key: cord-1033999-7w3dpelw authors: Mohindra, Ritin; Goyal, Manoj; Suri, Vikas; Bhalla, Ashish; Singh, Shubh Mohan title: Can being a ‘frontline doctor’ in the COVID-19 pandemic be a positive experience? date: 2021-07-13 journal: Asian J Psychiatr DOI: 10.1016/j.ajp.2021.102769 sha: e818871f0aed711c7630c63ae535803d2fc163e1 doc_id: 1033999 cord_uid: 7w3dpelw nan Various studies from India and other parts of the world have pointed out the high prevalence of psychological distress and morbidity among healthcare workers (HCW) and doctors, especially those involved in 'frontline' COVID-19 healthcare (Fiest et al., 2021; Parthasarathy et al., 2021; Usukura et al., 2021) . Indeed, our experience during the initial phase of the pandemic suggested that doctors and other HCW in our hospital were subjected to significant stigma and abuse, and were also experiencing mental health distress and emotional turmoil associated with health care roles (Mohindra et al., 2021 (Mohindra et al., , 2020 . This was however not confined to those in frontline areas but was rather more generalised among all categories of HCW. Psychological distress among HCW was also observed to be related to work environment related factors such as discomfort related to use of personal protective equipment, staff shortages etc. (Windarwati et al., 2021) . The authors observed that in the preceding year, contrary to expectations, the utilisation of mental health care services available for doctors (and other staff) was much less than expected. Similar findings have been reported in HCW elsewhere (Muller et al., 2020) . While there may be various reasons for this finding such as barriers to health care seeking or organisational reasons, it is also possible that doctors might have actually experienced less emotional problems and may have been able to cope better than might have been expected. The 'second wave' of the COVID-19 pandemic in India almost 12 months after the initial lockdown provided an opportunity to assess the emotional state of doctors involved in frontline roles in a tertiary hospital in North India (Lancet, 2021) . We also tried to find out the possible structural reasons associated with the same. One of the authors conducted interviews with doctors involved in intensive care and non-intensive care roles in the COVID hospital attached to a tertiary teaching hospital in North India. The interviews were conducted to explore the cross-sectional emotional state of the doctors, and possible factors attributed to that state by the respondents. Cross-sectional emotional state: Most doctors said that they were not as distressed or emotionally affected as they were during the beginning of the pandemic. In fact many doctors considered their predominant emotional state over the preceding few months as 'positive'. This was notwithstanding the usual variations in emotional states as routinely experienced and attributed to routine work and organisationrelated stresses. The reasons for this apparent incongruence between expectation and reality was explored. The various reasons attributed by the respondents are as follows. Familiarity with the disease: The initial part of the pandemic was characterised by misinformation and a fear of the unknown, many doctors were concerned about getting ill or passing on the infection to family members. The experience of the previous year had been a source of reassurance to the doctors. This was because most doctors (usually young and otherwise healthy) had asymptomatic or mildly symptomatic disease. There was a low rate of hospital acquired infections (as compared to community acquired infections) and it was observed that stringent and uncomfortable personal protective equipment requirements were not needed to prevent infections in non-aerosol generating areas. Masking and handwashing were usually effective in prevention of infection. Work related: In addition, many doctors experienced an enhanced sense of meaningfulness of work, felt valued and had increased selfesteem. Many doctors who were stuck in organisational roles that were not to their liking used the pandemic as an opportunity to 'rehabilitate' themselves into more meaningful work. Assurance of medical care: Working in a hospital meant that vaccines, quality healthcare was available and at hand for doctors and family members. Prevention of overwhelmed health care services: The hospital is relatively well-funded, is situated in a city with other tertiary hospitals and in a city with low population. Also, with an increase in number of patients other areas of the hospital were diverted to COVID care and the number of patients in the COVID hospital never became unmanageable as in other regions of the country. Change in organisational structures: many doctors found that modifications made in the COVID scenario made decision making hierarchies much more democratic, even junior members felt valued, independent and less intimidated than in usual circumstances. Many doctors also spoke of better teamwork and bonding with peers as compared to earlier. Respite: Doctors in frontline healthcare roles were usually posted in shifts for a period of a week or so. Unlike earlier, they could go back to their homes and families without the fear of carrying infection with them and did not require mandatory quarantine. Unlike earlier, doctors were treated with respect and as valuable members of society. This led to enhanced self-esteem. The caveats to the above findings is that this may not be true for all classes of employees. More detailed and intensive assessments may reveal hitherto unseen psychopathology. It is also possible that the mental health impact is not immediate and will be seen in the long term. It is also obvious that these findings may not be valid across other, lessadvantaged health-care settings. It is probable that given a favourable environment, doctors in frontline roles may find the COVID-19 experience a positive one. Psychological distress in this population may be related more to individual psycho-social and personality factors rather than a stressor such as COVID-19. The COVID-19 pandemic underlines the fact that even when faced with a common challenge, different countries and classes of populations face distinct challenges and react differently and sometimes unexpectedly (Tandon, 2021a (Tandon, , 2021b . None. The authors report no declarations of interest. Experiences and management of physician psychological symptoms during infectious disease outbreaks: a rapid review India's COVID-19 emergency Issues relevant to mental health promotion in frontline health care providers managing quarantined/isolated COVID19 patients The experience of social and emotional distancing among health care providers in the context of COVID-19: a study from North India The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: a rapid systematic review Mental health issues among health care workers during the COVID-19 pandemic -A study from India The bitter lessons of COVID-19: acknowledging and working through many points of tension COVID-19 and suicide: just the facts. Key learnings and guidance for action The mental health problems of public health center staff during the COVID-19 pandemic in Japan Stressor, coping mechanism, and motivation among health care workers in dealing with stress due to the COVID-19 pandemic in Indonesia None.