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e29 Conflict, War and the UK HCP

What this episode is about

Munir Adam: Innocent lives are being lost. Of course it's gonna affect me. Like, you know, I come to work every day and that's all I'm hearing on the news. I can't just pretend ,right, that I don't care about hundreds of people dying in the Middle East. 

Dawn Hunt: In a busy clinic, when a patient presents from a war torn country, when they share their story, present with PTSD, the reality of their day-to-Day and their story can affect us.

I work in a military area where colleagues and patients live with anxiety and are faced with uncertainty every day. When will family members be deployed? Are they safe? When will they come back? How do we respond to all of these questions? 

Munir Adam: Welcome back to your Primary Care UK. It's money item here, and this episode is about remaining professional amidst the global wars and conflicts.

Dawn Hunt: I'm Dawn Hunt. I'm a practice nurse and with Munir as a doctor, myself as a nurse, but [00:01:00] this episode will be applicable to you regardless of your role in the NHS. This episode will be relevant. We're aware that this has the potential to be quite an emotive episode, and our aim is to deal with that in a really sensitive way.

Munir Adam: So, yeah, it's Dawn and myself, and we do have, fortunately, some contributions from the GMC. I was speaking with Mark Swindells, who's the Assistant Director for Standards at the General Medical Council, which of course is the regulatory body for doctors. And we are also having discussions with some of the other professional organizations to get their approval.

And we're gonna include relevant guidance in the show notes and during the conversations where applicable.

Dawn Hunt: So why are we talking about this today? 'cause there's a lot of talk about it. It's high emotions. It's a topic that's likely to come up in our day-to-Day. And you might well be affected by it. Your patients as well, those that you work with, your colleagues, and in all of this, it's really important to respond appropriately.

Munir Adam: So just to be clear, this episode is [00:02:00] not about healthcare professionals that are working in conflict zones. May be relevant to people who are in that setting. And it's also not a political podcast, but like all of our episodes, it's an educational one. Now, it's not that political discussions about the things that are going on around the world aren't important.

Of course they are, but it's not the remit of this podcast. And actually, let's face it, there's actually quite a lot out there about those sorts of things being discussed from a political angle. And that's not what we're here for today. And also, we're not here to discuss, or represent any political views.

If we do end up saying something that comes across like this, we apologize and we don't mean to upset anyone. It's also not about discussing any individual conflict. It's not about discussing who's right or who's wrong. It's a reminder about what we should and should not be doing as healthcare professionals.

Dawn Hunt: Season two is produced in partnership and sponsorship from Integrated Care Support Services. If you would like to sponsor one or more episodes, please do get in touch using the email in the show notes. 

Munir Adam: [00:03:00] We're all human beings. We will be affected by emotional things to some extent. What I read out right at the start, that was me, that's how I feel, and we'll all probably have some political views.

Now, most of us, I think it's fair to say, are not politically minded people, but when we're bombarded with all these things on the news day in, day out, well, and depending on where we link up and who we listen to and what we watch, we're likely to form some sort of political view to some extent, even if it's happening at a subconscious level, 

And then we might be affected in other ways as well. We may have vacations that we've had to cancel because of these things. There might be financial impacts. We know certain wars can lead to quite significant energy price rises and things like that that we've seen in the last year. There may be practical implications. It might even affect relationships that we're in.

So we're all human at the end of the day, but so are all of [00:04:00] those around us. We may inadvertently trigger a strong emotional response in someone around us. We might end up colluding with somebody without even realizing it, and if we're really having a bad day, they might even record us doing that. We might post something on social media that we then regret.

It might upset people, or it may have other unintended consequences like, I dunno, getting us into trouble. The thing is, we might like to think that we're always totally objective and a hundred percent professional at all times. The truth is we get bombarded by conflicts going on around the world, on the news, on social media. People we know in conflict zones might be affected by it, and a lot is expressed in a strongly emotive and in engaging ways. That's how these things get sold and talked about. We might start to form our own views. This may trigger our conscience, and while it might be possible to come to work with and pretend none of this exists at all, for many of us, that may not be the case.

