Hi everyone
COVID 19 is changing our world as we know it - so let’s all take a collective deep breath and try to keep the pandemonium out of the pandemic. It will pass. As GPs with an interest in mental health, we are used to providing patients with solace and support at times of crisis but we sometimes neglect to care for ourselves. Transference and counter-transference are powerful processes and often insidious. Now is the time to slow down and remain mindful of our own anxiety and grief. Vicarious trauma is also insidious; we need to stay safe while helping others and this is absolutely the time to put your self care plans into action. So, pause for a few minutes and think, what positive, nurturing activities do you have planned for each day? Do you need to add a few more? Do you practice what you preach, for example, daily gratitude exercises (“what 5 things am I grateful for today”? etc), or meditation or exercise or smelling the roses in your garden?
With GP phone consultations there can be an instinctive rush to get them over with, briefly and quickly; I suggest you slow down and try to imagine your patient at the other end of the phone and put your listening and empathy skills into practice. Counselling by phone or video is a valid modality. If you normally spend 20 or 30 minutes counselling your patients then do this over the phone too. Focussed psychological strategies can now be delivered by phone, so do so when appropriate. Acknowledge the novelty of the medium and the uncertainty of the times during your conversations with your patients. Validate their concerns and talk about hope and despair as states that co-exist. Offering hope is a powerful therapeutic tool and one that we can instil into our practice. A Carer at a recent mental health meeting stated that his mood lifted when his GP offered to “hold hope” for him. What a powerful message!
Being at the coal face of a pandemic is not something that we GPs ever really expected to be in, despite our knowledge that they occur. Our anxiety is tangible and real and sometimes debilitating so let’s be realistic and try to balance our needs to care with our needs to be cared for. Talk to your practice colleagues about what this looks like for you. Try to support each other/debrief regularly.
Finally, one of the hallmarks of general practice is dealing with uncertainty. We deal with probabilities and differential diagnoses and indefinite prognoses. We manage this uncertainty by sticking to protocols and algorithms and diagnostic processes while maintaining flexibility and individualised care of patients. Discuss with patients how they too can manage these unpredictable and uncertain times.
Just listening is often enough.
Best wishes and keep safe.
Dr Cathy Andronis, MBBS, FRACGP, Dip Family Therapy Master Couple & Relationship Therapy
Chair of Psychological Medicine Specific Interests, RACGP
March 22, 2020
(Visuals by Dr Wendy Burton)
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