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Mutual Support and Limiting Moral Distress in the Time of C-19

Despite the enormity of pressures on the NHS and its workers – not least of which
has been the nationwide shortage of appropriate PPE – we are encouraged by the
show of mutual support and camaraderie being highlighted among the medical
community and essential non-medical staff, both on- and offline.

Surgeons are demonstrating their dedication and innovation not only through the
work they do in hospitals, but in their ‘off-hours,’ aligning with others in the medical
community to conduct research and share their findings to promote better support
systems for medics worldwide.

One such effort is the fascinating paper Limiting Moral Injury in Healthcare
Professionals During the COVID-19 Pandemic, which was published May 19 th and is
available here (

The work, which was co-authored by surgical trainee Matthew Roycroft; psychiatrist
Daniel Wilkes; GP and occupational health specialist Shriti Pattani; orthopaedic
surgeon Simon Fleming; and medical oncology SpR Anna Olsson-Brown, suggests
that the biggest long-term impact on many doctors on the front lines of the pandemic
may ultimately be derived from what they term ‘moral injury.’

The paper posits that moral injury stems from the moral distress felt when individuals
are prevented from doing what they believe is the right thing, as a result of external
factors (for example, resource availability); and that medics working to provide care
during the pandemic are likely to face such distress as a result of difficult decisions
needing to be made, high mortality rates, the futility of treatment and the myriad
moral/ethical dilemmas posed by the C19 outbreak. The authors cite a ‘crescendo
effect’ in which individuals who face a multitude of moral and ethical dilemmas in
quick succession with no processing time become less able to tolerate additional
moral dilemmas.

Three preventative strategies are outlined by the authors to combat moral injury in
medics, which they identify as key. They propose that complex decisions should be
shared among medics in order to provide enhanced decision-making support; that
the provision of time and space for clinicians to ‘decompress’ is vital; and indicate the
need for consistency in team staffing.

They say that these strategies will foster mutual support, and help to reduce the toll
on medics. Particular emphasis has been placed on the importance of providing
support structures for junior staff, in order to mitigate the emotional and
psychological pressures, and increase resilience.

The paper further states;

“We know that doctors are much better at picking up distress in their
colleagues but not recognizing it in themselves. We therefore expect that
those working within teams that get time to know each other are more likely to
cope with and adjust to the types of ongoing challenging and difficult
decisions that are to come.
Healthcare organizations with their duty to protect the mental health of their
employees should, in our opinion, adopt these strategies with expediency.”

The Confederation of British Surgery applauds the strategies generated by these
authors, which, if adopted, could help to mitigate burnout rates among medics in the
months and years ahead.
As the healthcare service has continued to work steadfastly to deliver essential care
under some of the most challenging conditions the United Kingdom has ever faced,
the CBS continues to recognise the tremendous work being conducted by surgeons,
surgical trainees, the royal colleges of surgery and surgical associations.

We endeavour to share and support the work, and the uniquely challenging
experiences of surgeons, trainees and medical students in the surgical training

pathway as we navigate these unprecedented times; and we value you sharing your
feedback, stories and photographs as we document the work being done to combat

We invite you to follow and engage with us on social media (@UKSurgeons), to tag
us into your posts, and to continue letting us know which issues affecting surgeons
need more attention and support.

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