling trainings on how to break bad news to patients and their families are areas which should be an integral part of medical training,” noted Dr. Shetty. 

For more than a year now, doctors have been resiliently at the forefront of the long battle against the contagion. The panel discussion offered some deep insights into the difficulty of the situation and how doctors are struggling, yet expected to jump right back in. Because that’s just how they have been trained over the years – the clinical approach to handling tough situations, keeping aside emotions and vulnerabilities. Unfortunately, it took us a pandemic to realise that this comes at a huge price!