Covid-19 is taking a huge emotional toll on everyone. The usual work-life balance tips don’t work as well when you can’t go out and everyone’s emotions are on overdrive. Finding ways to support each other and help deal with the situation is incredibly important.

1) It is a marathon, not a sprint.
Nobody knows how long this will last. There’s no point exhausting yourself too early. It is okay to be working in a quiet ward or a quiet hospital. Help your colleagues if you can, but don’t overwork yourself and certainly don’t feel anxious or guilty that you are not helping enough. Everyone will have their time at some point; taking it in turns and having fresh faces every few weeks is safer for staff and for patients.

2) Take breaks during work – Read the full article
It is easy to forgo breaks & food when your list of things to do looks endless. Know that missing out on these crucial components of your day will slow you down and will increase your risk of mistakes. Stack up too many days or weeks of missed breaks and you will start to hate your job.

It is very difficult as a new doctor to identify how best to prioritise jobs. Ask what will happen if you leave the job for an hour. Consider whether a patient is actively deteriorating and if that is the case, you probably need to escalate to the rest of your team. If jobs are urgent & you are drowning under them, before it gets this far you need to escalate to seniors and get their help.

3) Recognise that everyone’s not coping
You may feel you’re coping a lot worse than your colleagues. For juniors in any healthcare profession, this is a horrible start to your career – the kind of crisis that hasn’t been seen in hundreds of years. Your colleagues may feel even more scared than you & they do need your support.

Your senior colleagues also probably don’t know what they’re doing in this crisis. We’re just good at falling back on basic principles of medical care or pattern recognition. Essentially “fake it ’til you make it”. No one has dealt with such a pandemic before; none of us has training on how to manage a coronavirus outbreak nor the exact treatments they need. All of us are anxious about the constantly changing information. We need your support too.

Your colleagues (or you) might not deal with this stress well. You might find that there’s more arguments or difficulties between colleagues. Nobody comes to work aiming to do a bad job. Recognise that communication or relationships may be stretched by the crisis and constructive support will go much further than confrontation and relationship breakdown. Be wary of bullying.

4) Redeployment
You may be (regularly) redeployed to work in a range of settings you’re not used to working in with a rota that might be a lot more intense than you’re used to working. The GMC have written advice on this. This advice includes having adequate induction, ensuring activities aren’t beyond competencies with weekly reviews and updates. Also, that redeployment will be taken into account at the ARCP.

Some of you may feel excited about the opportunity to learn, others distressed or upset by what you’ll be needing to do. Know that you can rely on your colleagues and others for plenty of support – we get that this is difficult and at times overwhelming. Continue to raise your views and thoughts and if you can think of anything that can improve your working life then raise it to seniors. Ensure your resident doctor forum or whoever represents you plays an active role in operational decisions to ensure your voice is heard.

5) Communicating with Colleagues
A lot of nurses, therapists and other healthcare professions feel a lot of anxiety from lack of information. One of the things we’ve aimed to introduce on our ward is 10-15 minute lunchtime updates where the medical team provides teaching to help reduce these feelings. It helps the nurses feel more confident about how to send a Covid swab, recognise when these patients are unwell & need escalation, more confidently identify which patients need screening and ensure adequate contact precautions.

We’ve also introduced debriefs. Any person can raise the need for a discussion for any situation – but they are regularly held for patients who have become unwell, had an arrest or newly being managed palliatively. If you do a debrief, ensure you explain the purpose is to discuss what happened and identify how the team could work better to improve things next time. It is not constructive to blame a single person.

• How does everyone feel?
• What were the events that occurred? Who was involved and what did they do?
• What went well?
• How could the care of the patient be improved? Did anyone have any concerns?
• If there are specific actions that led to a performance gap
  • What was going through your mind when this was occurring?
  • Explain what you appreciated and what you were worried about
  • What strategies do you see going forward that could help in the future? How will learning about x impact your performance next time?

Recognise when your colleagues aren’t coping and take the time out to sit and talk to them. One of the things we are doing is several times a week we sit down with our colleagues to check in that they are okay over food bought by the mess team.

6) Normal emotions during this time
Most reactions are within normal expectations. What is important to recognise though are whether they are impacting you or your ability to work in a harmful way.  You may find your emotions cycle (often quite quickly) through some of the following:

• Elated from a surge of adrenaline “excited” to deal with the crisis
• Guilty for not being able to do enough or thinking you should be more competent/quicker or having to self-isolate
• Upset, stress or anxious due to uncertainty, concerns for family or patients
• Relief during periods of self-isolation or leave
• Anger at official bodies or the public (see number 10)

Try to recognise when your mental wellbeing or your ability to work is being impacted. Organise regular self-check ins where you evaluate throughout the day if you’re doing okay and how you’re feeling. Consider whether you need a break, to talk to colleagues/friends or family, use wellbeing apps, talk to occupational health or whether you are at crisis and need urgent support.

