Covid and challenges to good medical practice

By Professor Iqbal Singh OBE

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 that Covid-19 has had on BAME communities.

For medical profes­sionals treating patients during this period, it has, at times, been 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. They have had 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.

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 take on sev­eral roles include as a healer; partner and team worker; manager and leader; advocate; learner and teacher; and innovator

The doctor as a healer: In treating patients, doctors have operated in an environment that has seen the emergence of a new disease for which we have limited knowledge and are de­veloping an evidence base. They 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. In some areas, they have had to cope with a large num­ber of Covid-19 deaths. Some have sadly involved their 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 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 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 of the virus. Many were not only developing these risk assessment tools, but were also imple­menting them in their own practice. Doctors have had to use their own sound judgement in applying various situ­ations based on good medical practice (GMP) 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 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 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 GPs and hospital specialists have, over the course of the pan­demic, started to use the telephone and vir­tual video consultations. This has been 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 among people aged over 70.

It is important that the principles of GMP and professionalism are maintained during the course of the pandemic. As lifelong learners, teachers and professionals, doctors should be able to adapt and move for­ward in the newer, more challenging, situations that they find them­selves in. If they adhere to and practise the prin­ciples of GMP, they will be better prepared and hopefully better 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 and Eastern Eye are running webinars on ‘supporting doctors, building resilience and maintaining profession­alism’. Professor Dame Jane Dacre was the key­note speaker for the September 15 event.

Professor Iqbal Singh OBE is a consultant physician in medicine for older people and chair of CESOP. He is currently chair of the GME BME Doctors’ Fo­rum and previously chair of the Equality & Diversity Committee. He is also a member of the Health Honours Committee as well as the Diversity and Inclu­sion Committee at the Cabinet Office.