Anyway. What do our regulatory bodies think of all of this? Well, they're very aware of it. For example, the GMC has remarked that they have been following these events with deep worry and concern for everyone, are [00:05:00] aware of these being discussed on social media and that this is having an impact on members of the profession and the public.

And if you're not affected at all, you are sure to encounter others at work and amongst your patients who are. It's difficult to find information or research about this, though there are important relevant principles from the professional bodies that we can turn to.

Our wellbeing

Dawn Hunt: So how do we tackle this topic? I think one of the first things to think about is our own wellbeing. We've got to start with our own wellbeing 'cause if we are not doing well as a healthcare professional and as a workforce, then we're not going to be very much good to our colleagues and our patients.

So firstly, thinking about how do we feel about the conflict? How do you feel about conflict and what's your moral position or your political position versus what you see happening and how are we responding to the events as they unfold? I think it's so challenging, as Munir has mentioned, when we're listening to and watching the news, and [00:06:00] how do we feel about human suffering, especially as a healthcare professional, where serving humanity is at the core of what we do.

How do we feel when we encounter patients, injured or otherwise affected as they share their story? And how about if we are directly connected to somebody who is involved in one of the conflicts going on? How do we feel when an opinion we disagree with is shared by a patient or a colleague? If our wellbeing is being affected, this could affect our ability to concentrate on work.

We should be aware of that and seek help. We might display frustration or apathy, could have a sense of being overwhelmed. It can also affect our judgment or our professionalism. We might be unconsciously biased or, or have resentment. So I think self-awareness goes a long way just to be aware of what's going on in you and what your responses are.

Where can we get help? Is there a service within [00:07:00] your working environment? Is there psychological support? Do you have a health and wellbeing lead? Is this something that you can talk about with colleagues? In southwest London there's a coaching scheme at the moment for those who are in ARRS roles or allied health professionals, um, or for nurses as well. You can access free coaching and this is a forum where you could talk these types of challenges through.

I think it's really important, whether it's with a, a friend or a spouse or, or with somebody professional, to be able to, to have a forum in which you can share what's going on, on in you, being kind to yourself and being kind to your colleagues, having one another's back and taking a break when you need it as well.

Munir Adam: That's such an important point you said there, Dawn, about making sure that you take a break if you're not coping, rather than pretending everything's okay. Well, we hope that you are coping and that you are accessing any help that you need. 

Dealing with patients

Munir Adam: And so the next thing is to think about remaining professional with patients. Now, how do we [00:08:00] provide the care that we need to provide if we can't remain objective. Perhaps we feel so strongly that we wanna tell everybody about it. That's really quite common. I find that, um, people really want to express their strong views, especially if there isn't any other outlet or perhaps to as many people in everywhere possible.

I've got a really strong view. I'm right. Everybody else is wrong. I've gotta tell everybody about this. Um, at the time of producing this episode, there's a major conflict centered around Gaza and Israel. You may feel very strongly about this one way or another, and you feel that you, you almost might feel that you have a moral obligation to tell everybody about it.

And you start telling people on social media, go to rallies and so on. And the risk is that the emotional volcano that's heating up inside you decides to erupt in a clinical setting with a patient. Or it could be something that the patient says, or the way they say it, 

And it may not even be what they say. It might just be the way they're dressed or where they're from. They may say something where you have very strong views, um, and they may hit a raw [00:09:00] nerve, but I think that if you are aware of that, then you can normally control it. You know, in my opinion, it's easier to empathize with people who have opposing views, you know, because we, we do kind of get trained to do that, but it's being aware of speaking to people who have the same political view.

Then you, you continue the conversation thinking that you are speaking along the same lines and totally agree with each other. And you may find that very satisfying, but we should be very aware, they may not be their genuine political views, so we have to be very careful of that. And, um, there have been examples where people have been stabbed in the back in that sense.

Now on the topic of discussing politics with patients, what does the General Medical Council say about that? Let's hear from Mark. 

