Uncertainty, fear of contagion , changing protocols, ethical dilemmas, deaths, physical and mental exhaustion … are some of the causes that have affected the mental health of doctors during the coronavirus pandemic. In two years, the Comprehensive Care Program for the Sick Physician (PAIME), which was created in 1998 to offer specific care to professionals with mental disorders and / or addictive behaviors, has attended 1,201 new cases , almost 37% more than in the two years prior. 60% of the patients who have attended the program are women. Cases of addiction account for 13.5%: 66% for alcohol abuse and 34% for other toxins.
This is stated in the report of the Foundation for Social Protection of the Collegiate Medical Organization (FPSOMC) that is released this Thursday and to which ‘El Periódico de España’ has had access. They clearly draw the bill that the pandemic has passed to Spanish health workers in terms of mental health.
At least those who have been cared for through PAIME, a veteran program – born in 1998 – that was created to offer specific care to doctors with mental disorders and / or addictive behaviors. With nuances, explains to this newspaper, Dr. Gustavo Tolchinsky , secretary of the College of Physicians of Barcelona (CoMB), because, being a national program, the PAIME is “very heterogeneous” since, in reality, it represents the microcosm of the 52 Colleges of Physicians of Spain, “with their particular reality very disjointed “. The report is prepared with all the data provided by the school leaders from the different communities .
Dr. Tolchinsky is one of the thirty experts who, on November 4 and 5, will meet in Cádiz to address the main mental health challenges of the medical profession, within the framework of the IX National Congress of PAIME and III Latin American Meeting of the same program.
1,201 new cases
Days before, the FPSOMC has revealed some statistics that will be put on the table and on which the doctors will debate. For example, with those registered for 2019 and 2020, it has been found that this program attended almost 37% more cases (a total of 1,201) than in 2017-2018, when the average was around 400 professionals per year . Since 2011, the first year in which the FPSOMC records the evolution of registered cases, almost 6,400 physicians have gone through this specialized program.
Doctors, out of fear, feeling of guilt or social stigmatization of their own disease, tend to hide it
In the period of the last report, mental disorder has been the main reason for admission to the PAIME with an increase of more than two points (76.8%) while addictive pathology represents 13.5%. Of this percentage, 66% are cases of alcohol abuse and 34%, for other toxins. Cases due to dual pathology decreased to 9.7%, according to the study.
Like other groups, doctors too, out of fear, feelings of guilt or social stigmatization of the disease itself, tend to hide and deny it. They are not easy patients, admits Dr. Gustavo Tolchinsky from Barcelona. ” It is difficult for them to admit it . That a doctor has a disease does not mean that he is incompetent, what he cannot be is irresponsible.” In addition, it draws attention to a fact: this type of program actively monitored doctors with mental disorders or addictions before the COVID. The “brutal” impact of the pandemic was unforeseen.
Doctors asking for help
The report by the WTO Foundation for Social Protection reveals an increase in the number of members who have spontaneously attended the program: 63% in 2020 . The largest number of cases is related to adaptive disorders . Of the 1,201 new admissions, a total of 233, that is, 19.4%, have required hospital admission to the Galatea Clinic in Barcelona, dependent on the Foundation of the same name, which is the hospital resource available to the doctors they need psychiatric care.
Of the total number of doctors attended, the vast majority 63% were working when they entered the program
Of all these cases, 20.3% have been considered complex and, of these, 60% represent risks to practice . Of the total number of doctors attended, the vast majority 63% were working at the beginning of the program, 34% had sick leave ; 2% were unemployed and 1% had temporary professional disqualification. In terms of job performance, 86% work in the public health system, 9% in private practice and 5% in both.
More women served
Regarding sex , the percentage of female doctors affected by mental health problems and / or addictions (60%) continues to be higher than that of doctors (40%) and continues its upward trend in recent years, the report points out. By age group, the data show a worrying reality: a rebound in the number of physicians treated who are less than 30 years old.
Psychiatry and anesthesiology specialties are presented as the most vulnerable
The specialties with the highest number of cases attended by PAIME are Family and Community Medicine and Emergencies, followed by anesthetists (6%), pediatricians (6%) and psychiatrists (4%). However, if it refers to the susceptible population, the study indicates, they are Anesthesiology and Psychiatry, the specialties with the greatest vulnerability.
PAIME is a pioneering program in Europe with a long history: almost 24 years since its launch. It is coordinated through the different professional associations and has procedures (direct access, confidentiality , the use of therapeutic contracts for the follow-up of complex cases, etc.) and a care unit, through the Galatea Foundation .
Psychologists and psychiatrists warned him from the outbreak of the crisis. The harshness of fighting face to face with covid-19, with overflowing health centers, professionals at the limit and trying to save lives in a collapsed country, would leave consequences. Anxiety, impotence, anguish , sleep disorders, pain … were some of the most common reactions among health workers.
For this reason, the secretary of the Barcelona College of Physicians distinguishes, if the impact of the pandemic is discussed, between health workers with serious mental health problems – who have required psychiatric care – or those who have needed to go through programs such as the Support Service Emotional Health Professionals (SEPS), also from the Galatea Foundation , with milder pathologies.
In these months there have been numerous studies published on the effects on the mental health of those who faced the disease on the front line. The Collegiate Medical Organization (WTO) already published in February 2021 the study ” Repercussions of covid-19 on the health and exercise of the profession of doctors in Spain”. A work carried out by researchers from the WTO, the Galatea Foundation and Mutual Médica. The investigation – now working on a new wave of data – yielded devastating figures: 51% felt overwhelmed by the pandemic. And 34% had thought about leaving the profession at some point.
In the worst of the crisis, the Mental Health units of the large hospitals urgently deployed their professionals to the centers themselves to attend to their colleagues, especially those who worked in the most sensitive areas such as the Emergency Department, the ICU or covid patient isolation plants. The situation was so dramatic that it was attended to at the foot of the track. Wait a minute, in a hallway. Emergency therapy so that they would return to work tirelessly.
Those were those days when most communities also opened psychological care lines for health workers, their families and, of course, for patients. Specific programs and circuits that, as the incidence of the virus has been decreasing, have been dismantled, explains to EL PERIÓDICO DE ESPAÑA, Javier Prado Abril , clinical psychologist in Zaragoza and member of Anpir (National Association of Clinical and Resident Psychologists) .
More nurses in therapy
During this time, what clinical psychologists have been observing, Prado Abril explains, is that, during the pandemic and also now, those who have resorted to therapy the most have been women, many of them nurses. “There may be a gender profile , and women are more predisposed to ask for help,” he says. Most of the consultations, he details, have been for depression, anxiety , exhaustion, burning, insomnia and, also, some case of serious mental disorder.
“We are still injured and there is no plaster that heals at the moment” says a nurse on Twitter
“I cry every time I remember what I lived, what I felt and what I lost. A smell, a person or a word triggers a cascade of emotions that I cannot control, we are still injured and there is no band-aid that can heal for now ”. These are words, in the form of a tweet, written just a few days ago by nurse Ana Antón on the social network. Very illustrative of what the toilets still feel.
The Nursing Union , SATSE, has denounced that the different public administrations have left “to their fate” health professionals who have been seriously affected at a psychological level by their care and assistance work during the pandemic. They criticize that specialized support offices have not been set up in the hospitals themselves, Primary Care areas or in the social and health centers .
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