Mental and physical exhaustion of health-care practitioners

Health-care workers are experiencing mental and physical exhaustion after coping with 18 months of the COVID-19 pandemic. Many dedicated staff members are retiring from the field and leaving their jobs. This occurrence is now widespread. A recent study by The Physicians Foundation found that doctors were heavily affected by the COVID-19 pandemic: 61% reported often experiencing feelings of burnout; 57% had experienced inappropriate feelings of anger, tearfulness, or anxiety; 46% had isolated themselves from others; and more than 55% know of a physician who has either considered, attempted, or died by suicide.¹ Despite the high incidence of mental health symptoms, only 14% of doctors sought medical attention. Similarly, a study by the International Council of Nurses showed that rates of burnout among nurses globally rose as high as 80% during the pandemic.²

The emotional, physical, and mental exhaustion of health-care workers need to be urgently addressed. The standard responses to burnout are not working. For one reason, health-care practitioners do not have paid time put aside for them to practise self-care. In our self-care experience, many practitioners say they do not have the time to practise spirituality, meditate, walk in nature, or spend valuable moments with their families. Providing a safe, nourishing, and restorative healing environment for human beings has to be given priority over finances, efficiency, and productivity if caregiving professionals are to avoid allostatic overload and severe burnout with mental anguish and exhaustion (which leads to abandonment of the vocation).³ The moral injury inflicted by the business-oriented medical systems of today needs to be mitigated in the context of the added moral injury imposed by the burden of crisis judgments now pummelling clinicians who care for patients with COVID-19.

The fear and uncertainty created by SARS-CoV-2 in our patients and the public is overwhelming and has spread through all sectors of society. Within this stressful environment, a person's ancient fear and uncertainty processing centre, comprising limbic amygdalae, responds to pandemic stress with conditioned emotional responses predicated on activation of brainstem stress systems, which in turn activate the sympathetic nervous system and the innate immune response.⁴ If the current reality continues unabated, our brains will move away from a state of alert safety and high performance aided by a well-resourced prefrontal cortex to a state of amygdala-dominated distress, which will usher in an increased vulnerability to burnout and to many stress-related non-communicable diseases, including depression.

To address this crisis, we recommend a series of actions: strictly allocated brief patient visits need to be eliminated;⁵ medical teams need to be immediately assembled and fully supported; health-care practitioners should be provided biweekly or monthly Balint groups to discuss the most difficult clinician–patient relationships with colleagues in a safe empathic setting;⁶ time for one of the web-based or in-person stress management and resilience training programmes should be allocated for front-line clinicians;⁷ and mindful movement and the so-called laying on of hands should be encouraged—eg, based on the emerging model of interoception, health-care practitioners might benefit from allocated time for a paid experience of mindful exercise, physical therapy (for moderate–severe body pain), or massage.⁸

Our health-care practitioners are a treasure; we must assure that their health and wellbeing become a top priority alongside the health of our patients.

© 2021 Alfredo Estrella/AFP/Getty Images

We declare no competing interests.