Exhaustion, burnout and distrust: The reality for 8 Australian doctors right now.

Our doctors are struggling.

They're experiencing unprecedented levels of anxiety, depression and burnout as the under-pressure healthcare system in Australia continues to fall victim to the direct and indirect effects of the COVID-19 pandemic.

A recent review by the Black Dog Institute and The University of NSW, published in The Lancet, found that while mental health issues were already on the rise in the Australian medical workforce, the pandemic has only exacerbated them.

WATCH: A young Melbourne nurse shares his experience with COVID-19. Post continues after video.

As misinformation around COVID-19 hits new levels, our medical staff are watching on horrified as their fellow citizens - albeit a minority - protest their right to overwhelm their workplace.

As Victorian nurse Merowyn Olaver told Mamamia earlier this year, "We are begging you, please think of us. Please think of us when you say 'open up', because we will be the ones picking up the pieces. WE will be the ones putting our lives at risk with stretched resources."

But it's not just that. As the eight doctors in this article will tell you, they're also dealing with financial woes, fears of bringing the virus home to their families and the same isolation fatigue as the rest of us. 

Here's how they're really feeling, more than a year and a half into the pandemic: 

Dr Mariam Chaalan, Sydney.

My name is Dr Mariam Chaalan, I am a GP, researcher and Health Literacy Advocator working across Hurstville, Burwood and Blacktown.

Dr Mariam Chaalan. Image: Supplied.

As a general practitioner having to spend most of the day engaging with the vaccine hesitant, I am exhausted. Countless hours are spent trying to battle the misinformation that has spread like wildfire across social media feeds. My days consist of demands from patients requesting exemptions and continually expressing their frustrations at healthcare and government. I am also involved in debunking misinformation and treating those with acute mental health issues. 

Doctors are worried because trust is such an important element of the doctor-patient relationship, and is especially crucial in a pandemic. What we are now seeing is not only mistrust with government and health professionals, but an element of anger and rage toward those who support public health measures and vaccinations. This distrust is influencing people’s decisions regarding their health, treatments, and well-being, with some of their choices impacting the health of the wider community. 

My bigger concern is what will happen to our health care system when the restrictions ease. We are already at capacity and we suspect that there will be a sudden increase in COVID cases requiring hospitalisation and support in a system that is already wearing thin. The strain on the health care system would be proportionate to the number of people who are unvaccinated. 

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As medical experts, we are trained in critical thinking, fact-checking, and critical appraisal of literature - all of which takes time and effort. We do this to provide the best and most up-to-date appropriate care to all our patients. We are exhausted when patients continually question our motives. We are concerned that decisions made by patients (not getting the vaccine) will potentially have disastrous consequences. We are concerned that as restrictions ease, our hospitals will not be able to cope. We are worried that those people with cancer and heart disease, for instance, will not be able to access the care they need. 

I have patients who are angry and distrustful. I have patients who abjectly refuse to get vaccinated despite the medical evidence I put to them. I am a doctor first and foremost and will continue to treat these patients despite the adverse decisions they make for themselves and the community.

Dr Olivia Ong, Melbourne.

I’m Dr Olivia Ong, a pain physician from Melbourne and a mum of two. I am currently working full time from home doing Telehealth consultations with my patients in my public and private practice.

Dr Olivia Ong. Image: Supplied.

I am coping reasonably well in the current lockdown in Melbourne but there are some days where I feel the symptoms of pandemic fatigue such as low energy, poor sleep patterns, tiredness and irritability. Some of my most effective ways to overcome these feelings include identifying and practising self-care strategies that work for me, walking 2-3 times per week and connecting virtually with my friends and family.

I am most worried about the wellbeing of my fellow medical peers who are working in the frontline. They are now suffering from physical and mental health conditions due to burnout, which results in relationship and financial issues, moral injury and PTSD but there is fear of stigma and license compromise when seeking help for mental health support.

I want the public to know that the doctors are burnt out and they need access to more mental health support. 

We can all agree it’s true that when doctors suffer from burnout and physical and emotional exhaustion, they leave the healthcare profession, and the healthcare system collapses. The truth is that doctors were burnt out way before COVID. 

