Impact of COVID-19 on experiences of BAME doctors and future steps:

Zurafa Sakel • May 6, 2022

Silence in the presence of oppression is a gateway to complicity.

It is not an unknown fact that we have an unequal NHS. However, what is often denied, is the fact that this unequal culture significantly disadvantages BAME health care professionals.(1). COVID-19 has disproportionately impacted BAME communities via a combination of racial, discriminatory, and socioeconomic inequalities (2)

It is perhaps not a surprise that the impact of the crisis has significantly affected those already facing discrimination. These double jeopardy scenarios are not uncommon. Throughout the pandemic BAME doctors have reported that they felt additional pressures and that they were put at a greater risk due to inadequate PPE and were deployed to work frontline on the COVID wards within the workplace (3,4). In April 2020 the BMA called for an inquiry into the impacts on the BAME communities as they were found to be at higher risk of acquiring the infection (5).

A survey of health care workers undertaken by Mr Aftab on their views of racism within the workplace highlighted the continuing lack of risk assessments and protection for BAME health care professionals (6). It also demonstrated the prevalence of both outward racial attacks as well as microaggressions. Microaggressions are defined as “common and daily verbal/ behavioural indignities that communicate hostile or derogatory racial insults towards people of colour” (7). They often stem from unconscious and implicit bias and are not intended to be offensive (8). The unintended consequences make it difficult to fully comprehend the impacts; this does not negate its importance. Accordingly, institutions need to be deliberate and inclusive and acknowledge that racism, not race, is the driver of health inequalities (2).

The extent to which an organisation values its minority staff is a good barometer of how well patients are likely to feel cared for (2). Having a motivated, involved, and valued workforce benefits patient safety and provides high quality patient care with increased patient satisfaction.

The Workforce Race Quality Standard (WRES) was implemented in 2016, and functions to break down structural barriers regarding race equality9. Going forwards, equality, diversity and inclusion measures could be used as key performance indicators and should be core to appraisal.

What can be done?

There is a need to move beyond rhetoric and token gestures and address the structural root causes. It is not enough to just “not be racist”. Rather, it is imperative that we move towards anti-racist environments. Participation is required at all levels of decision making, with economic support and explicit goals put in place2. Those in positions of power need to be allies and take accountability. Real change requires radical and transformational actions.

Open and perhaps uncomfortable discussions surrounding racism and its impacts on health disparities are essential social movement approaches (8). These are needed to motivate change and make commitments to inspire progress. The persistence of racial inequalities could in part be accredited to the lack of political will in addressing the subconscious bias. Nevertheless, all medical professionals need to take an active role to challenge inequalities (10).

Negative perceptions and stigma often based on historical injustice need to be challenged. A key issue in this pandemic is tackling vaccine hesitancy. This requires BAME doctors’ active involvement to reduce suspicion from BAME communities towards authorities. There are perceptions that inappropriate behaviours by these communities could be increasing their risk of contracting the virus in the first place. Research studies should explore evidence to substantiate or refute that (11,12).

The professional identity of a doctor is not just clinical but psychosocial- this extends to colleagues as well as patients. Frontline clinicians and the wider community need to unite around a shared purpose- vanquishing the blight of inequality within our healthcare systems.


Acknowledgement and References:

Many thanks to Dr Mohamed Sakel for inviting me to attend the cross-specialty research team live event (5th March 2021) on “Evolving trends in vulnerabilities and impact during COVID-19”.

  1. Nagpaul, D. (CBE). Experiences of BAME doctors in NHS prior to and during the pandemic. Presentation presented at; 2021; Webex.

  2. Rao, M (OBE). Evolving knowledge of vulnerabilities and unequal impacts during COVID-19. Presentation presented at; 2021; Webex.

  3. Cooper K. BAME doctors hit worse by lack of PPE [Internet]. The British Medical Association is the trade union and professional body for doctors in the UK. 2021 [cited 6 March 2021]. Available from: https://www.bma.org.uk/news-and-opinion/bame-doctors-hit-worse-by-lack-of-pp e

  4. Rimmer A. Covid-19: Disproportionate impact on ethnic minority healthcare workers will be explored by government. BMJ [Internet]. 2020 [cited 5 March 2021];369:m1562. Available from: https://www.bmj.com/content/369/bmj.m1562.short

  5. COVID-19: the risk to BAME doctors [Internet]. The British Medical Association. 2021 [cited 5 March 2021]. Available from:

  6. https://www.bma.org.uk/advice-and-support/covid-19/your-health/covid-19-the-risk-to-bame-docto rs

  7. Aftab,S. Survey of health care workers about risk assessment, PPE + perception and views about racism at their place of work. Presentation presented at; 2021; Webex.

