26 November 2021

Let’s take pride in what we did this year

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So here we are. My last TMR editorial for 2021 … and I have to admit a sense of déjà vu.

Looking back, this time last year my final editorial was more or less a prequel to what was hoped to be the end of the pandemic. This time last year we were feeling pretty comfortable, with most of country having very few if any covid cases and the vaccine seeming to be just around the corner. There was a strong sense of excitement as we anticipated what we hoped was imminent freedom.

Well, as the Red Queen said to Alice, it feels like it has taken all the running we could do to stay in the same place. 

However this time, at the end of 2021, it’s real. We’ve done it. Over 85% of the country double-vaxxed and freedom really is very, very close. 

But what a hell of a year it’s been! 

There’s been a lot of talk about GP burnout and the possibility of mass resignation, which leads me to think I’m not the only GP who feels a bit exhausted by 2021. 

Of course I feel guilty even typing those words. I haven’t had to deal with patients struggling to breathe courtesy of the virus, or deal with the grief of their families, or even wear full PPE day in and day out. 

Nonetheless covid has significantly impacted general practice. For me, the hardest part hasn’t been the incorporation of all the hygiene measures into our daily practice, or the training and implementation of the vaccine rollout, or the almost overwhelming demand for the vaccine, or the constantly changing advice on who was eligible for what. 

No, for me, the most exhausting aspect of 2021 has been trying to manage what seems to be the huge surge in mental health presentations, particularly among younger people. I can’t say I really noticed it in 2020, but it has really hit home in the past 12 months.

It seems like all my previously anxious or depressed patients have gone downhill this past year. In addition, I’ve had so many patients with new mental health issues, including teenage girls who have become so anxious in lockdown they can’t return to the classroom or complete assignments; young children who fear something (such as covid) happening to their parents so they can’t sleep; and a number of depressed young parents worn down by juggling home-schooling, working from home and a house full of people 24/7. 

I know this is anecdotal but AIHW data backs up my experience.

According to report published last October, covid has resulted in an increase in psychological distress in younger people.

“For younger people (18-44), average levels of psychological distress were higher in 2020 and 2021 (including August 2021) than they were before the pandemic, especially for those aged 18-24,” the report stated.

This was not unexpected. In October 2020 the government announced patients could access 10 additional Medicare subsidised psychological therapy sessions as part of their mental health care plan – this being a clear acknowledgement that the virus and our efforts to reduce its transmission was likely to take  a psychological toll.

But I’ve got to say, as grateful as I am to have this added support to offer to patients, these extra appointments seem to have reached saturation point very quickly. I have found it almost impossible to access a psychologist for a new patient in any time frame less than months! And if you want someone seen face to face – well that’s just a complete fantasy. I know, I know – we all need to be covid-safe, but for a first-time psychologist patient it has to be more difficult to build a good rapport via phone – or even a video link. 

So where does that leave us? I don’t think I’m Robinson Crusoe when I suggest that a significant proportion of this increase in patients’ psychological distress has fallen back on GPs. Believe me, I am no expert in managing mental health, but one thing I do know is that regular connection is important. Keep in touch often. Keep bringing patients back to check on them and check in with them.

But it’s a vicious cycle. I find treating mental illness exacting and exhausting, yet to treat it properly you have to see patients often and give them time. The next appointment gets made as the patient walks out of your consultation room. All of a sudden, you find every day, your patient list will include at least three or four people who you know have challenging mental health issues. Some days when I go home, I just feel spent. 

However, as 2021 finally draws to a close we can be reasonably be certain better days are ahead – for us and our patients. 

I know I give the impression I am limping over the finishing line rather than embracing the future, but I do believe as the borders open and the restrictions lift, psychological distress will lessen. Life will return to normal.

As a specialty we should feel an enormous sense of satisfaction for a job well done in 2021. We are responsible for more than half of all the vaccines delivered in this country and more than that, we have been at the frontline of delivering advice, allaying fears, and really selling confidence in both the vaccine and the program. 

What’s more we have dealt with all the “other” consequences of covid – the isolation, the loneliness, the anxiety and the depression – and not just our own! This, in my opinion has been the really hard bit. 

So goodbye, 2021 – it’s been an experience. Here’s to a very happy, restful and restorative Christmas holiday period and let’s look forward to a much more normal 2022. Take care.

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