The burnout rate of doctors pre-COVID is 40 per cent and the burnout rate of doctors post pandemic is 68 per cent. Research by The Washington Post showed that 30 per cent of doctors and nurses are leaving the profession, and by 2032 the US will have a major shortage of doctor and nurses. I fear the same will happen in Australia.

In 10 years, we are not going to have enough healthcare workers to support Australia’s healthcare needs. That’s why, to achieve the goal, we need to prioritise finding and implementing a solution to pandemic fatigue burnout in doctors. 

Dr. Amy Carmichael, rural Queensland.

I'm Dr Amy Carmichael, I am a medical doctor and I've worked across rural regions in Tasmania and Queensland during the last two years of pandemic.

Dr Amy Carmichael M.D. Image: Instagram @dramy.carmichael.

I feel incredibly saddened by the political nature of this health crisis and the divide it is making amongst people. It has become an economic and political game. 

I'm most worried about the mental health challenges people are facing. Having worked in COVID wards, testing centres, hospital quarantine and out of hours GP practices, I've dealt with increasing amounts of anxiety, depression and suicide from social isolation, segregation and division of the people. Furthermore, one in 10 are avoiding seeking healthcare advice and we are having large delays in presentations to the emergency department. 

I want people to understand that we are here to help and that Telehealth services are available 24/7. There is always someone who can help.

Dr. Farhan Shahzad, Sydney.

I am Dr. Farhan Shahzad, an occupational physician from Sydney.

Dr Farhan Shahzad. Image: Supplied.

Overall, I am exhausted. These uncertain times have been challenging and isolating. As a parent and a doctor, I've had to quickly learn to adapt in my career and personal life to be available to support my wife and three children throughout homeschooling and lockdown while working in the same capacity. 

Being confined to four walls and not having the freedom to escape has made days more exhausting, especially for my younger children. I want to keep my children safe but also provide them the freedom to learn and grow normally.

This time has been made even more difficult with several of my family members overseas contracting COVID-19. Knowing I cannot be there to support them and provide care is very disheartening.

While I know firsthand the effects of COVID-19 and understand the importance of vaccinations to try and minimise the symptoms and severity it can have, I am very concerned for the emotional wellbeing of my young children not having been able to socialise with friends and family. I understand children are resilient, but you always hold concern for them as you can never honestly know how they are coping.

Thankfully, much of what I do has been able to be done through Telehealth technology. Telehealth has allowed the health system to cope with the ever-changing pandemic situations and ensure the important work for employees' wellbeing does not stop.

The healthcare system will always be available to those who need help, and patients should not hold off consulting with a doctor. Although healthcare strategies such as Telehealth have changed how some things work, no one should ever delay getting health checks.

Dr Joshua Jones, Melbourne.

Dr Joshua Jones, GP and owner of Albert Road General Practice, Melbourne.

Dr Joshua Jones. Image: Supplied.

Like everyone else, I’m exhausted. 

I do count myself very fortunate that I am still able to work, but it really feels like we have been running a marathon over the last two years. But I am also optimistic. 

With vaccination rates steadily increasing in Victoria, I am hopeful that we will start to see less lockdowns and people will come out of their homes. Not just to see their doctor (which, if you’ve been putting it off for the last two years, I can’t stress how important it is to do a health check with your GP ASAP), but to get out and live life again. I kind of feel like I can finally glimpse the light at the end of this long, dark tunnel.

I am quite concerned about the acute mental health of people right now, but I am growing more concerned about the flow-on effect the pandemic will have over the next 5-10 years on mental health in the community. Financial stress, lack of security in work (for those employed), and lack of confidence in the viability of business (in those who own a business), relationship breakdowns, lack of exercise and poorer eating habits are all common themes amongst my patients. These all lead to increased health risks, including serious mental health issues such as anxiety and depression.

Stress and mental health issues need to be addressed now – people need to be seeking mental health support, and speak to someone about their problems. But given the current difficulty in accessing mental health services, as well as the fact that many people simply don’t feel that speaking to someone about their problems will help them, (it’s hard to blame them given the glum situation around), I am most worried that those who have been hit hardest by COVID will not get the support they need to recover to their state of health and happiness they enjoyed prior to the pandemic.