Mark Swindells: Doctors, like all citizens are entitled to their political opinions. There's nothing in the professional standards that the GMC sets that prevents a doctor from exercising their right to campaign or issues or hold a particular belief.

However, we would urge a lot of caution in terms of sharing those beliefs with [00:10:00] patients. And we have some particular guidance about personal beliefs, which I'd encourage people to read. It's available on the GMC website. In particular, we say that doctors must not express their personal beliefs, which can include political, religious, and moral beliefs to patients in ways that could cause them distress.

And doctors must not unfairly discriminate against patients or colleagues by allowing their personal views to affect their professional relationships or the treatment they provide or arrange. 

Dawn Hunt: So just go going along that train of thought, thinking about remaining professional with patients, it's really important that we act in the patient's best interests.

And just thinking about the NMC Code of Conduct, promoting professionalism and trust is one of the core principles in the NMC Code of Conduct and making sure that you do not express your personal beliefs to people in an inappropriate way. Also, staying objective and having clear professional boundaries at all time with people in your care.

It's really important that we don't abuse our [00:11:00] position to influence political views. It's not to say that those views don't matter or shouldn't be expressed, just that patients trust us and they need to be able to share their views without being judged. 

Why is it so important? This isn't a time to debate professionalism. Suffice to say we need to be professional to maintain public confidence in our professions. If we lose that, if patients don't feel that they can trust us with their health and with their lives, their health and wellbeing and our credibility will suffer. 

About Protests and Social Media

Munir Adam: Okay. What about when we're with others? What about when we're with other health professionals, maybe with our friends?

Are we expected to be perfect everywhere we go? Never hold any political opinion? Just do our job and pretend that these issues don't exist, right? A big topic at this time is about going on protests. So by way of example, what does the GMC say about that? I. 

Mark Swindells: Doctors, like all citizens are entitled to their political opinions.

There's nothing in good medical practice or are other professional standards that we [00:12:00] set that prevents a doctor from exercising their right to campaign on an issue, including via protest. Public trust in doctors is rightly very high, so it's important that we all act to protect that. It means, for instance, that it's essential that doctors act within the law at all times, including when protesting.

In the event a doctor were convicted of an offense or accepted a police caution, we do have a duty to consider those. So doctors must tell us if that happens without delay. We would only act where there's a risk to patients or public confidence in doctors or where it's necessary to maintain professional standards.

Munir Adam: So there we are within the right safeguards, there is some flexibility there. And how about the use of social media, that's another big one? 

Mark Swindells: At the GMC, we often get asked whether doctors can express their political opinions on social media. Doctors are entitled to express their opinions. In sharing opinions on social media or other public forums, however, doctors must consider how what they say may be understood by others and the impact this [00:13:00] may have on the public's trusting and perception of doctors as a whole. Our social media guidance has more information. This guidance highlights that doctors must always treat colleagues fairly and with respect, and that online posts are subject to the same laws of copyright, defamation, and and so on as written or verbal communications.

Our ethical hub on our website also provides information on how to apply this guidance in practice and explores common questions we receive from doctors on using social 

media.

Munir Adam: You know, I'm thinking back to a WhatsApp group that I'm a member of, and this is quite recent, where a couple of members made some remarks that really did touch raw nerves, and sadly, quite a lot of members after that decided to leave the group, and I honestly don't think that anybody intended to upset anyone, but it's just so easily done.

At our Workplaces

Munir Adam: So we do need to be careful with social media and we need to be careful in the workplace as well. Especially perhaps when we're dealing with those with whom there's a power imbalance. So I'm thinking about, for example, GP [00:14:00] trainees. In the case of supervisors and educators, perhaps the medical students, nursing students, Physicians Associate students, et cetera.

There are some relationships that are horizontal. There are some relationships where one party is particularly vulnerable. If people are not on an equal footing, you can feel that you can't express your opinion, and so you're not on a fair position to be having those sorts of discussions, especially if you have different views.

