Changing self-concept in the time of COVID-19: a close look at physician reflections on social media

Abstract

Background The COVID-19 pandemic has changed the healthcare landscape drastically. Stricken by sharp surges in morbidity and mortality with resource and manpower shortages confounding their efforts, the medical community has witnessed high rates of burnout and post-traumatic stress amongst themselves. Whilst the prevailing literature has offered glimpses into their professional war, no review thus far has collated the deeply personal reflections of physicians and ascertained how their self-concept, self-esteem and perceived self-worth has altered during this crisis. Without adequate intervention, this may have profound effects on their mental and physical health, personal relationships and professional efficacy. Methods With mentions of the coronavirus pervading social media by the millions, this paper set out to collate and thematically analyse social media posts containing first-person physician reflections on how COVID-19 affected their lives and their coping mechanisms. A consistent search strategy was employed and a PRISMA flowchart was used to map out the inclusion/exclusion criteria. Results A total of 590 social media posts were screened, 511 evaluated, and 108 included for analysis. Salient themes identified include Disruptions to Personal Psycho-Emotional State, Disruptions to Professional Care Delivery, Concern for Family, Response from Institution, Response from Society and Coping Mechanisms. Conclusion It is evident that the distress experienced by physicians during this time has been manifold, multi-faceted and dominantly negative. Self-concepts were distorted with weakened self-esteem and perceived self-worth observed. The Ring Theory of Personhood (RToP) was adopted to explain COVID-19’s impact on physician personhood as it considers existential, individual, relational and social concepts of the self. These entwined self-concepts serve as ‘compensatory’ to one another, with coping mechanisms buffering and fortifying the physician’s overall personhood. With healthcare institutions playing a vital role in providing timely and targeted support, it was further proposed that a comprehensive assessment tool based on the RToP could be developed to detect at-risk physicians and evaluate the presence and effectiveness of established support structures.

Systematic scoping review on moral distress among physicians

“…Care and resource limitations and concerns over compromised patient care amidst the COVID-19 pandemic have fanned reports of moral distress (MD) among healthcare professionals (HCPs) in medicine, pharmacy, allied health, psychology and social work. [1][2][3][4][5][6][7][8][9][10][11] However, while this increase in reports of MD is unsurprising, the diverse nature of accounts of MD among HCPs suggests that concerns extend beyond Jameton's original notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. [6][7][8][9][10][11] With data suggesting that concepts of MD may also differ between HCPs by virtue of their practice and settings, we focus on the study of MD as conceived by physicians.…”

A systematic scoping review on patients’ perceptions of dignity

“…This especially evident in the differences in the role of relational ties and influences on autonomy in Western and Asian data [ 6 , 10 ]. Data from China and Japan suggests the influence of relational autonomy, which prioritises familial interests, over individual interests within concepts of personhood and dignity [ 13 , 16 , 45 ].…”

“…Positing that current concepts of dignity are informed by self-concepts of personhood or "what makes you, you", we adopt Krishna [12] 's concept of the Ring Theory of Personhood (RToP) to evaluate current ideas on dignity [13][14][15]. Shown to capture individualised notions of identity, self-worth and respect [16][17][18][19][20][21] that are intimately associated with current ideas of dignity the RToP provides a robust and evidence-based lens to appraise current this individualised and changing concept (Fig. 1).…”

“…The RToP offers both a reflexive, longitudinal, holistic and evidence-based approach to capture evolving concepts of dignity [12,[32][33][34][35][36][37][38][39]. Using the lens of the RToP it is possible to understand how the Individual Ring and its associated concept of Individual Identity balance sometimes competing preferences, biases, beliefs, mores, norms, values and principles, in a variety of psycho-emotional, experiential, perceptual, and contextual considerations; and prevailing professional, sociocultural, legal, ethical, and personal considerations [16,17,[40][41][42][43][44].…”

Mentoring future mentors in undergraduate medical education

“…A shortage of experienced clinical mentors [1], changing mentoring and clinical practice, and shifting expectations upon mentees, mentors and mentoring relationships particularly during the COVID-19 pandemic [2][3][4][5] has seen mentoring programs struggle [6]. Traditional concepts of dyadic relationships between an experienced and trained physician and a medical student or junior doctor have come under scrutiny over their ability to contend with raising concerns over gaps in structure [7,8], assessment and oversight [9] of mentoring relationships and the mentoring environment [10,11].…”