A survey of Canadian emergency physicians’ experiences and perspectives during the COVID-19 pandemic

Abstract

Background The objective of this study was to explore Canadian emergency physicians' experiences, concerns, and perspectives during the first wave of the coronavirus disease pandemic. Methods This cross-sectional survey of physician members of Pediatric Emergency Research Canada and the Canadian Association of Emergency Physicians explored: personal safety/responsibility to care; patient interactions; ethical issues in pandemic care; institutional dynamics and communication practices. Data analysis was descriptive: categorical data were summarised with frequency distributions, continuous data [100 mm visual analog scales (VAS)] were analysed using measures of central tendency. Short open-ended items were coded to identify frequencies of responses. Results From June 29 to July 29, 2020, 187 respondents (13% response rate) completed the survey: 39% were from Ontario and 20% from Quebec, trained in general (50%) or pediatric (37%) emergency medicine. Respondents reported a high moral obligation to care for patients (97/100, IQR: 85-100, on 100 mm VAS). Fear of contracting COVID-19 changed how 82% of respondents reported interacting with patients, while 97% reported PPE negatively impacted patient care. Despite reporting a high proportion of negative emotions (84%), respondents (59%) were not/slightly concerned about their mental health. Top concerns included a potential second wave, Canada's financial situation, worldwide solidarity, and youth mental health. Facilitators to provide emergency care included: teamwork, leadership, clear communications strategies. Conclusion Canadian emergency physicians felt a strong sense of responsibility to care, while dealing with several ethical dilemmas. Clear communication strategies, measures to ensure safety, and appropriate emergency department setups facilitate pandemic care. Emergency physicians were not concerned about their own mental health, requiring further exploration. Keywords COVID-19 • Emergency medicine • Pediatric emergency medicine • Physician wellness • EthicsRésumé Contexte L'objectif de cette étude était d'explorer les expériences, les préoccupations et les perspectives des médecins urgentistes canadiens pendant la première vague de la pandémie de coronavirus (COVID-19).

Potential Circumstances Associated With Moral Injury and Moral Distress in Healthcare Workers and Public Safety Personnel Across the Globe During COVID-19: A Scoping Review

“…Regional studies replicated these concerns around PPE supply. About 49% of physicians working in the emergency department reported concerns around lack of PPE, with 31% occasionally providing care without appropriate PPE ( 49 ) (Canada). Similarly, nursing home staff have reported insufficient or a complete lack of appropriate PPE for weeks ( 58 ) (Belgium).…”

The responsibility to care: lessons learned from emergency department workers’ perspectives during the first wave of the COVID-19 pandemic in Canada

“…COVID-19-related research has focused on ED physicians’ and nurses’ mental health or burnout [ 7 – 12 ]. ED physicians report a strong moral obligation to care for patients, while dealing with their own fears of contracting COVID-19 [ 13 ]. Understanding ED workers’ concerns and perspectives is fundamental to design supportive, responsive emergency preparedness policies during this ongoing pandemic.…”

Impact of SARS-CoV-2 Virus (COVID-19) Preventative Measures on Communication: A Scoping Review

“…These findings are echoed in survey responses, with participants reporting that masks muffle and attenuate speech, and people with hearing loss reporting more difficulties than those without ( 22 , 33 , 42 , 44 ). However, acoustic and behavioral measures do not capture the psychosocial effects that opaque masks have on communication in terms of limiting ability to recognize emotions from facial expressions, decreasing feelings of engagement in a conversation and emotional connection with the speaker and self-confidence ( 7 , 12 , 14 , 40 , 42 , 59 ), eliciting feelings of loneliness, depression, fear, and anxiety ( 12 , 43 , 44 ).…”

“…Masks have always been a part of medical practice, however, their now ubiquitous use has had broad impacts on communication within the medical context. In addition to detrimental effects on verbal interactions, masks have been reported to affect HCP-HCP and HCP-patient interpersonal relationships, decrease trust and perceived empathy, create fear and anxiety in patient, and reduce HCP's situational awareness-all of which can subsequently affect quality of care ( 24 , 28 , 30 , 31 , 33 , 34 , 36 , 38 ). Indeed, Trecca and colleagues ( 62 ) reported that more patients with hearing loss attributed problems with surgical masks to the inability to lip read than to the speech being muffled, while the study of Kratzke et al ( 36 ) found patients perceived HCPs to be more empathetic and trustworthy than when they are wearing transparent masks rather than opaque masks.…”