In fact, you know, one of the things that got me started about making this episode was one of my trainees said to me, gosh, isn't it terrible what's happening? And she was referring to the recent news that we've been hearing about, uh, Israel and Gaza. , I found myself responding by referring her, redirecting her to an interesting video I watched, which was designed to try to allow people to understand things from both sides in terms of normal civilians living in each of those areas.

But actually, I then thought to myself, is that even the right thing to do? Is that what she wanted from me? Should I have responded in a different way? Should I have not responded at all? Should I have said no, this is not the place to discuss. I mean, it was a [00:15:00] perfectly benign comment, right? I. So what is the right way to respond?

And, and then I, afterwards I thought to myself, would I feel more comfortable discussing this with my senior partner? I don't know. I mean, there are risks even in that arrangement really, isn't it? I don't think the professional organization said that you can never discuss any issues ever. But I do think that we need to be extremely careful and think about the consequences, uh, and so my view is that we should try and avoid these kind of conversations as much as we can, I think. What do you think, Dawn?

Dawn Hunt: Hmm. I think it's a really good question, and it's interesting because so often with our colleagues, they're actually the people that we can see more than our friends. You know, if we're working long days, sometimes more than those that we live with, and so I think, there is value in being able to have conversations that are sensitive and supportive to one another. I think it's also really important for people to be able to say, actually, I'm not comfortable talking about this. Hmm. Um, and I think it takes [00:16:00] sensitivity to, to recognize where other people are at. 

So just thinking through how we can respond, and if a, a patient or a trainee or a student reacts in a certain way, what can we do?

I think so often actually just listening to one another and acknowledging and empathizing with what they're saying gives a person space in which they can process. I think it's also really important to be sensitive towards one another and to remain objective. Listening and therapy and counseling, all of that can be really helpful.

I think it's also important to think about with patients, confidentiality remaining, um, confidential, but also thinking about when there needs to be exceptions to that, uh, with radicalization, if it's in the best interest of the patient or the public for something to be divulged. 

Munir Adam: Okay. Dawn, I think you're right actually.

Yeah. It, it isn't black and white, it's not so clear, is it? And there are potential benefits of discussing things as well, as long as, you know, you think about the caveats that you've just mentioned. [00:17:00] And the bottom line is that if you have concerns about a colleague, or you even want to discuss your own plans, like, I dunno, you know, I'm gonna go on a rally, is it appropriate? Et cetera, then you are strongly encouraged to seek advice from your professional organization, you know, play it safe. 

Final comments

Munir Adam: Okay, so, so really we've tried to keep a complex topic, really short and simple in order to deliver this reminder. Because we believe that half the solution is just to be aware and to be on our guard.

I don't think we've said anything that's rocket science. We all know most of this. It's just that we can get carried away if we're not careful, or we can get stuck if somebody says something unexpected and it just catches us. I. So, you know, forewarned is forearmed

And our intention was to educate and just to remind healthcare professionals about our duties to patients and to each other, what the public, the patients, and our professional organizations expect from us.

It wasn't to express particular political viewpoints, as we mentioned, either overtly or covertly. And we apologize if, if it does feel that way, that's not our intention. 

Dawn Hunt: If you found this a useful reminder, do [00:18:00] let us know. And anyway, please do leave your feedback on the Apple Podcast or wherever you listen. 

Munir Adam: Our sympathies go to those innocent ones that have been affected, or whose loved ones have suffered as a result of war and conflict, wherever it may be, and whoever they may be.

But thank you for staying with us, and until next time, keep well and keep safe.

Disclaimer

Munir Adam: Primary Care UK was developed by Therapeutic Reflections Limited to inform, educate, support, and unite the primary care workforce. Specifically, it is not for the general public or patients. All information and advice contained therein is time, location, and context dependent and is general advice only.

[00:19:00] No guarantees are provided with respect to the accuracy of the content. The hosts, contributors, and the organizations they represent do not accept liability for any actions, consequences, or effects that result directly or indirectly from the content provided. Please refer to the episode description.

Thank you for listening.