Research reveals 'ugly truth' faced by doctors responding to COVID-19 on the frontline
13 December 2021
Frontline healthcare workers say they are angry at being treated as 'COVID cannon fodder, not COVID heroes' after responding to the virus for nearly two years and working at full capacity, reveal the findings of new research.
'It's been ugly': A large-scale qualitative study into the difficulties frontline doctors faced across two waves of the COVID-19 pandemic' is the first study of its kind to capture the views of over 1,300 doctors in the UK and Ireland responding to COVID-19 since early 2020.
Authored by researchers from the universities of Bath, Bristol, UWE Bristol, and the Royal College of Emergency Medicine and published today [13 December] in the International Journal of Environmental Research and Public Health, the study paints a bleak picture of the multiple challenges doctors are facing.
These highlight dual issues of a worrying lack of support for doctors’ basic needs (e.g., insufficient places to rest, food to eat, and relentless shift patterns), and a significant lack of appropriate psychological support to help them decompress.
Despite working at '100% capacity, 100% of the time', the frontline healthcare workers told researchers of their frustrations at those not following public health advice, and towards Government for ‘failing in so many ways to support us.’ Doctors said they felt ‘expendable’ and left traumatised by events – expressed by one person as 'I'm not a COVID hero, I'm COVID cannon fodder.'
Participants recruited for the study comprised frontline doctors who worked in emergency medicine, anaesthetics, and intensive care medicine in all parts of the UK and Ireland. All genders, ethnicity and seniority levels were represented in the sample of 1,379 participants who responded to a longitudinal survey asking them to answer freely: 'What has been most difficult about the pandemic?'
Analysis from the research group identifies four themes expressed by frontline workers responding to COVID-19: (1) that doctors feel exposed and unprotected; (2) the relentlessness and pervasiveness of COVID-19 (‘no respite’, ‘shifting sands’); (3) The ugly truth of the frontline, including 'inhumane care'; and (4) an overwhelmed system (overstretched and under-resourced with constant changes and uncertainty).
Dr Jo Daniels, lead researcher and clinical psychologist at the University of Bath, explained: "Some of the stories frontline workers told us about for this research are truly devastating: last moments spent trying to set up an iPad in time for a young mother to say goodbye to her children; wrestling to intubate agitated patients; family members watching loved ones die remotely via video link.
"Added to this is the scale – the sheer number of frontline workers for whom these experiences have just become normalised – these results are truly shocking. We are seeing increasing levels of staff attrition, absenteeism, poor psychological health, and loss of life, yet frontline doctors are expected to just carry on.
"Despite the popular media narrative of healthcare workers being our COVID-19 heroes, many simply do not feel that way in terms of how they are being supported."
These findings build on recent work from the same team, including the CERA study, which sought to quantify psychological distress experienced by emergency doctors during COVID-19, and the COVID-19 Clinician Cohort (CoCCo) study model, which highlighted a hierarchy of needs for frontline workers responding to the pandemic. These ranged from supporting workers’ basic needs with hot food and drinks, through to embedded peer support, psychological care, and interventions. The team say it is imperative policymakers learn lessons from this study as they respond to the impact from the latest Omicron variant.
Dr Daniels continued: "COVID-19 shone a spotlight on problems that already existed: doctors are overworked, and the capacity of the NHS is at breaking point. A multipronged approach is now essential to ensure that working conditions are conducive to effective practice; pathways to psychological support are coherent and well resourced; and that effective leadership does not disperse in high pressure environments.
"We're calling to action Royal Colleges and policymakers to join together to address these issues instead of attributing culpability and waiting for others to act. The consequences of this pandemic will cast long shadows, and it is our collective responsibility to repair and prevent further damage."
Dr Edd Carlton, Consultant Senior Lecturer in Emergency Medicine at Bristol Medical School: Translational Health Sciences and Professor of the Royal College of Emergency Medicine, added: "This work demonstrates the massive impact the pandemic has had on our frontline medical workforce in terms of working conditions, morale and psychological distress.
"What is most worrying is that COVID-19 has compounded issues that were already commonplace pre-pandemic and now are putting a tangible strain on doctors’ own physical and mental health. As the NHS attempts to recover, this research shows that there needs to be a renewed focus on properly supporting doctors to protect their health and wellbeing so that they can be there for all of us when we most need them."
The study was led by Sophie Harris and Jo Daniels at the University of Bath, with Elizabeth Jenkinson (UWE Bristol), Edward Carlton (University of Bristol / Royal College of Emergency Medicine) and Tom Roberts (North Bristol NHS Trust / Royal College of Emergency Medicine).
'"It's been ugly": a large-scale qualitative study into the difficulties frontline doctors faced across two waves of the COVID-19 pandemic' by Sophie Harris, Jo Daniels et al in International Journal of Environmental Research and Public Health [open access]