  8. Sue DW, Capodilupo CM, Torino GC, et al. Racial microaggressions in everyday life: implications for clinical practice. Am Psychol. 2007;62(4):271–289 https://doi.org/10.1037/0003-066x.62.4.27

  9. Acholonu R, Cook T, Roswell R, Greene R. Interrupting Microaggressions in Health Care Settings: A Guide for Teaching Medical Students. MedEdPORTAL [Internet]. 2020 [cited 5 March 2021];16(1):10969. Available from: https://www.mededportal.org/doi/full/10.15766/mep_2374-8265.10969?utm_campaign=mededportal&utm_medium=email&utm_content=newsletter&utm_source=sfmc

  10. England N. NHS England » NHS Workforce Race Equality Standard [Internet]. England.nhs.uk. 2021 [cited 5 March 2021]. Available from: https://www.england.nhs.uk/about/equality/equality-hub/equality-standard s

  11. Hockey D, Omar S, Gavin M, Power R. Health inequalities: what can health care professionals do?. Presentation presented at; 2020; Zoom.

  12. Hossain MA, Jahid MIK, Hossain KMA, Walton LM, Uddin Z, Haque MO, Kabir MF, Arafat SMY, Sakel M, Faruqui R, Hossain Z. Knowledge, attitudes, and fear of COVID-19 during the Rapid Rise Period in Bangladesh. PLoS One. 2020 Sep 24;15(9):e0239646. doi: 10.1371/journal.pone.0239646. PMID: 32970769; PMCID: PMC7514023.

  13. Knowledge, Attitudes and Behaviours towards COVID-19 amongst Kent BAME residents during the UK COVID-19 pandemic, a qualitative study. University of Kent. Principal Investigator: Dr Mohamed Sakel

In Conversation with: Dr Patrice Baptiste

By Dr Patrice Baptiste. Edited by Omolara Akinnawonu • January 7, 2021
1) Introduction: About yourself and the career speciality you are in now? I am a portfolio GP, medical educator, entrepreneur, writer, author, visionary and champion for diversity within the medical profession. As a portfolio GP, I spend the majority of my time in clinical practice with the remainder of her time divided between a number of other careers and interests. As a medical school examiner at Queen Mary University London I examine students during their practical or Objective Structured Clinical Examinations (OSCEs). I also works for the General Medical Council (GMC) examining doctors who have qualified abroad and wish to practice in the UK through my role as a PLAB (Professional and Linguistic Assessments Board) examiner. Through my company, DreamSmartTutors, which launched during 2016, ( www.dreamsmarttutors.co.uk ) I support prospective medical students on their medical journeys whilst simultaneously aiming to increase diversity within the medical profession. As a STEM ambassador, I also aim to encourage school students to pursue Science, Technology, Engineering and Mathematics (STEM) subjects. I am also a keynote speaker, having delivered a number of talks at places such as Oxford university, The British Medical Journal (BMJ) Live Careers fair and The Royal College of Physicians Edinburgh. As a freelance writer I have written for the British Medical Association (BMA), the BMJ, the Medical Protection Society (MPS) and the Support for Doctors Network to name but a few. I regularly contribute to GP online ( www.gponline.com ) discussing important topics pertaining to General Practice and have published a short guide for those looking to understand a medical career in addition to this first of four poetry books. These can be found in the 'Publications' section on her profile below. 2) What is the most rewarding/most challenging aspect of your job? I enjoy being able to establish and maintain a long term doctor patient relationship with my patients. This is very difficult to do when working in the hospital. I am also able to follow patients up and provide continuity of care. This enables me to provide a high standard of care for my patients. 3) What can medical students/ aspiring students do now to get to where you are now? Everyone has a different path and therefore my advice would be to get to know yourself, your personality, what you enjoy and don't enjoy. This will enable you to create a unique career path that you are happy with. 4) What advice would you give your younger self ? Don't worry so much. Often the things I worried about during my journey to becoming a doctor were so unimportant looking back and I can barely remember what the worries were about! If you find you are a worrier then ask yourself, whatever you are worrying about in the grand scheme of things does it really matter and will it matter/will you remember it in 5-10 years? If the answer is no, then try not to worry so much! 5) What inspires and motivates you to do the work you do? I have always been an ambitious and highly motivated person. I enjoy learning new things and developing as a person.

