Almost a third (31%) of healthcare professionals in South Africa have suffered verbal or physical abuse from patients, patients’ relatives or the public during COVID-19, according to a survey by the Medical Protection Society. MPS Medicolegal Consultant Dr Volker Hitzeroth looks at the challenges faced by doctors – and how they might be overcome.
As medical professionals, we sometimes have to communicate difficult news to patients and their families. This past week I’ve been communicating difficult news, but in this case, it relates to us as a profession.
At MPS’s annual Ethics For All conference, I announced the results of a MPS survey, which found that one in three healthcare professionals in South Africa have suffered verbal or physical abuse from patients, patients’ relatives, or the public during COVID-19.
However, I also had the opportunity to communicate more positive news during Ethics For All – that despite the many challenges we face as a profession, there are concrete steps we can all take to improve our well-being.
The survey’s more than 500 respondents comprised healthcare professionals both from across South Africa and across specialties. The results showed that 26% have experienced verbal or physical abuse from patients or patients’ families. A further 5% said they had experienced verbal or physical abuse from members of the public outside of a medical setting.
It is sad and deplorable that so many healthcare professionals in South Africa, who go to work every day in the most challenging circumstances, putting patients first, face abuse.
What is more challenging still, is that many doctors will not be surprised by the findings.
Of course, the challenges for healthcare professionals in South Africa did not start with the pandemic and will not end with it.
However, the pandemic has exacerbated existing challenges; already burdened health resources are being stretched further, doctors are worried for the safety of their patients and their own families, and are now facing compounding threat of abuse from the very people they seek to care for.
This presents yet another source of anxiety for doctors at a time when many have expressed grave concerns about their mental well-being. Almost half of survey respondents – 45% – said their mental well-being was worse compared to the start of the pandemic.
Without support to address an array of mental well-being concerns – including those caused by verbal and physical abuse – doctors are at risk of becoming disillusioned or will suffer in silence with psychological injuries. Both of these outcomes would put their safety and the safety of their patients at risk.
The most common mental health symptoms seem to be related to depression, anxiety and burn out. Hence complaints of feeling low and sad alongside a loss of pleasurable experiences, spontaneous tearfulness, a vegetative shift and hopelessness may suggest depressive features whilst overwhelming feelings of fear and panic may indicate prominent anxiety.
Related to anxiety are specific conditions like post-traumatic stress disorder, specific phobias and panic disorder. Burnout is an occupational phenomena presenting with physical and mental exhaustion, negativity, cynicism and detachment.
Support for medical professionals
MPS has, since the beginning of the pandemic, extended its free and confidential counselling service to members experiencing work-related stress (see details below). Many professional societies are also stepping up with dedicated colleagues looking after the well-being of their members.
While there are many support options available to healthcare professionals, a nationwide campaign to raise awareness, and provide additional support, would help join up these efforts and ensure that doctors who need support can access it when they need it most.
Sometimes, we are our own first line of defence. Self-care is a vital component of staying well amidst challenging circumstances.
During my Ethics For All session, rather than dwell only on the challenges, I also suggested some possible solutions.
- There are a number of interventions and strategies that might assist you in coping during this challenging time. These include, but are obviously not limited to physical activity and exercise.
- Nurturing your social network and engaging in meaningful relationships.
- Practicing your faith or spirituality.
- Mindfulness and meditation.
- Becoming involved with, and investing in, other distracting activities, new causes or developing new hobbies.
- Seeing humour and joy in the small things around you.
- Practicing acceptance, tolerance and gratitude.
If you (or a colleague) are struggling with a decline in your mental health and psychological wellbeing then it is important that you:
- Confide in a trusted person such as a spouse or partner, a senior colleague or trusted friend;
- Make contact with support organisations such as MPS, the Health Care Workers Care Network (HWCN) and the South Africa Depression and Anxiety Group (SADAG) and share your concerns.
I would also recommend that you consult a GP, psychologist or psychiatrist. This may seem like a daunting task, but it is important to commit to an initial and comprehensive assessment and discuss the way forward.
You may be hesitant to consult a colleague in your area with whom you may already have a professional working relationship. The solution might then be to consult with a colleague outside your immediate catchment area. This may add some anonymity and ensure a professional rapport.
Self-prescribing of medication is strongly discouraged. Similarly, prescribing medications for a friend, family members or a colleague without a formal assessment, regular clinical consultations and a documented treatment plan is also deemed to be unprofessional. Finally, avoid self-medicating with alcohol or substances.
Click here for details of the MPS counselling service including how to access the service. The service is entirely independent and confidential. Call ICAS on 080 099 9050 or +44 3300 241 021 from overseas to book a free session. If you are a MPS member I would strongly encourage you to read about the service that is available and call to book a session if you feel it is right for you.
Alternatively, I encourage any medical professionals who are struggling amidst the pressures of the pandemic to consider the strategies and resources outlined above – your well-being is every bit as important as that of your patients.