COVID-19 Pandemic: Perspective on Medical Professionalism

COVID-19 has disrupted the life of millions with frontline healthcare workers being at the greatest brunt of this pandemic. The second wave of the COVID-19 pandemic has crippled India enormously. It caught the entire country unprepared with daily numbers and deaths soaring record high. In this perilous predicament, doctors and nurses have tried their hardest to deliver the best possible treatment to those affected with the disease. In the absence of any effective medication and a highly infectious behavior of the virus, many health workers got infected and even lost their precious lives. Going by the numbers given by the Indian Medical Association, more than 500 doctors have lost their lives to this deadly virus in the second wave and more than 700 during the first wave.[1] Many doctors and other health professionals have faced mental stress and fear of passing on the disease to family members while going back home from duties. However, this was a testing time for all of us as we were fighting against an unknown enemy while doing the sacred duty in the service of society. Doctors and nurses are frontline warriors in this struggle; hence, some casualties were expected. Our physician friends who lost their lives in this struggle will be remembered for their sacrifices.

This pandemic has taught us many lessons and exposed the weakness of our health system. We not only need adequate infrastructure but also competent professionals. The quality of training and development of specialities is the need of the time. We have very few critical care specialists and infectious disease specialists in the country. Similarly, the number of trained nurses in the ICU care is limited. The medical profession needs serious reforms. The long duration and lack of opportunities for professional growth has seriously affected the attraction to join this profession. Presently, it is no longer the preferred career attraction amongst the bright students. The society cannot afford to have their health care needs in the hands of mediocre students. This pandemic has taught that health profession needs dedicated bright brains with excellent training to handle serious health issues. The importance of having public health specialists to handle such health crisis has been amply realized. Hope, the new NMC addresses these issues to ensure quality training, development of new desired medical disciplines and ensure adequate opportunities. Another lesson we learnt during this pandemic is having adequate resources for providing adequate infrastructure and facilities to health professionals. Problems concerning the (re)allocation of scant medical services are pervasive, with healthcare professionals not only fighting to combat the virus, but also limiting accessibility and the grade of treatment for several other patients, presenting underlying ethical considerations of equality and equity.[2]

Guidance control (capacity to complete a planned activity) and regulatory discretion (capacity to select amongst options) are required to be both professionally liable and ethically right.[2]

Medical professionalism in clinical settings requires communication involving physicians and patients, and this should be a relationship founded on empathy, honesty, and accountability, which has proven to be challenging in this pandemic scenario. Trust is a prerequisite for a positive physician–patient relationship. The patient should have faith in their clinicians that the decision made by them serves their optimal interest.[3] However, to care for others in a sustained manner, health care worker should first care for themselves, which necessitates the use of adequate personal protective equipment (PPE) along with adherence to infection-control policies, even if this defers or decreases contact with patients in the ER. We shall triumph over this generational challenge counting on our medical professionalism if we work united with a shared goal. Physicians have a professional obligation to operate in accordance with the core doctrines of medical professionalism, which include prioritizing patient care, patient autonomy, and social justice.[4] The community and the government have a comparable responsibility to ensure that the infrastructure along with the assistance obtained will permit professionals to carry out their duties as securely as feasible.

Doctors' physical and mental well-being have suffered because of their active involvement. Several recent studies have revealed that frontline medical workers involved in direct care and treatment of COVID-19-infected patients are more susceptible to depression, post-traumatic stress disorder, or other mental health ailments.[5] Due to the scarcity of appropriate protective gear, long working hours, insufficient drugs, distress of catching the illness, and lack of suitable skill have put health caregivers under tremendous physical and emotional stress.[5]

There seems to be an immediate necessity for a system-level approach to address challenges raised by COVID-19 to effectively secure and preserve our medical professionals in the future. Such methods must emphasize organizational culture and employee well-being as essential components of professionalism and patient care. Physician well-being must be recognized as a quality-of-care metric for all health-care systems.[6] Improving physicians' professional environment may enhance health care delivery, enhance patient experience, promote population health, and reduce costs. Alongside ensuring medical professionalism, care and safety of the physician well-being is equally imperative for the system to function optimally.

Publication History

Article published online:
19 November 2021

• References

• 1 Outbreak C. 513 doctors died in second Covid-19 wave, at least 103 in Delhi: IMA. India Today. Accessed June 15, 2021 at: https://www.indiatoday.in/coronavirus-outbreak/story/513-doctors-second-covid-19-wave-103-delhi-deaths-ima-1806960-2021-05-26. Published 2021
• 2 Ćurković M, Košec A, Ćurković D. Medical professionalism in times of COVID-19 pandemic: is economic logic trumping medical ethics?. Intern Emerg Med 2020; 15 (08) 1585-1586
• 3 Harkin D. COVID-19 and medical professionalism in a pandemic. Postgrad Med J 2021; 97 (1143): 53-54
• 4 ABIM Foundation. American Board of Internal Medicine; ACP-ASIM Foundation. American College of Physicians-American Society of Internal Medicine; European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med 2002; 136 (03) 243-246
• 5 Das S, Singh T, Varma R, Arya YK. Death and mourning process in frontline health care professionals and their families during COVID-19. Front Psychiatry 2021; 12: 624428
• 6 Goddard AF, Patel M. The changing face of medical professionalism and the impact of COVID-19. Lancet 2021; 397 (10278): 950-952