7) Coping with crisis
Overwhelming emotions often occur unexpectedly. It is important to therefore use other parts of this article to identify ways to prevent this occurring, but if it does familiarise yourself with local and national resources to support yourself.

All hospitals have wellbeing resources – people you can contact if you are going through a crisis. These might include going to A&E and talking to the psychiatry team, talking to hospital-based teams or supervisors that you’re comfortable with.

• BMA 24/7 counselling & support (contact number: 0330 123 1245)
• samaritans.org (contact number: 116 123) for emotional support
• giveusashout.org (text: 85258) for text-based support
• https://www.rethink.org/aboutus/what-we-do/advice-and-information-service/get-help-now/
• https://www.mind.org.uk/information-support/guides-to-support-and-services/crisis-services/getting-help-in-a-crisis/

8) Relaxing outside of work
This is difficult when the entire country is under quarantine and everything is closed. Fortunately, it does mean friends and family are more available. You can call or message people that usually you wouldn’t, to check that they are doing okay. This is a great way to start a conversation but to also build a robust support framework of people who will check on you in the future.

This is not the time to start picking up new hobbies. Things that usually relax you or make you feel better are the things that you will much more heavily rely on now. Self-care of food & sleep are absolutely vital. Exercise is a very good idea and personally, I have been doing family exercise classes using video calling which have been a huge success. Other things might be finally watching that TV show, film or reading that book that’s been on your list for a long time.

Ensure you do spend time relaxing though and this includes taking your annual leave. It is easy to start picking up extra locum posts or pushing your annual leave until the next rotation because you don’t want to be the only one at home. However, everyone’s looking to socialise more as everyone else’s alone at home unable to work.

9) Self-isolation
Essentially everyone will need to self-isolate at some point for 7 to 14 days. After recovering from being ill reactions of guilt or relief are quite normal, but remember that this is the safest and most important thing you can do for your colleagues and patients. Hospitals will continue to work without you.

Ensure you follow your usual local policies to let the right people know (usually your team & HR). This shouldn’t affect your ARCP and you should get paid for your time off (even if you are doing a bank shift). Ensure you follow all the usual “coping with illness” advice during your time off which includes reducing your risk of infecting others.

During your time off expect that doing your usual “life admin” will be difficult. You will be exhausted, distracted or stressed and so you might find you’re inefficient. Don’t be disheartened if you achieve nothing, relaxing and recharging is exactly what you need. Mind.org.uk has a great list of things you can do:

• Connect with friends & family
• Keeping active
• Clear outs (of physical or digital things)
• Creative endeavours (painting, DIY, mindfulness, music, writing)
• Keep your mind stimulated (books, magazines, articles)

10) Watch out for (social) media
There are lots of reasons why it might be helpful to keep social media and watching the news to a bare minimum during your time off. During a crisis, both can be quite distressing. News services tend to be quite negative as these articles get more views but this can be quite disheartening. On social media, people may deal with their own anxieties by taking their anger out on the government or other official bodies – it is easy to get wrapped up in this anger and perpetuate it. Fake news can make this even worse with people sharing it inadvertently or for instant fame. You can easily get triggered by this or by the public ignoring official advice e.g. “selfies in FFP3 masks”.

The first thing you need to appreciate is what you can and can’t control. You can’t address other peoples’ responses to this crisis. All you can do is regulate your own reactions and aim to spread correct information only. If you want, you can report or comment with factual information on posts. However, avoid any responses that might promote argument or are trying to be inflammatory. Note that people have unhealthy ways to deal with stress and this can be arguing with people or blaming a single person or body for everything that’s gone wrong. Keep reminding yourself that these things are hardly helpful nor constructive. If they really wish to correct whatever serious problem they’ve identified, they can follow the correct channels to inform someone who can correct it. Policies aren’t made by government officials reading Facebook walls and tweets.

Finally, switch off from all of this and tell your friends you want to talk about something else. Do not let your entire life be dominated by Covid-19.

Further reading

• https://www.mind.org.uk/information-support/coronavirus-and-your-wellbeing/
• https://www.samh.org.uk/about-mental-health/self-help-and-wellbeing/coronavirus-and-your-mental-wellbeing
• https://www.nhs.uk/oneyou/every-mind-matters/coronavirus-covid-19-staying-at-home-tips/
• https://www.nhsemployers.org/news/2020/03/free-access-to-wellbeing-apps-for-all-nhs-staff

Written by Dr Akash Doshi CT2