Maintaining faith in medicine

By Ellen Nelson Rowe. Editied by Omolara Akinnawonu • December 7, 2020
In a world where there are prevalent medical ethics, such as recently stances on physician-assisted dying, views on abortions, gender and much more, I believe that maintaining faith has been so important to face these challenges and approach them with Godly wisdom. Faith for me has also been my first comfort in the stresses of medicine - the huge workload, the long working hours, the emotional labour. Making faith a priority can definitely be a challenge and my aim is to share some principles that I have found useful in managing this!

Still we rise.

By Toyosi Omotoso. Edited by Omolara Akinnawonu • October 25, 2020
Growing up black comes with so much hardship, however, when faced with adversity, we are still able to rise and accomplish extraordinary things. With the resurgence of the BLM campaign alongside the protests happening in Africa, Black History Month is especially important this year, despite it being difficult to celebrate our success whilst enduring hardship. Africa is such a powerful continent with rich culture and resources and has so much to offer, but neo-colonialism and poor leadership have prevented it from its potential. In Nigeria, there are END SARS protests against brutality and oppression by the police. SARS Special Anti-Robbery Squad was created in the early ’90s to protect its people, yet over the years instead of protecting its citizens they have abused their position of power and murdered and tortured their people instead. People deserve to be able to live in peace and not live in constant fear. In Namibia, there are protests against sexual and gender-based violence and there's currently a holocaust going on in Congo. Ghana and the Ivory coast children are being trafficked, in Cameroon, there is the anglophone crisis and in South Africa, there is a rise in femicide. During the Black Lives Matter movement earlier on this year, we stood as one and our voices were being heard. We need to continue to use our voices and spread awareness for there to be change because all black matters matter everywhere. These are devastating times and it can be so heart-breaking and overwhelming especially having to face it daily, the weight of this can be unbearable but it needs to be acknowledged. We cannot live fulfilling lives without overcoming the hurt and the anger. Adversity as a black woman is nothing new; our hair, character and sexuality are constantly scrutinised but when it comes to our safety and the way we are treated people are not concerned in the slightest. This is deeply rooted in racism which is so covert nowadays we tend to ignore it and continue to carry the burden, but as Malcolm X said ‘The most disrespected person in America is the black woman. The most unprotected person in America is the black woman. The most neglected person in America is the black woman.’ Our pain and struggles continue to be overlooked and this is very much evident with the death of Breonna Taylor. Emphasising once again that every aspect of society is a reminder that racism and discrimination is very much alive, and it is going to take a collective effort to rid ourselves of centuries of hatred and prejudice. Her murder along with the countless innocent lives ruthlessly killed has once again shown us that black lives and especially black women are disposable, and we are invaluable and the very people that were put in place to protect her, are the ones who caused the most harm. Even in Nigeria the government, most importantly President Buhari has a duty to its people and to do right by them but rather than obliging the basic cry for help from the youth of their country they are governed by greed and corruption. Black Pound Day (BPD) founded by Swiss; a member of So Solid Crew, started for the first time at the end of June and allows us to celebrate black-owned businesses and help circulate more money within our own economy, which in turn helps us to give back to our community. Maya Angelou said, ‘You may shoot me with your words, you may cut me with your eyes, you may kill me with your hatefulness, but still, like air, I’ll rise.’ BPD helps showcase smaller businesses and gives us a way of celebrating our culture and success. GUAP media company has shown a new and innovative approach of displaying and promoting diverse individuals within the creative industry. Their magazine the Renaissance issue this year featured a prominent figure in the UK creative industry Nella Rose on the cover, which captured not only her beauty and showcased her talent and culture but highlighted the importance and influence she has within the community and despite the injustices we face we are still able to flourish. Sharon Chuter of Uoma Cosmetics came out with a Pull Up for Change initiative, which helps give economic opportunities to black people. The aim of her campaign is to hold brands and companies more accountable. It asks the ones who came out in support of the Black Lives Matter movement to release the number of black employees in the organisation especially in executive and senior roles. Many companies showed solidarity and support publicly, but it is important to see what companies are doing behind closed doors and what they are going to do to improve. This month is all about highlighting our success and educating ourselves and others as well as learning from these experiences. We still must be able to celebrate ourselves as a community and be able to uplift ourselves whilst recognising our struggles. We can celebrate ourselves by not being ashamed of our culture and truly embrace it particularly when it comes to food, clothes and our hair and normalising sharing our culture to our friends of different ethnicities. By Toyosi Omotoso University of Ostrava

Why is Black History Month important?

