Family Doctors Report Increase in Mental Health Cases During Coronavirus Pandemic: Survey

The number of patients reaching out to doctors with mental health needs has spiked during the COVID-19 pandemic, even as many patients refuse to visit doctors’ offices for fear of contracting the coronavirus and physicians struggle with a lack of tests and personal protective equipment (PPE), a survey of Canadian clinicians says.

A survey of 64 clinicians including doctors in family medicine, advanced nursing and other disciplines conducted in April by the Primary and Integrated Health Care Innovations Network (PIHCIN) paints a grim picture of how the pandemic has impacted primary care across the country. The PIHCIN is an initiative run by the Canadian Institutes of Health Research to study and improve healthcare delivery. The results of the survey were provided to VICE by a healthcare professional who works with the PIHCIN.

Doctors’ responses to the survey reveal anxiety about patient well being, physician capacity to provide care and the economic viability of their practices, as lockdown measures in place across Canada stretched into weeks and months. (Some provinces are now starting to relax those measures.)

Survey respondents included clinicians from Ontario, British Columbia, New Brunswick, Alberta, Manitoba, and hard-hit Quebec, the epicenter of the COVID-19 crisis in Canada.

One family physician said that a “lack of [personal protective equipment] and lack of testing” for coronavirus are “the most pressing problems” facing their practice. Another said that “routine care [has] almost disappeared” for patients during the pandemic.

In April, 36 percent of clinicians reported they were unable to test patients for coronavirus and had to send suspected cases to external COVID-19 testing centers. Nearly half of those surveyed, or 45 percent, said they “lack PPE” in their primary care clinic, with 28 percent relying on “used and homemade” personal protective equipment when caring for patients.

Also in April, 61 percent of clinicians reported an increase in the number of patients exhibiting mental or emotional health needs, while 69 percent saw “rising family and economic concerns” among patients.

Clinicians reported “seeing fewer sick children and postponing all routine preventative care” and said prenatal and newborn visits with doctors are now being done “mostly virtually.” Respondents voiced concern about the long term impact the trend will have on overall health: virtual visits weaken doctors’ ability to assess for cancer, coronary artery disease and other conditions, and can lead to delayed immunizations in kids, the survey notes.

The economic impact of lockdown measures put in place to slow the spread of COVID-19 are also raising concerns among clinicians.

More than half of clinicians surveyed saw “rising economic concerns” among their fellow medical professionals, including concerns about not being fairly compensated for virtual care provided to patients by email and video calls.

According to the survey, one in five clinicians say they aren’t sure if they have enough cash to keep their practices open. Seventy-five percent reported a “dramatic decrease” in patient volume, partly due to patient fear of contracting the coronavirus. Primary care providers note that patients are “afraid to go out” and are “avoiding the ER”, even when they are presenting “very worrisome” symptoms.

Practices are also operating at a lower capacity: 50 percent of survey respondents said clinician illness or quarantine has impacted their capacity to care for patients, while 33 percent said administrative staff becoming ill or quarantined has reduced their capacity to provide care.

As a result, 83 percent of clinicians report limiting appointments for well patients and patients with chronic health conditions “for COVID-19 related reasons.”

The survey authors point out that people living below or close to the poverty line, especially those who do not speak English or French, have “the most challenges accessing care” because they may not have access to a computer, wifi or a phone. Sixty-one percent of clinicians reported having patients who cannot use virtual health tools because they lack either a computer or a phone.

The survey concludes with stark policy recommendations to keep family medicine offices open and running well.

“Federal and provincial governments must take decisive action to make sure that primary care practices across Canada are not shuttered," it reads. "Additional support is needed for primary care clinicians to address mental health concerns and fears of patients, particularly those who are suffering more stress due to financial instability or unstable housing."

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