Covid-19 and Challenges to Medical Professionalism

By Professor Iqbal Singh OBE FRCP

Covid-19 has had a devastating impact and highlighted the huge structural inequalities that exist in the UK; in fact the pandemic has accentuated many of these differences.

In the UK there has been increasing concern about the disproportionate impact Covid-19 has on BAME communities.

For medical professionals treating patients during this period, it has been, at times, very challenging.

More than 44 per cent of doctors in the NHS are from a BAME background and have an increased risk from the virus - both in terms of their susceptibility and increased virulence to it. Therefore, these doctors have been placed under increased stress and strain. Doctors have found difficulty with the complex ethical and clinical decision making they had to endure, ensuring that they are not taking unnecessary risks themselves and are not exposing their patients to further harm.

The medical professionalism is a set of values, behaviours and relationships that underpin the trust that the public has in doctors. The seven characteristics that are fundamental to professionalism and sees the doctor taking on several roles are:

• Healer

• Partner

• Team worker

• Manager and leader

• Advocate

• Learner and teacher

• Innovator

The doctor as a healer

In treating patients, doctors have operated in an environment which has seen the emergence of a new disease for which we have limited knowledge and are developing an evidence base. Doctors have had to face these challenges head on with the knowledge that they have sometimes limited treatments and resources at hand to change the outcomes. Doctors in some areas have had to cope with a large number of Covid-19 deaths. Some of these have sadly involved their own colleagues, friends and families.

The doctor as a Partner and Team worker.

This has been a huge challenge for both the doctors themselves and the patients receiving their care. It has been difficult to maintain adequate social distancing measures and communicate effectively with patients while wearing Personal Protective Equipment (PPE) and at the same time recognising that evidence in terms of symptoms and the overall clinical picture that may be changing or developing rapidly is limited. Doctors have had to perform duties outside of their own particular specialist area and have at times had to quickly undergo further training and take on new roles.

The doctor as a leader and advocate

Many doctors have found leadership roles in coping with Covid-19 and many BAME doctors were involved in developing risk assessment tools in hospitals and their communities. This was being done while the NHS was trying to decide as to what action needed to be taken to minimise the disproportionate impact. Many doctors were not only developing these risk assessment tools, but were also implementing them in to their own practice. Doctors must use their own sound judgement in applying various situations based on Good Medical Practice and Professionalism.

Doctors have long been and continue to be advocates for patient safety and this is for them a paramount concern. Covid-19 has demanded of doctors that they undertake difficult discussions with colleagues, patients and their relatives, regarding difficult treatment options that they may be considering. Doctors also have a responsibility to raise awareness around issues such as the lack of PPE availability.

The doctor as a teacher and innovator

For a while during the pandemic a lot of teaching, activities, meetings and conferences were either postponed or cancelled. It is a doctor’s duty and responsibility to keep up to date with their knowledge and to give support to the trainees who are our future clinicians and leaders. The current situation has caused people to find innovative ways to be able to continue with teaching, support and mentoring.

In medicine there is a new normal that may remain with us for a very long time to come. Many General Practitioners (GP’s) and hospital specialists have, over the course of the pandemic, started to use telephone and virtual video consultations. This has been very beneficial - especially to older people who are more at risk to the virus due to their age and possible multi-comorbidities. Older people are more at risk of death from the virus. We know that 70 per cent of excess mortality is in people aged over seventy years.

It is important that the principles of GMP and professionalism are maintained during the course of the pandemic. As lifelong learners and teachers and professionals, doctors as professionals should be able to adapt and move forward in the newer more challenging situations that they find themselves in. If we adhere to and practise the principles of GMP we will be better prepared and hopefully able to cope with the demands that are placed upon them from an ever-changing environment.

The Centre of Excellence in Safety for Older People (CESOP) in association with the British Journal of Hospital Medicine (BJHM) and Eastern Eye are running a series of webinars on Supporting Doctors, Building Resilience and Maintaining Professionalism.

Professor Dame Jane Dacre was the Keynote Speaker for the webinar on September 15, 2020

Professor Singh is a consultant physician in medicine for older people and is chair of the global Centre of Excellence in Safety for Older People (CESOP).

Currently chair GME BME Doctors’ Forum and previously chair Equality & Diversity Committee.

He is also a member of the Honours Committee Health and of the Diversity and Inclusion Committee at the Cabinet Office.