By By Nana Asafu-Adjaye. Edited by Omolara Akinnawonu • October 15, 2020
“Why do we still need Black History Month (BHM)?” “It disregards other POC communities” “It’s way better than it used to be” “We don’t have a White History Month!” Sound familiar? Perhaps there is an element of truth to these statements. A truth that believes that things are actually getting better, that the black struggle isn’t “as bad” anymore or that we are creating our own division by only showcasing our success and not everybody else’s. But who is this rhetoric true for? As a young black woman, I take pride in celebrating BHM. I believe the foundations of our past must be brought to light, to not only black people but the world. The unfortunate reality is that we live in a world where those that have suffered at the hands of societal norms are not seen the same as their counterparts.

Malone Mukwende - Failing to start: Why we accept mediocrity and how to change! 

By Malone Mukwende. Edited by Omolara Akinnawonu • October 12, 2020
Hi, my name is Malone and I'm a third year medical student at St Georges University of London. I am one of the Co-authors of mind the gap which is a clinical Handbook of signs and symptoms in black and Brown skin. The summer has been quite hectic since I posted the work of Mind the gap on my Twitter page on the 18th of June 2020 as ‘Mind the Gap’ has been viewed over 100 million times with notable mentions from celebrities such as John Boyega, Lupita Nyonggo and Priyanka Chopra. I noticed there was the issue at medical school on the lack of teaching in darker skins on arrival this was very concerning to me because I was almost unable to even spot signs and symptoms on myself. I knew that if I couldn't do this on myself then how am I expecting myself to be able to do this on others. With increased awareness on some of the healthcare disparities that exist in the UK such as black women being five times more likely to die during childbirth and black men more likely to be sectioned under the Mental Health Act it became apparent to me that something needed to be done. I have spoken about ‘Mind the Gap’ on various platforms so I won’t repeat the same story again for this platform. Alternatively, I'm going to use this platform to speak about the impacts that it has had thus far on both myself and the world. Over the past two months had featured in many news articles such as the Washington post, Sky News, ITV News, BMJ, and the CBC in Canada. This has led to a great amount of attention surrounding my name. Unfortunately, with this attention has come a lot of hate. Many people we’re unaware of the need for ‘Mind the Gap’ and it almost felt like I was creating unnecessary agendas and given the political climate of the world in 2020 many people felt entitled to try and stifle our attempts. Of course, everybody is entitled to their own opinion and thoughts however many would go out of their way to express their thoughts by sending hateful messages and emails. As a student who is just trying to do something positive this of course would get me down, however one thing that I knew is that change will always be met with resistance. It was clear to see that some people hating the fact that ‘Mind the Gap’ was having such a good impact. Before the ‘Mind the Gap’ Handbook was released I could see a shift and a hyper awareness from the world that we need to do something about the lack of diversity in imagery. I could see that many news articles were now starting to include signs of how conditions present in COVID-19 on darker skin. This was extremely positive as I didn't believe that my co-authors and I could have such a big impact on the world. My aim with this blog post is to illustrate how resistance is a by-product of change. I want to use this opportunity to help people acknowledge that sometimes your ideas won't always be met with open arms however don’t let that get you down. This message is for anybody who may have an idea but is almost holding themselves back due to fear of not being accepted. I think it's so important to have faith in your own work and then from there everything else will fall into place. To keep up to date with mind the gap and associated posts please follow my social media. Instagram @malone_187, Twitter: @malone_mk Catch us interviewing Malone on Tuesday 27th October at 7pm over on our instagram @acmedicalmentors

Black Impact in Medicine: How this shaped the journey to medicine for me

By Emefa Vondee. Editied by Omolara Akinnawonu • October 6, 2020
“Accomplishments have no colour.” - Leontyne Price This statement says a lot in a few words - partially true in my opinion. For example, when we turn on lights or boil a hot cup of tea, we never sit down to think about the racial background of the respective inventor/creator. However, have you ever wondered what contributions our own black people have brought to the table? What about in the realm of medicine? We don’t learn much in school apart from how black people were oppressed. However, at notable times of the year such as Black History Month, we now have a chance to celebrate how far black people have come.

