For the last couple of years, I have been interviewing British surgeons about their emotions, professional identities, and working lives. For the last couple of weeks, a new question has been added to the list: how are you feeling about the novel coronavirus pandemic? Many of them answer in ways you might expect any healthcare professional to respond. They’re frustrated about the lack and quality of Personal Protective Equipment, they are anxious about the health of themselves, their colleagues and their loved ones, and they are buoyed by public support and a reinforced sense of community.
However, they also have concerns specific to the surgical profession and for many of the retired practitioners I have interviewed, their feelings are ambivalent.
Many surgeons share the anxieties and grief we all feel. In interviews, they express concern for family members’ safety and sadness for children and other young people not being able to participate in the rites of passage we have all come to expect like finishing exams, celebrating birthdays, and graduating university.
Equally, the crisis has cemented many surgeons’ commitment to the health service and increased their pride in working for the NHS. This is one of the most marked changes between conversations I have had with surgeons before and after the beginning of the covid-19 crisis. Many of the surgeons I interviewed before the pandemic tended towards dissatisfaction with their working lives rather than pride and fulfilment. This crisis has perhaps put practitioners back in touch with their reasons for becoming healthcare professionals.
Some of the conversations I have had with surgeons quickly became political. They criticised the state’s response and for many, this current crisis has reinforced their belief that the current government has long failed to support the NHS. They direct particular attention towards the lack of PPE and the absence of adequate preparation. One surgeon I spoke to had purchased his own PPE complete with respirator because he reckoned his own hospital would be unlikely to provide him with the necessary equipment.
While this surgeon’s anxieties about PPE are likely shared by many healthcare professionals—and many of the practitioners I spoke to acknowledged that the issues they are facing are by no means unique to surgery—surgeons are also exposed to specific risks and must face problems peculiar to the profession. Neurosurgeons I have interviewed all talked about change to operative practice due to covid-19. One said, “I’m not offering pituitary surgery to most of my patients as there is a significant risk to all the theatre staff from performing surgery through the nose.”
Across the country, elective surgery has been cancelled. “Decision making has certainly changed” and operations are limited. Hospitals are also attempting to create more critical care beds and trying to discharge as many people as possible. These changes have prompted a range of emotional responses and for many surgeons expose unresolved and unresolvable tensions. The right decision is not always apparent and surgeons must acclimatize to a new and acute landscape of risk and uncertainty. While many surgeons encounter such quandaries regularly—what counts as elective, what risks are necessary to take, and in what circumstances?—for others, this uncertainty rubs up against some of the fundamental tenets of the surgical identity.
I am a cultural historian writing a book about the recent history of surgical stereotypes, experiences of work, and professional self-image. I have written elsewhere about what surgeons and myself term the “paradigm of sorting out problems” Self-efficacy is a vital component of the mental training necessary for surgical performance. Uncertainty, therefore, fits uneasily into a surgeons’ personal or professional narrative.
For some surgeons, this professional “paradigm” is proving particularly challenging because they feel under-prepared to participate in the NHS’s pandemic response. For those surgeons who have been redeployed to support non-surgical roles—or, in the words of the Royal College of Surgeons of England, “to extend temporarily the scope of their practice beyond the normal range of their expertise”—now is a time of anxiety and frustration.
Retired surgeons returning to work are, of course, worried about their safety—even as they commit fully to this returned role. The emotions of retired surgeons not returning to hospitals are, however, also complex. Some miss clinical practice and wish they could be returning to help in whatever way they can. For others, the pandemic and the NHS’s response has prompted them to reevaluate their careers.
Nostalgia is a regular feature of my interviews with retired and senior surgeons. Many practitioners lament the changing nature of healthcare work. They say that new policies and managerial practices introduced over the last two decades eroded the sense of community and comradery that marked their earlier experiences of surgical training.
While we all might be nostalgic for a time before covid-19, this new pandemic seems to have offered these same retired surgeons an altered perspective on surgical work and on their own careers. One retired urology consultant I spoke to said,
I suspect that when all of this blows over there will be two generations of doctor—those before covid and those post covid—the impact on attitudes towards moral vs contractual duty, sharing and coping with fear uncertainty and regret, and maintaining work life balance, will be enormous and beyond anything that my generation of baby boomers have ever had to face up to. The musings of retired doctors about a relatively trouble free time will become rather superfluous.
While I, as an historian, will never think the musings of retired doctors “superfluous,” he is right to recognise the altered emotional landscape surgeons are now working in and is, I think, right to acknowledge that covid-19 will change many things—not least how healthcare professionals feel about their work, the government, and the NHS. The question is, how will it change those feelings and more importantly, will they be heard?
Agnes Arnold-Forster is a cultural and medical historian. She is a postdoctoral research fellow on the Wellcome Trust Investigator Award, “Surgery & Emotion,” based at the University of Roehampton. Twitter @agnesjuliet
Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: My research is funded by the Wellcome Trust as part of the “Surgery & Emotion” Investigator Award.