The strong impact of the Covid epidemic on the mental health of liberal doctors in France

Ariel Frajermann, insert and Jean-Francois Costemale-Lacoste, insert

Since the start of the Covid-19 pandemic in early 2020, psychiatrists have warned of the risk of an increase in psychiatric disorders. Very early studies were carried out in young people (adolescents, students and health students), in hospital caregivers and also in the general population).

But, paradoxically, few studies have focused on liberal doctors.

Suffering that precedes the pandemic

The psychological suffering of liberal doctors is a problem that appeared and was known long before the recent pandemic. In fact, it had already been studied for at least 20 years, notably with the work of Dr. Didier Truchot and Dr. Leopold’s report to the National Council of the Order of Physicians in 20036. Before the pandemic, the prevalence of burnout among French general practitioners it was estimated at 48% in this population.

Medical burnout is a public health problem not only for the doctors who suffer from it, but also for their patients due to the consequences on the quality of the care provided: less empathy, more risk of medical errors, etc. Thus, a study on English general practitioners found an association between a long time to perform administrative tasks and a low level of well-being/high level of exhaustion, which, in turn, was associated with an increased risk of medical errors.

Poor mental health is also associated with a greater desire to stop exercising. The psychological suffering of doctors could therefore be an indirect factor that aggravates the shortage of professionals.

In France, at 1^Ahem In January 2021, independent physicians accounted for 41.8% of regular active physicians, a drop of 11% compared to 2010. This worsening shortage of independent physicians has resulted in an increased workload for those who remain . In addition, there is an aging of doctors: half are over 60 years old compared to only 30% in 2010.

This looks very worrying for the next few years, with a high retirement rate.

The pandemic as an indicator

The global pandemic has had an impact on the mental health of populations and has highlighted the importance of this issue in the general population.

In a previous article we explained the problems related to measurement methods and the definition of “Mental Health”. In this new text, we will talk about depressive and anxious symptoms, evaluated by the HADS scale (Hospitalization and Depression Scale) which is validated in French and widely used throughout the world.

We will also address the issue of burn-out, a term created in 1974 to designate the professional exhaustion of caregivers and since then extended to other populations. And we will deal with insomnia measured by the Sleep Severity Index (ISI), a measurement scale recognized and used for studies on this topic throughout the world.

During the first wave, 46.6% of physicians working in resuscitation and intensive care units suffered from anxiety symptoms and 25% from depressive symptoms (HAD score > 7); they were 47.4% and 30.8% respectively during the second wave.

The question of the suffering of liberal doctors during the pandemic has been studied less, probably because the main problem was finding support beds for patients with severe symptoms. During the first wave, one study found 30.6% depressive symptoms among French radiologists and another 49.6% feelings of anxiety among general practitioners.

Our study assessed the psychological distress of 1,992 French private physicians, all specialties combined, including 48% of general practitioners, registered on Doctolib, during the second wave (November 2020). 73% of the respondents were between 30 and 60 years old and 25% were over 60 years old; 58% were women.

We used the same scales as for a study conducted with doctors from the AP-HP hospital in 2017-2018: we evaluated the presence of anxious and depressive symptoms with the HADS (HAD score>7), the presence of burnout with the Copenhagen Burnout Inventory (CBI) and insomnia with the Insomnia Severity Index.

In our study, 71% of physicians suffered from burnout, 46% insomnia, 59% anxiety symptoms, and 27% depressive symptoms. This psychological suffering had a significant impact: during the last year, 31% had taken psychoactive drugs (anxiolytics, antidepressants, sleeping pills, etc.) and 28% had increased their consumption of alcohol or tobacco.

General practitioners also reported experiencing much more burnout than other specialties (75% vs. 68%) and using more psychoactive drugs (34% vs. 28%).

Several reasons, some of them old, but accentuated by the pandemic, can explain these worrying figures: the heavy workload linked in particular to the lack of doctors, the growing administrative burden, the suffering of patients and their families, fear to contract the virus and transmit it to their family, the absence of clear recommendations for the management of patients in the face of an emerging disease.

Another reason is the climate of violence towards doctors. As a recent English study indicates, the increase in acts of aggression predates the pandemic. In France, over the last four years (2017-2020), the medical safety observatory has recorded an average of more than 1,000 incidents per year. More recently, opponents of vaccination have gone so far as to threaten practitioners with death.

And an opportunity for change?

As noted in an editorial in the British medical journal

Tea LancetCovid-19 has represented a challenge for the well-being of doctors, but it can also serve as an opportunity to raise awareness of the problem and develop actions to remedy it.

In fact, even if since 2018 there is a free number for doctors in difficulty and some hospitalization units for exhausted caregivers, the subject remains taboo. The medical culture is one of suffering in silence, with a stigmatization of doctors who recognize that they have psychological disorders.

The site of the order of doctors, however, lists some regional mutual aid associations for caregivers such as the ASRA Network (Caregiver Help Auvergne-Rhône-Alpes) or the MOTS association (Better for better care). But structures of this type are still few in number.

Raising awareness linked to the pandemic can therefore be an opportunity to break the taboo and develop actions that have already proven their effectiveness: stress reduction therapies, small group discussions, peer support communities… In accordance with the recommendations international organizations, psychiatrists should be called upon to develop and organize these actions.

The development of these actions requires financial resources, and this was not discussed during the Ségur de la Santé. At the organizational level, it would be possible to have the Councils of the order of departmental doctors and the Regional Unions of Health Professionals (URPS) representative of liberal doctors throughout the territory.

Ariel Frajerman, Md-PhD, psychiatrist at Hopital Kremlin-Bicêtre, insert and Jean-François Costemale-Lacoste, clinical psychiatrist and doctor of neuroscience, specialist in mood disorders, researcher (“MOODS” team), insert

This article is republished from The Conversation under a Creative Commons license. Read the original article.