People seem to have this image that medical practices would be really busy during a pandemic, but at the end of the day, our practice is still a small business that relies on a steady stream of patients to ensure the continuing viability of the business. Our practice is located on the fringe of the Melbourne CBD along the St Kilda Rd corridor, and 50 per cent of our patient base were people who worked in the nearby offices along St Kilda Rd. When the lockdowns sent everyone home, we lost 50 per cent of our patient base almost overnight. 

During the pandemic, I have had team members who ordinarily deal with stress very well, snap at the smallest issue. Some have become easily overwhelmed with minor tasks. Meanwhile my wife and I have had to try to maintain the financial viability of the business with our savings, all whilst juggling life with a newborn (who is now one).

To some extent it is comparatively easier to compartmentalise and manage the stress for which our patients come to us for help. We deal with our patients’ health issues on a daily basis and are trained to handle them effectively. But the stress on small businesses right now – the uncertainties of the pandemic and lockdowns when it comes to the viability of the business, the pressure to make sure we are doing the right thing by our team, keeping COVID at bay – medical practices also share in this stress.

Many medical practices have had to endure patients being incredibly aggressive and sometimes even abusive to the medical staff. People seem to forget that many medical practices are struggling as much as other small businesses right now. A little bit of kindness to the team would go a long way in encouraging us in the medical profession to keep going through these really difficult times.

Associate Professor, Dr Sanjay Warrier, Sydney.

My name is Sanjay Warrier. I am a breast surgeon who specialises in breast oncology and oncoplastic surgery. I am based at Chris O’Brien Lifehouse in Sydney which is a premier cancer centre in Sydney providing holistic care to patients. I am also an Associate Professor with Sydney University through the Institute of Academic Surgery.

Associate Professor Sanjay Warrier. Image: Sydney Breast Cancer Foundation.

I feel relatively supported through the pandemic currently but there are definite stresses. The support comes through a similar routine of going to work and helping patients with my professional expertise. I have an amazing warm staff that brighten my day. I exercise regularly and play tennis 1-2 times weekly which is my passion outside of my work. The pandemic has given me more free time to spend with my family and we enjoy going for walks, and playing tennis and basketball.

The stresses have come from the overarching threat of COVID and its impact on resources at work. This includes reallocation of staffing to important COVID areas. Professionally I am concerned about patients who are not prioritising their health at this time due to fears of COVID and it leading to delayed diagnosis when things do start to open up. I implore anyone with any symptoms at this time to not dismiss them and to investigate with their GP and seek a referral to a specialist.

I am also concerned about resourcing for patients who do develop COVID. We are doing well as a state [in NSW] getting patients vaccinated but we are also coming up to a very tough month where we will see pressure on our hospital system with patients who have already had COVID-19. I am cautiously optimistic we have the systems in place to cope with this pressure but there is a real concern right now around the pressure increasing cases will place on the medical system. Like many people across the community, I am hoping we can get our vaccination rates very high and thereby reduce the severity of COVID for patients who do end up getting the virus.

On a personal level I would like the public to know we represent them and are just humans like them. When we come home we have families and we are absolutely trying our best in tough conditions.

On a professional level we are all wanting to continue to do what we are trained to do at a high level but it is difficult with the potential strain from COVID-19. The medical profession is collegiate and we are working in teams to provide care to patients. There are friends of mine who are assisting with vaccinations through GP clinics, others who are involved with policy and others managing outbreaks in areas. At the end of the day, these are real people who are committed to doing their best to be part of the health delivery at a strained time.

We appreciate a lot of people are doing it tough and would really stress the importance of everyone doing their bit by complying with government rules and also prioritising vaccinations for themselves and their families.  

Dr Mike Millard, Sydney.

I am Dr Mike Millard, a consultant psychiatrist and Clinical Director of THIS WAY UP, a Digital Mental Health Service at St Vincent’s Hospital Sydney.

Dr Mike Millard. Image: Supplied.

