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

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Ariel Friegerman Inserm and Jean Francois Coastal Lacoste, Inserm

Since the start of the COVID-19 pandemic in early 2020, psychiatrists have warned of the risk of an increase in mental disorders. Very early on, studies were conducted in young adults (adolescents, students, health students) and caregivers in hospitals as well as in the general population).

But ironically, few studies have focused on liberal physicians.

The suffering that precedes the epidemic

The psychological suffering of liberal physicians is a problem that emerged and was known before the recent pandemic. In fact, it has already been studied for at least 20 years, with the work of Dr. Didier Trochot in particular and the report submitted to the National Council of the Medical Syndicate by Dr. Leopold in 20036. Before the pandemic, the prevalence of fatigue among French general practitioners was estimated at 48 % in this population.

Physician fatigue is a public health problem not only for physicians who suffer from it, but also for their patients because of the consequences for the quality of care provided: less empathy, increased risk of medical errors, and so on. General practitioners of English found an association between longer time to carry out administrative tasks and a lower level of well-being/higher level of fatigue which was itself associated with a higher risk of medical errors.

Poor mental health is also associated with an increased desire to stop exercising. Therefore, the psychological suffering of doctors could be an indirect factor that exacerbates the shortage of professionals.

In France, at 1Verse In January 2021, self-employed physicians represented 41.8% of regularly active physicians, a decrease of 11% compared to 2010. This worsening shortage of self-employed physicians has increased the workload of those who remain. In addition, there is an aging of doctors: half of them are over 60, compared to only 30% in 2010.

This looks very worrying for the coming years, with the retirement rate on the rise.

The epidemic as an indicator

The global pandemic has had an impact on the mental health of the population and has highlighted the importance of this topic 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 symptoms of depression and anxiety, assessed by the HADS (Hospitality and Depression Scale) validated in French and widely used around the world.

We’ll also address burnout, a term created in 1974 to designate occupational burnout for caregivers and has since been extended to other demographics. We will deal with insomnia measured by the Sleep Intensity Index (ISI), a scale recognized and used for studies on this topic around the world.

During the first wave, 46.6% of clinicians working in resuscitation and intensive care units had symptoms of anxiety, and 25% had symptoms of depression (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 less studied, perhaps because the main problem was finding supportive beds for patients with severe symptoms. During the first wave, a study found 30.6% of depressive symptoms among French radiologists and another 49.6% of feelings of anxiety among general practitioners.

Our study assessed the psychological suffering of 1992 French private physicians, all specialties combined, including 48% of general practitioners, registered with Doctolib, during the second wave (November 2020). 73% of respondents are between 30 and 60 years old and 25% are over 60 years old; 58 percent of women.

We used the same scales used in a study of AP-HP hospital physicians in 2017-2018: we assessed the presence of symptoms of anxiety and depression with the HADS (HAD score >7), the presence of fatigue with the Copenhagen Burnout Inventory (CBI) and insomnia with the Insomnia Severity Index.

In our study, 71% of physicians experienced fatigue, 46% reported insomnia, 59% had anxiety symptoms, and 27% experienced depression symptoms. This psychological distress had a significant impact: over the past year, 31% took psychotropic substances (anxiolytics, antidepressants, sleeping pills, etc.) and 28% increased their consumption of alcohol or tobacco.

General practitioners also reported significantly more fatigue than other specialties (75% vs 68%) and consuming more psychotropic substances (34% vs 28%).

These alarming numbers can explain several reasons, some of them old, but exacerbated by the epidemic: heavy workload associated in particular with a shortage of doctors, an increased administrative burden, the suffering of patients and their relatives, fear of contracting the virus and passing it on to their families, with no clear recommendations for managing patients who are facing an emerging disease.

Another reason is the climate of violence towards doctors. As a recent English-language study notes, the increase in aggressive actions precedes an epidemic. In France, over the past four years (2017-2020), the Doctors Safety Observatory has recorded an average of more than 1,000 accidents per year. Recently, opponents of vaccination have gone so far as to threaten practitioners with death.

And a chance to change?

As noted by an editorial in the British Medical Journal

tea LancetCovid-19 has represented a well-being challenge for clinicians, but it can also be an opportunity to raise awareness of the problem and develop procedures to address it.

In fact, even if since 2018 there has been a toll-free number for doctors in difficulty and a few recovery units for exhausted caregivers, the topic is still a taboo. Medical culture suffers in silence, with stigmatization of doctors who perceive they have mental disorders.

However, the Doctors Ranking website lists some regional mutual aid associations for caregivers such as the ASRA Network (Help for Caregivers Auvergne-Rhône-Alpes) or MOTS (Better for Better Care). But structures of this type remain few in number.

Awareness related to the epidemic can be an opportunity to break taboos and develop procedures that have already proven effective: stress reduction therapies, small group discussions, peer support societies… According to international recommendations, psychiatrists should be invited to develop and organize these procedures.

The development of these measures required financial resources, and this was not discussed during the Ségur de la Santé. At the organizational level, it will be possible to rely on the rank boards of departmental physicians and on representatives of the Regional Unions of Health Professionals (URPS) of liberal physicians throughout the territory.Conversation

Ariel Fragermann, MD, psychiatrist at the Kremlin Hospital Bicester, Inserm and Jean-François Costal-Lacoste, clinical psychiatrist and neurologist, specializing in mood disorders, researcher (“MOODS” team), Inserm

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

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