My dental journey so far

By By Nana Asafu-Adjaye. Edited by Omolara Akinnawonu. • August 28, 2020
Where do I even start? This journey was not an easy one AT ALL. It’s been a long and untraditional journey but nevertheless one of the most rewarding things I’ve ever done. LESSON #1: Even When Things Are Going Great, Don’t Get Comfortable In Year 11, I did 10 GCSE’s and managed to get: 4A’s 2A*, 3B’s and a C in Physics which to this dayyyy still baffles me, the subject just has me like

Studying as a graduate entry medical student

By Monique Wheatle. Edited by Omolara Akinnwonu • August 11, 2020
Medicine is all I have wanted to do since I was about 15. I never had a concrete reason why, but I would say I’m quite an intuitive person, and my spirit just took to medicine, it fit for me. I failed to secure an offer the first time round, so after achieving a first-class degree in Biomedical Science, I currently study Graduate Medicine at the University of Birmingham. Studying medicine as a Graduate is rewarding, and for the most part very enjoyable. I can’t see myself doing anything else. However, it has brought certain challenges which I wanted to share in this post for anyone that can relate to this, whilst giving a realistic idea for those considering it. Firstly, it is really intense, I will be studying consecutively for 7 years. Within that time, I have completed one degree, applied for Graduate Medicine (which is extremely competitive) and studied the entire 2-year preclinical course in less than a year. This is why it is so important to take breaks and be realistic with your workload to avoid burning out. I have multiple outlets which give me a breather and allow me to enjoy myself outside of medicine. I play netball, spend time with loved ones, run ACMM, attend every soca event possible and countdown to carnival every year. These things allow me to have a life outside of medicine which is crucial. Also, the funding for the Graduate Entry Course is substantially different to the undergraduate course. For the first year, it requires a contribution of over three thousand pounds, and in subsequent years you get a combination of student finance and the NHS bursary which is usually less than your previous student finance loan. It is therefore common that there is a financial pressure on graduate students, which is why many have a year out prior to beginning the course in order to save. I had an offer straight from Biomedical Science so was not able to do this. Unfortunately, financial pressure is not uncommon amongst students in general, but it is an even more important consideration for Graduate Entry Medicine.

Words to my younger self

By By Dr Rumbi. Edited by Omolara Akinnawonu • August 3, 2020
2020 has been a rollercoaster of a year. It feels like with each progressing month another level of Jumanji is reached. This year was one I had so many plans for, particularly this summer, the summer I was to graduate and finally become a doctor after 8 years of university. There were times in the previous years where I just wished I was finished; I wished I was graduating already. At times I envied those graduating whatever year it might have been. As the saying (or the pussycat dolls song) goes, be careful what you wish for, because you just might get it. In April 2020, my wish came true. The circumstances however were those beyond what my mind could even imagine, a virus taking countless lives, keeping loved ones apart, sweeping the globe. If you told me three months ago that today, as I’m writing this post, I would be in my first working week as an employed doctor? I would not have believed you. Three months ago I had only just written my finals, celebrated with travel, well, I came home to a different world than when I stepped on the plane to leave. Class of Covid-19 as I like to affectionately call us, has been called up for duty. Who knew a global pandemic chose the year in which I was due to qualify to make its entrance into the world. I write this open letter to my younger, student, self and other medical students (both current and future) to say this. Don’t wish away where you are now, because tomorrow might not be what you expect. Each season in life has its purpose. The times I cried because I didn’t get any offers to study medicine? Well they led to me finding joy in Midwifery. The days when I worried how I would pass my exams, study and find go to work; they led me to be resourceful and manage my time. Not everyone believes in fate, or in destiny but I believe all those times and moments where leading up to this season, starting as a doctor in the most extraordinary of circumstances. These days will be written about in the history books and we are living through them. There is a lot of uncertainty for medical students and those that were planning to apply this coming September. There is restructuring of exams, cancelled placements, virtual lectures and other socially distanced changes. Take all the anxiety and worry that might come with the uncertainty and consider this an opportunity. Take hope and comfort in where you are now, for it is preparing you for where you might be tomorrow. Don’t wish away the experiences you are having, embrace the hurdles because they train you to jump higher. I know it is easy for me to say because now I am at the other end of this journey but with every ending there is a new beginning, different challenges, more lessons. More on early provisional registration of final year medical students and its impact on medical students Covid-19: medical schools given powers to graduate final year students early to help NHS Joint statement: early provisional registration for final year medical students Medical Students Are Not Essential Workers: Examining Institutional Responsibility During the COVID-19 Pandemic The Impact of COVID-19 on Medical Education

