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If not now, when? Enhancing cardiologists’ psychological well-being as a COVID-19 gain
  1. Rishi K Patel1,
  2. Mark D Sweeney2,
  3. Christopher S R Baker2,
  4. Neil Greenberg3,
  5. Susan E Piper4,
  6. Sukhi S Shergill5,
  7. Derek K Tracy5,6,
  8. Carla M Plymen2
  1. 1 National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
  2. 2 Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
  3. 3 Health Protection Research Unit, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
  4. 4 Department of Cardiology, King's College Hospital, London, UK
  5. 5 Department of Psychosis Studies, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
  6. 6 Department of Psychiatry, Oxleas NHS Foundation Trust, London, UK
  1. Correspondence to Dr Rishi K Patel, National Amyloidosis Centre, University College London, Royal Free Campus, London, NW3 2PF, UK; rishipatel{at}

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COVID-19 has highlighted potential shortcomings in our approach to psychological health that had perhaps become the accepted status quo within cardiology. Importantly, the pandemic may offer a unique opportunity to redress them. During 2020, physicians have had to question their ability to deliver optimal care with scarce resources, limited knowledge, concerns about personal safety and, by extension, the safety of one’s family. For some, these challenges may have a lasting psychological impact. Encouragingly, many staff have acknowledged the potential effect of these pressures on their mental health, making short-term adaptations and promoting staff camaraderie. However, achieving long-lasting changes in our approach to supporting those affected could create a positive legacy to this pandemic.

The idea of ‘moral injury’, originally recognised within the military, describes the psychological distress which may follow ethical or moral beliefs being challenged. Such situations can lead to overwhelming feelings of culpability, shame or anger, which increase someone’s vulnerability to develop, or exacerbate, mental ill health including post-traumatic stress disorder (PTSD) and depression.1 The attribution of moral injury to healthcare workers during the pandemic is increasingly recognised.2 Equally important is the concept of post-traumatic growth,3 which recognises that most people will survive and psychologically develop following these unwished-for experiences. Evidence shows that good organisational structures, management and psychologically savvy teamwork can calibrate this and push the needle more towards growth and away from injury.

Although moral injury in cardiology has yet to be substantiated, evidence suggests that cardiologists report some of the highest levels of burn-out and work longer hours than other physicians. However, only 23% report being willing to seek professional help for feelings of depression or suicidality.4 This may result from a stoicism existing within cardiology where a culture of appearing impervious to pressure prevails and is lauded, suggesting that many …

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  • RKP and MDS are joint first authors.

  • Twitter @rishipatel06

  • Contributors RKP and MDS are the main contributors to this editorial in equal amount and should therefore be credited as 'joint first author'. All other authors contributed to this manuscript with equal importance.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests NG is a director of March on Stress which provides psychological resilience training to some NHS organisations.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.