Judith Dawson: Healthcare workers during covid-19—Dulce et Decorum est

Problems in the supply of PPE during the covid-19 pandemic are symptomatic of the ongoing neglect of doctors’ wellbeing, argues Judith Dawson

Working as a healthcare professional has long been associated with the risk of exposure to disease and the denial of self. Starting as a new medical house officer in 1989, I had an occupational health medical. The  consultant looked at me seriously and said, “You will always need to be vigilant for signs of tuberculosis as this hospital serves a high incidence population.”

Later in my career, I was suspended from doing invasive procedures for four weeks as I showed no response to hepatitis B vaccination and was suspected of being a carrier, perhaps even infected, while working on the paediatric liver unit.

A working week of more than 100 hours has led to junior doctors being trained to deny their own physical needs and ignore the warning signs of illness. One of the doctors in my graduating year cohort developed sleep deprivation epilepsy after working a one in two rota. Colleagues fell asleep at the wheel driving home after weekends on call. More recently, we have experienced the hypocrisy of an approach that advises the general public to lose weight, exercise, and reduce stress, while driving the medical workforce to work longer hours in unhealthy environments with poor nutrition and rest facilities. How is it possible to be so inhumane as to devise on call rota arrangements that deny individuals the right to arrange time off for family funerals or weddings?

The incoherent and dishonest approach we’ve seen to the provision of personal protective equipment (PPE) during this pandemic is the culmination of years of downgrading the medical profession and sublimating it to centrally driven target delivery at all costs.

Luckily, in our practice at the start of the covid-19 pandemic, we were given an early insight into the realities of what was coming as one of the partners graduated from Milan and was in touch with many doctors experiencing the working conditions there. Our stocks of PPE were derived from all the local DIY shops and we had coveralls, goggles, and face visors weeks before the official deliveries came through. We watched in dismay the delays in provision from central resourcing and the continued refusal to agree that CPR is an aerosol generating procedure.

There is a real risk in mythologising and glorifying frontline healthcare workers who adopt a sacrificial approach, as it fails to acknowledge that there was originally an alternative to the sacrifice. My great grandfather was in the Royal Army Medical Corps in 1914-1918. He returned home to his practice in London, one of the lucky ones, only to then succumb to influenza in the 1918 pandemic. His patients, including civilians living in Ypres who he had treated during the war, contributed to a memorial statue to his care and compassion. Our current workforce, however, deserve a policy change and not a static cenotaph. Cleaners, porters, administrative staff, and clinicians work for the health of the nation and the nation should repay them all in kind.

Judith Dawson is a salaried GP in Northamptonshire, UK. 

Competing interests: none.