Surviving COVID 19 as gastroenterologists
July 13, 2020 | Neel Sharma, Sara Mahgoub, Ismaeel Al Talib and Jason Goh
The global pandemic that is COVID 19 has meant that gastroenterologists are now being asked to move from their traditional roles as IBDologists, hepatologists or endoscopists to cover frontline services in the hope to help prevent further lives being lost. However, with this new expectation there is also fear and concern about how well we as a specialty will be able to deliver during these uncertain times.
Neel Sharma, Sara Mahgoub, Ismaeel Al Talib and Jason Goh from the Department of Gastroenterology, Queen Elizabeth Hospital, Birmingham, UK provide some useful real life tips for gastroenterologists globally as they all unite during this pandemic.
- Make sure you are fully in tune with your hospital’s protocols – this pandemic has meant we have to truly understand the treatment of confirmed cases and when it is right to escalate a patient or not. This in itself is a daunting task. As juniors, realise you are not alone in this. You will have your senior colleagues to help you when unsure. Decisions regarding ceiling of care are never easy in any case but the uncertainty surrounding which patients will benefit from being ventilated makes this even more complicated. Ask for help.
- Ensure you are donning PPE correctly. Health care systems globally are battling with a lack of PPE. Whilst we recognize that this remains an issue there will be no glory in treating COVID patients while endangering your own health, and risking becoming a carrier.
- Look after your mental well-being. You will worry about your patients, your family and your friends. You will feel lost at times and it can be difficult to admit that the pressure of the pandemic is taking a toll on your mental health. There is nothing shameful in admitting you may be suffering. Sure we are doctors but we are not made of steel!
- Think carefully about attending endoscopy. The current pandemic could serve to increase concerns around safe practice for juniors. For more senior trainees, continuing on with endoscopy may be reasonable, but junior trainees should not feel compelled to train at this time of uncertainty. An emergency GI bleed in a confirmed COVID 19 patient could be a double battle of feeling confident to cease the bleed as well as feeling safe in relation to the risk of virus exposure.
- The COVID 19 crisis has brought about unthinkable changes to the way we work in Medicine. It is helpful to shift, fundamentally and temporarily, one’s mindset from being a super specialist (or trainee) to being a generalist first and foremost. GI trainees are often highly experienced in acute and general medicine and could potentially best serve the nation by being deployed in acute medical units. Locally, trainees may even be upskilled to work in hot areas such as intensive care units, palliative care medicine or pop up field hospitals. Flexing oneself to work outside one’s comfort zone is required of all doctors during such trying times.
- There has never been a more important time to bolster team-working. If you are still working within a GI team, start the day with a team brief so that the tasks of the day ahead are clearly outlined and labour is fairly divided. Seniors should protect juniors from high risk aerosol generating endoscopic procedures. Depending on your seniority and experience, your role within the GI team will be tailor-made to suit the needs of the service. End each working day with a proper debrief.
Remember your seniors will share all of the high degree of anxieties you are experiencing. You will have to muster all your emotional strength and resilience throughout this crisis, support each other mentally and physically. Many hospitals will have reconfigured rotas to ensure there are enough ‘off days’ for you to recover mentally and physically. It is human to recognize the extraordinary stress working as a doctor in the time of this pandemic- anxiety about personal health and safety, working very differently and outside one’s comfort zone, upset about patients and deaths. It is also human to seek help if you are not coping well and colleagues should be in a position to offer you support. Above all, we ought to take great pride in playing our personal and collective part in this global effort to fight the pandemic.