Orla Whitehead is a salaried GP in Weardale, and NIHR In Practice Fellow, Newcastle University. She is on Twitter: @orlawhitehead
The covid pandemic presents risks to GPs and their staff.
We are concerned about being physically ill, whether we can access PPE, sick pay, vaccines. We are concerned about being mentally ill, anxious, depressed, isolated. Covid presents a challenge to the spiritual health healthcare professionals; not just in that times are feeling apocalyptic, but as Maslach described it, the ‘erosion of the soul’ that is burnout.1
Burnout leads to lack of meaning, depersonalisation, loss of connection to our patients and community, and emotional exhaustion. These contrast with how GPs define the term ‘spiritual health’.2 While services are advocating for rapid protection for physical and mental health, there needs to be priority action to prevent an epidemic of broken spirits.
There needs to be priority action to prevent an epidemic of broken spirits.
General practice has rapidly changed. Our physical interactions with patients are limited, watching them enter the room, welcoming them into our space, listening, engaging, examining and closing the consultation with reassuring words. We connected, making people feel better, even when ‘cure’ is complex or impossible. Human interaction has become remote and virtual, or as brief as possible via masked faces. We’ve lost the chance to put a hand on an arm and physically absorb distress, we’ve lost the comforting ritual of examining our patients, bridging our differences. Ours may be the only touch a person receives. Engaging with our mutual humanity, finding meaning within our consultations, is what helps protect us from the loss of meaning and personal accomplishment that are the features of burnout.
Medical personnel are at risk of moral injury.
Medical personnel are at risk of moral injury, a term taken from the military returning from battle, where severe distress is caused when we transgress our deeply held morality.3,4 During the pandemic, we face being forced by circumstances and limited resources to move away from our core beliefs about delivering good patient care. When I asked GPs what the term ‘spiritual health’ meant to them, they said being true to themselves and their own ethical code was crucial to concepts of spirituality of the self.2 The challenges posed by the covid, and limitations of our internal and external resources, and the reasonable limitations of ourselves, leave us as a profession at risk of moral injury, where we are forced to behave counter to our internal codes, and behave in ways damaging to our spiritual health.3 Working outside of our usual areas of expertise, working in unfamiliar ways, and making uncomfortable ethical assessments all keep our morality and souls under exhausting tension.
Simultaneously, everyone is restricted in terms of their usual spiritual practices and rituals, due to social distancing. Religious and tribal communities are parted and there is a loss of our physical connectedness to others, habits and rhythms. We are facing unprecedented spiritual challenge at a time when society’s spiritual coping mechanisms are unavailable. The three aspects of how English GPs themselves define spiritual health- self-actualisation and meaning, transcendence and relationships beyond the self, and religious practices – are all under threat from the changes to our work caused by the covid.2 Activities that nurture our spiritual health can be deeply personal, but are often communal. Further research into how organisations and systems can contribute to the spiritual health of medical staff has never been more imperative, given the extraordinary strain we are under.
Activities that nurture our spiritual health can be deeply personal, but are often communal.
Spiritual health is stigmatised, and doctors are uncomfortable with the topic.5 When I explain my research, investigating the concepts of hope, meaning, and humanity in primary care, there is a recognition that these issues affect many others. As a profession, we need to become more self-aware that understanding spiritual health is key to our own holistic health. We need to be aware of our own spiritual needs, discuss how organisations can nurture positive spiritual health, starting with an acceptance that if we do not know what strengthens our souls, what lifts our spirits, we face being eroded, and our profession burned out.
1. Maslach C, Leiter MP. The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It: Wiley 2008.
2. Whitehead IO. Discussing spiritual health in primary care in England. Innovation in Aging 2019;3(Supplement_1):S884-S84. doi: 10.1093/geroni/igz038.3237
3. Greenberg N, Docherty M, Gnanapragasam S, et al. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ 2020;368:m1211. doi: 10.1136/bmj.m1211
4. Dean W, Talbot S, Dean A. Reframing Clinician Distress: Moral Injury Not Burnout. Fed Pract 2019;36(9):400-02.
5. Best M, Butow P, Olver I. Why do We Find It so Hard to Discuss Spirituality? A Qualitative Exploration of Attitudinal Barriers. Journal of Clinical Medicine 2016;5(9):77. doi: 10.3390/jcm5090077