In the process of authentic reflection, the agent both recognises the turmoil brought forth and accepts the associated struggle to reconcile one’s beliefs and understanding of themselves and their surroundings, leading to a place of reconciliation, solace and ‘truth’. In this way, reflection becomes a liberating, transformative and enlightening experience. An experience which allows the agent to feel ‘whole’ and, in turn, simultaneously breeds grounded resilience, perseverance and passion.
While the above notion may well seem similar to the ‘journaling’ proposed by the stoic26, this process should be considered a distinct action in that it promotes a self-reflection grounded in the subjective experience, formulating “emotional movement”23, as opposed to a more objective approach, perhaps more aptly described as ‘rumination’. It is the latter understanding of reflection that has governed the reflection of the medical practitioner, in modern healthcare, prior to COVID- 19. Admittedly, there is value in a narrative approach23, however it is limited by the reductive framework of assessment, dominance of ‘reason’27 and the extrinsic motivation with which it is perceived by the physician.
For the reflective process to be truly realised, it must be intrinsically motivated and navigated by the physician. Moreover, this shift in motivation may, through the growth it provides, even allow the physician to have a more sustainable commitment and become more highly achieving within their field28,29.
The COVID-19 Pandemic and its Fruits
Medicine and healthcare are bound to the political, cultural and economic environment around them. The interplay of these factors (and indeed many others) is complex and discussed in-depth in medical literature30-33. The COVID-19 pandemic has affected all aspects of society and the norms the individual is accustomed to, prompting existential and ethical crises as societal axioms and customs are withdrawn and challenged34-36.
In addition to this, the physician has also become inundated with troubling experiences within their profession. The ideals to which they attempt to treat patients seem distant as many ethical dilemmas and challenges arise in the current climate37, such as healthcare rationing38and the disproportionate impact of COVID-19 on BAME individuals39,40. All of these factors amount to a cumulative and additional existential stress for the physician, particularly when considering their identity and duty. This stress is directly comparable to the ‘meaningless suffering’ that ensues as healthcare workers are prevented from carrying out their ethical ideals23, which Wang and Ko label “difficult ethics”41.
The overwhelming nature of the pandemic and the inability to escape from its grasp, as quarantines and lockdowns are imposed and infection-related terms become normalised in societal lexicon, may have provided fertile ground for authentic reflection to grow. Unable to ignore the pandemic and engulfed completely by it, the physician has become Geoffrey Vickers’ “agent-experient”, which Yancey refers to in her citation of Schon42. In the face of increasing demand and stresses, the principles of ‘slow medicine’43 have somewhat paradoxically taken hold, predisposing the physician to reflect authentically and conscientiously. This has led to an engagement with emotions and conflicts, as the physician has little choice but to ‘move’ through their feelings rather than dismiss or steer past them.
The aforementioned engagement, here synonymous with reflection, has led to the development of characteristics formed under immense stress and stimuli. These characteristics are perhaps ineffable but fall amongst the concepts of ‘resilience’44, ‘toughness’45 and ‘grit’20. Each term’s definition suggests that the reflective physician would become adaptable, dynamic and a participant in “intellectual humility”46. These prove to be necessary qualities for the doctor to succeed existentially and holistically (as a flourishing, ‘eudaimon’47 individual) but also in reference to the expectations laid before them by regulatory bodies48.
Indeed, this is further perpetuated by the prominent and recent recognition of the sacrifices and efforts of healthcare workers, by the general public49, in turn providing ‘permission’ to feel to the physician. A permission which previously has been denied by the culture and system of healthcare and its unwritten rulings, where healthcare workers must not use time to reflect but rather “pinball from one moment of crisis to the next”50. As the fallacy of the ‘invincible doctor’ is dismantled in the public eye and the physician’s struggle is understood and acknowledged, it follows that the physician may begin to self-actualise in an environment of awareness.
Self-care and self-actualisation have both been considered an ethical obligation in many philosophies and societies. This pandemic has the potential to transform modern society, into one that may more readily strive to this goal once more. For the physician, reflection is a predicate to achieving such an outcome and the healthcare system must begin to accommodate the existential aspects of reflective practice. Cannon states that “lives can be saved by listening to someone who has spent their entire life never being heard”50. If the pandemic does indeed allow for the physician to finally listen to themselves and for the development of a system that listens to such reflections, it follows that many lives, including the physician’s own, may well be saved as a result.