Clerking patients with Mania

By Jessica Katanga. Edited by Omolara Akinnawonu • July 4, 2020
Earlier this year, I had a six-week placement in psychiatry and had the privilege interacting with many admirable psychiatrists who went above and beyond for their patients and with patients who kindly shared their stories and struggles with me. I knew this placement would be unlike any other I had been on and in this article, I recall the first time I clerked (interviewed) a patient with mania… and it was definitely a unique experience… Disclaimer: All initials and some details have been omitted/changed to preserve patient anonymity. Patient KL is a 16-year-old, male who was top of his class but in the last 6 months, this all changed as his behaviour changed from ‘calm and likeable’ to ‘angry and irrational.’ He stopped going to school for 2 months and spent all his time on his laptop, planning how to end world poverty and become a billionaire. He fell out with his family and in the days leading up to his forced admission, he hadn’t showered or ate in days; a common occurrence in severely manic patients. On interviewing him, he exhibited delusions of grandeur, concrete thinking, flight of ideas, pressured speech, auditory second person hallucinations and lack of insight. For the non-medics, this means he believed God and angels spoke to him and that he had been appointed by God to end world poverty. When talking about this, he spoke in a very fast, uncontrollable way and did not doubt these ideas at all. During the consultation I felt an array of emotions, including curiosity, confusion and sadness. Curiosity: As it was the first time, I had taken a history from somebody with mania, it was amazing to see grandiose delusions, an abstract concept I had only seen in textbooks, come to life. I wanted to know more about his ideas and where they originated from. Some of his ideas, regarding business and education, I’d find myself agreeing with until he’d then add something completely bizarre, thus reminding me of how unwell he was. I wondered how psychiatrists reserved from getting pulled into a patient’s convincing spiels. Confusion: I was confused as to what had caused/triggered this manic episode as he didn’t seem to have any past personal or family psychiatric history nor alcohol or drug use. In fact, he had so many protective factors against a serious psychiatric condition, such as supportive family, good education and more. My confusion at the seemingly random nature of his illness led me on to sadness… Sadness: The lack of any risk factors showed me that anybody can be struck by a mental health imbalance. This patient was a young man aspiring to get into university and I was saddened by the fact that he was so ambitious and hard-working, but this episode had become a hurdle he must face as he steps into adulthood. I hope that this illness does not throw him off his trajectory but instead can be used as fuel for his aspirations. Amused: Although this might sound cruel at first but I was not laughing at him but rather with him. During the consultation, we were able to build rapport as he still made jokes and these breaks of laughter allowed us to connect, even if only briefly, and reminded me of the human connection between physician and patient, a connection that sparks off real recovery as it allows you to truly treat the person in front of you and not just a bag of symptoms. After interviewing KL, I had ample opportunities on my placement to interview other psychiatric patients, all with an array of disorders but all from different walks of life. This further affirmed that mental health can affect anybody. This patient happened to be south Asian and his family were completely, understandably in denial and shock that their son had turned from a high achieving student to a mental health inpatient. The intersectionality of mental health and race is an important aspect to be considered as there is a wealth of evidence that being of African or Asian origin is associated with poorer mental health outcomes. Whether that be due to lack of access, delayed presentation, lack of family support or difference in prescriptions and treatment. As you can see from just this one encounter, that I experienced a whole breadth of emotions and it is for that fact that psychiatry is not for me. The 6-week placement left me emotionally drained and confused as you literally get thrown into patient’s worlds, from having to deal with very complex social issues to listening to their deep emotional turmoil. I have the utmost respect for psychiatrists because I honestly don’t know how they remain resilient in the face of very challenging patients with complex needs. Jessica Katanga 5th year medical student