A survey of more than 6,600 physicians in Sweden shows that general practitioners (GPs) who managed COVID-19 patients were twice as likely to report severe symptoms of exhaustion, often the first sign of burnout. The study was published today in BMC Primary Care.
The study was based on data gleaned from the Longitudinal Occupational Health survey in Health Care Sweden (LOHHCS), and researchers used the Burnout Assessment Tool (BAT) to assess severe symptoms of exhaustion.
Though much attention was paid to the stress and trauma experienced by emergency and critical care doctors in the early months of the pandemic, GPs were seeing and diagnosing COVID-19 patients while also caring for patients who had other conditions. The authors said the dual nature of the GPs' role in the pandemic may have uniquely primed those doctors for burnout.
In this study, burnout was defined as "the inability to perform, as indicated by exhaustion and cognitive and emotional impairment, together with the unwillingness to perform, as indicated by mental distancing." Exhaustion is characterized by both mental and physical fatigue, or feeling drained, tired, and weak.
More exhaustion among female GPs
The researchers administered the survey in spring 2021 to 1,013 GPs in Sweden, and they found exhaustion in 14.4% of respondents. The prevalence was 16.4% among female GPs and 11.6% among male GPs, and 17.0% in junior GPs, compared with 13.8% in senior GPs.
19.9% of GPs who reported excess workload due to the pandemic also had severe symptoms of exhaustion.
GPs who managed COVID-19 patients had a significantly higher prevalence of severe exhaustion symptoms: 16.7%, compared with 7.8% in GPs who did not see COVID patients.
"Furthermore, 19.9% of GPs who reported excess workload due to the pandemic also had severe symptoms of exhaustion, and amongst those who stated that their workload was unchanged, the prevalence was 11.5%," the authors found.
Lack of managerial support cited
In all survey responses, GPs who reported a lack of support from management were more exhausted. Severe exhaustion was reported in 29.1% of those who said they had poor managerial support, compared with 12.8% of doctors who said they had good support.
In several models built by the authors, GPs who managed COVID-19 patients were more than twice as likely to report severe symptoms of exhaustion compared to those who did not manage COVID-19 patients (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.39 to 3.90).
On top of that, being a female GP treating COVID patients was linked to a 54% higher risk of exhaustion (OR, 1.54; 95% CI, 1.05 to 2.26).
GPs who reported their management had provided unsatisfactory working conditions had the highest risk of exhaustion (OR, 3.37; 95% CI, 2.00 to 5.67).
The authors of the study said GPs in Sweden may have experienced higher stress and exhaustion because of their unique role in treating elderly citizens.
"In Sweden during the COVID-19 pandemic, the situation within elderly care was ethically demanding for GPs, entailing difficult medical decisions regarding the frail and elderly," the authors wrote.
"For instance, Swedish GPs responsible for care in nursing homes have been accused of denying COVID-19 patients hospital-based care, and even guilty of euthanasia. Further, there has been criticism about the fact that relatives of palliative-care residents were not involved in the end-of-life care."
