“It’s Been Ugly”: A Large-Scale Qualitative Study into the Difficulties Frontline Doctors Faced across Two Waves of the COVID-19 Pandemic

Abstract

This study aimed to gain an uncensored insight into the most difficult aspects of working as a frontline doctor across successive COVID-19 pandemic waves. Data collected by the parent study (CERA) was analysed using conventional content analysis. Participants comprised frontline doctors who worked in emergency, anaesthetic, and intensive care medicine in the UK and Ireland during the COVID-19 pandemic (n = 1379). All seniority levels were represented, 42.8% of the sample were male, and 69.2% were white. Four themes were identified with nine respective categories (in parentheses): (1) I’m not a COVID hero, I’m COVID cannon fodder (exposed and unprotected, “a kick in the teeth”); (2) the relentlessness and pervasiveness of COVID (“no respite”, “shifting sands”); (3) the ugly truths of the frontline (“inhumane” care, complex team dynamics); (4) an overwhelmed system exacerbated by COVID (overstretched and under-resourced, constant changes and uncertainty, the added hinderance of infection control measures). Findings reflect the multifaceted challenges faced after successive pandemic waves; basic wellbeing needs continue to be neglected and the emotional impact is further pronounced. Steps are necessary to mitigate the repeated trauma exposure of frontline doctors as COVID-19 becomes endemic and health services attempt to recover with inevitable long-term sequelae.

‘Running Towards the Bullets’: Moral Injury in Critical Care Nursing in the COVID-19 Pandemic

“…The widespread reports of a lack of PPE in hospitals also played a significant role in engendering a sense of moral injury for the CCNs. It echoes findings from studies on doctors during the pandemic who felt the lack of appropriate equipment left them 'exposed' and was 'a kick in the teeth' (Harris et al, 2021(Harris et al, , p. 1367. CCN3 explained: 'We started to get really upset because … they couldn't get [PPE] fast enough.…”

“…You know, it's not a very satisfying job to just know that you're keeping somebody going and that ultimately, you'll be withdrawing treatment on them in a few days. (CCN47) Many nurses felt that this came at the expense of the patient, leading to situations in which care might be considered inhumane (Harris et al, 2021). CCN39 explains: I think a lot of people that aren't nurses or doctors maybe don't realize there's a huge dignity and a privilege in giving a good death.…”

“…Witnessing suffering during crisis in an organizational setting can be a traumatic experience (Powley, 2009), and we all owe a massive debt to those that, when called to do so, ran ‘towards the bullets’ and risked not only their own lives but their psychological well-being so that those infected with the virus might have a better chance at survival. During this period, the pandemic has put unprecedented strain on healthcare professionals around the globe (WHO, 2020) – in particular, in intensive care units (ICUs), where the very sickest patients were sedated, intubated, and often ventilated as doctors and nurses fought to wrestle each individual from the grip of a deadly virus with a high mortality rate, no known cure, and no known reliable course of treatment (Harris et al, 2021).…”

Super-Spreaders: Shaming Healthcare Professionals

“…As one doctor expressed: 'I'm not a COVID hero, I'm COVID cannon fodder' . 49 Central to these experiences was significant emotional strain, with exhaustion, grief, stress and burnout being commonly reported. 50 Of course, shame was part of this landscape of emotions.…”

Perceived Risk of COVID-19 and Employee Decision-Making: How Psychological Distress during the Pandemic Increases Negative Performance Outcomes among Healthcare Workers

“…The novel coronavirus, also known as COVID-19, is a highly transmittable and pathogenic disease [ 1 ]. It has instigated fear and caused panic all over the globe [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ], negatively affected public health, crippled economies, and transformed social and business environments [ 16 ]. The COVID-19 pandemic, which is regarded as one of the worst pandemics in human history [ 17 ], has also had an unprecedented effect on the living conditions and deaths of human beings.…”