This article has been written by a guest contributor: Dr Alex Butcher. Dr Alex Butcher is a Cambridge University graduate with an interest in anaesthetics and intensive care. He is currently working in an intensive care unit in North London having recently completed his foundation years of training.
The Covid-19 pandemic has been the greatest health crisis the NHS has ever faced. All healthcare professionals have had to adapt to some degree and junior doctors are no exception.
As junior doctors of the future, you will be working with seniors whose formative years working as a doctor were completed under very unusual circumstances. An understanding of how this affected them will be useful to better relate to their perspective and experience. Before you even reach this stage though, it is likely that this unprecedented health crisis could well mean some medical school interview questions surrounding this topic may arise. For this reason, it would be beneficial to be able to demonstrate that you have an appreciation for the impact Covid has had on the health service and junior doctors. Finally, Covid-19 isn't going away quite yet and could well significantly impact your time in medical school and possibly beyond.
In this short article, I hope to use my rotations as a foundation doctor through different hospitals and specialties to highlight some of the challenges and opportunities the pandemic has created for juniors.
There is a single word that strikes fear in the heart of any doctor or nurse. A word that if uttered allowed will surely bring disaster and ruin to your shift (and no it's not Voldemort). Dare to comment that the shift looks like it's going to be 'quiet' and you will hear immediate harsh intakes of breath. This will then be followed by worry and trepidation for the doom you have just bestowed for now surely a tidal wave of patients is about to arrive. Covid has brought an addition to the list of words that make doctors wince - redeployment. Particularly in the first and second waves, the flow of patients through the hospital changed dramatically. Critical care departments became much busier whilst other areas of the hospital, such as those involved in elective surgery, emptied nearly completely. To make the best use of the doctors assigned to these areas many were asked to be redeployed, often with very little notice. For all foundation year doctors, an entire 4-month rotation was cancelled to reduce the disruption that comes along with changeover. For medical and surgical trainees often it meant less time working in their area of interest and fewer development opportunities. Another thing that impacted training was the implementation of Covid rotas. Unfortunately, these did not involve the stay at home in your pyjamas working from bed all day 'Covid rota' that my non-medic friends were enjoying. These varied from location to location but often involved more unsociable hours and being moved between new locations regularly.
One of the greatest changes to ways of working can be seen in general practice. Whilst remote consultations had been increasing in popularity, the ability to review patients at a distance suddenly became a necessity to prevent viral transmission. General practitioners and junior doctors working in the community became adept at video and phone consultations with patients. Part of this also involved screening patients prior to in-person reviews to assess the likelihood that their symptoms could be Covid related. Whilst this new way of working enabled crucial consultations to continue through the pandemic, some patients have interpreted the preference for telephone consultations as laziness on the part of general practitioners. If anything, the number of actual patient contact events per GP has continued to increase and the health service continues to battle with a relative lack of primary care physicians. What will happen next, now that social distancing restrictions have been lifted, is still to be seen. It is fair to say though that whatever final balance is struck between remote and in-person consultations, the pandemic has shifted the balance towards remote working for the near future at least.
What is burnout? Put simply, it is what people experience when they are consistently asked to do too much with too little. People may feel exhausted, cynical or lack a sense of fulfilment from their job. Some factors that may contribute to burnout include staff vacancies, shift pattern of working, discrimination, lack of training or support and excessive workload. It's not hard to see how busier departments during the pandemic, staff having to isolate and the emotional toll of looking after patients dying with limited treatment options have all contributed to burnout. Whilst it's difficult to assess the full size of the problem, the Health and Social Care committee released a report this year addressing the issue. It's believed that NHS staff are 50% more likely to experience high levels of work-related stress compared to the general population. For those already struggling with burnout prior to the pandemic, the added strains on the health service have been one step too far. It's thought that before Covid around one-quarter of trainees felt burnt out to a high or very high degree whereas now it is closer to a quarter. The deleterious effects of this stress on trainees are likely to have far-reaching consequences in terms of staff morale and retention.
It's not all doom and gloom! While it's true that the pandemic has created challenges it has also presented opportunities. Whilst burnout has increased, so too has the awareness of this amongst seniors and the royal colleges of each specialty. In line with this, departments have tried to have a greater focus on the well-being of trainees. Some examples of new initiatives to facilitate improved morale include buddy systems between younger and older trainees to provide training and pastoral care and dedicated lunch time tea and empathy sessions. The pandemic has also shown us the ability for healthcare systems and processes to change - hopefully for the better. Particularly at the beginning of the crisis, there was great scope to avoid bureaucracy and red tape that would normally prevent services evolving to keep up with the new normal. Systems could be streamlined, teams worked more collaboratively, electronic patient records were advocated more than ever and many of these changes will persist going forwards.
As we have progressed through the pandemic and as society has reopened, Covid has become a less frightening prospect for many. We have seen that vaccines can provide effective protection so that thankfully now most people can worry more about Covid wrecking their holiday plans than wrecking their health. However, for the doctors still working on Covid wards, the pandemic is very much an ongoing everyday reality and for the rest of the healthcare service, the long-term effects of burnout and training disruption are yet to come.
Author: Dr Alex Butcher (Guest Contributor)
Editor: Allegra Wisking