The impact of COVID-19 on the well-being of general practitioners and trainees is multifacated and requires intensive diagnostic efforts

We read with interest the article by Zhang et al.[1] on a cross-sectional study of mental health, career opportunities, impact of restricted access to training and knowledge of COVID-19 in 38 general practitioners (GPs) and 43 GP trainees (GPTs) using a self-administered online questionnaire. There was no significant difference between the two groups in terms of mental health, knowledge scores, career opportunities, and CPD.[1] The study concluded that the pandemic had no significant impact on mental health, knowledge of COVID-19, and career opportunities in either GPs or GPTs.[1] The study is convincing, but some points should be discussed.

The first point is that the study was conducted using an anonymous, electronic questionnaire.[1] Electronic questionnaires have the disadvantage that it is not possible to check whether the addressee is the person filling in the form, that it is not certain that the answers given are true, that it is not possible to determine whether the addressee is mentally capable of completing the tasks and unaffected by medication or drugs, and that it is not certain that the addressee is capable of operating electronic devices themselves.

The second point is that the two groups were neither compared with a healthy control group nor with a cohort of GPs and GPTs unaffected by the pandemic. To answer the question of whether the pandemic has influenced the parameters studied, it is essential to compare the selected cohorts with healthy control groups or with GP/GPT groups outside the pandemic.

The third point is that the questionnaire used may not be sufficient to test the target groups for their mental health.[1] More reliable results on the mental health of GPs/GPTs can be obtained by using more sophisticated scores such as the Patient Health Questionnaire-9, the Mental Health Quotient, the Generalized Anxiety Disorder Assessment, or the Warwick–Edinburgh Mental Wellbeing Scale.[2] Were any of these or other tests used in the study groups?

The fourth point is that only subjects with a maximum of three years’ GP experience were included.[1] Since experience naturally makes it easier to deal with the circumstances of the pandemic, experienced GPs should be compared with inexperienced GPs.

The fifth point is that knowledge of COVID-19 is highly dependent on individual training interests and the type of practice. GPs who work in hospitals or outpatient clinics will have a different knowledge of COVID-19 than GPs who only work in the office. Those working in a hospital are likely to deal not only with mild or moderate COVID-19 cases but also with severe cases requiring mechanical ventilation, ECMO, or dialysis.

Overall, this interesting review has limitations that put the results and their interpretation into perspective. Addressing these limitations could strengthen the conclusions and reinforce the message of the study. Before concluding that the pandemic had no impact on mental health, education, career opportunities and knowledge of SARS-CoV-2 among GPS/GPTs, more detailed testing needs to be conducted. It is also important to compare the target groups before and during the pandemic.

Ethical approval

Not applicable.

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Consent for publication

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Availability of data and material

All data are available from the corresponding author.

Author contribution

JF was responsible for the design and conception, discussed available data with coauthors, wrote the first draft, and gave final approval.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.