Who isn’t anxious? It’s a completely normal response to these totally abnormal times. That said, I work hard to keep my anxiety in the helpful zone and not become overwhelmed. For me, that’s a commitment to looking out for my unhelpful thinking patterns, staying in the present and focusing on the things that I can control. Sometimes that means just maintaining the basics of sleep, diet and exercise. I know that if I take the time to care for my body, it will take care of me.

Every day I hear about increasing levels of mental distress in the community, and I worry that we aren’t getting the message out that there are skills that can be learnt now that will improve the way you feel today. We don’t need to be stuck in this world of waiting lists. Australia is a world leader in digital mental health and wellbeing programs that have no waiting lists, are proven to work and are accessible in the privacy of your own home. In fact, the research shows us that 80 per cent of people who complete an online course (like THIS WAY UP) have significant benefit, and 50 per cent are no longer troubled by their symptoms.

Isn’t that a much more empowering message to be sending to those who are struggling with their wellbeing? Surely a greater awareness of these digital tools would allow our already stretched mental health system to focus on those who are most vulnerable. It’s time we get smarter at using the resources we already have.

Levels of stress, anxiety and burnout have surged during the pandemic, and I've seen it first-hand on the frontline at St Vincent's Hospital Sydney. Together with THIS WAY UP, our digital mental health and wellbeing service, we have been on the front foot to support and maintain a mentally healthy workforce. We want people to know that self-care is about focusing on practical solutions, maintaining healthy skills and techniques and being aware of what may make us vulnerable. 

As things begin to reopen and we inevitably see a further strain on the healthcare system, I see self-care as our psychological PPE - to ensure each of us is best prepared for whatever the future may bring.

Dr Vivek Eranki, Perth.

I'm Dr Vivek Eranki, I am a cosmetic surgeon from Perth. 

Dr Vivek Eranki. Image: Supplied.

I practice mindfulness techniques to ensure mental optimisation. My role requires me to have clarity of thought to ensure I make balanced decisions which has an effect on the livelihood of many staff and suppliers. I find having a well-balanced life is protective to your mental health. My life consists of a good work-life balance, healthy diet and daily exercise. Many studies have found having a good routine to be protective against mental health ailments such as depressions or anxiety. This is something I am focusing on even more so during the pandemic.

All doctors want is to act in their patients' best interests. The medical profession is very heterogeneous, in that all doctors have a different footprint of clinical practice. As my priorities are increasingly becoming about maintaining work-life balance, I am able to transition out of my clinical role which insulates me from much of the stressors the typical doctor faces.

Regardless of the type of medicine practiced, many doctors are becoming increasingly concerned about medicine evolving from a pure doctor-patient relationship to one that is increasingly dictated by bureaucracy, regulation and medical administration. These facets, ironically, increase the pressures on the doctor which further influences their decisions towards appeasing these parties along with the patient. As such, the ‘client’ or the ‘consumer’ is no longer only the patient.

Further to this, many doctors, especially cosmetic surgeons face an inherent dilemma of clinical practice. Doctors are trained to first do no harm and secondly to treat the diagnosis. In Cosmetic Surgery, doctors often undertake surgery which does not add function or reduce morbidity, but rather is purely for aesthetic gain. Secondly, in Cosmetic Surgery the ‘diagnosis’ is what the patient perceives to be inherently ‘wrong’ with them, which may be very subjective driven by extrinsic motivators. This provides the surgeon with a moral dilemma; do they treat the ‘diagnosis’ to make the patient ‘happy’?

With more patients online during the pandemic being influenced by bloggers and influencers spreading unrealistic and photoshopped perfection, this is becoming a bigger issue. 

Read more:

• “It’s not really about you”: I’m a nurse on the frontline. And I just want you to know this.
• 'Cancer is still going to happen.' 5 health checks you shouldn't miss, even during lockdown.
• "I'm a doctor, and here are the 6 questions I get asked most about the COVID vaccine - answered."

If you think you may be experiencing depression or another mental health problem, please contact your general practitioner. If you're based in Australia, 24-hour support is available through Lifeline on 13 11 14 or beyondblue on 1300 22 4636.

Feature image: Supplied/Mamamia.