Table 3

Ethical challenges, total count: 248

CountSubthemesIllustrative quotes from participants
  • ‘I think if you [ask] me the most challenging [experience] is seeing a lot of sick people and going home fearing that you are [going to] take the virus to your family. So, that was really the worst thing. You feel bad [that] your kids have to be under risk because of your job.’- P10

  • ‘I lived alone the first 2–3 months. I was isolating from my family. Everyone was so scared.’ -P14

  • ‘You know I was almost living a double life.’ -P4

  • ‘Two of my team [members] contracted the infection. I felt so bad honestly that day. I felt so bad and I was asking myself was it the way we, you know, by which we were, you know, rounding on the patients? Did we get close to each other without taking precautions? Being the leader, you would ask yourself, you would feel guilty about that.’ -P9

  • ‘You start signing more DNRs, and at some point, you ask yourself am I doing the right thing? You are not thinking much about it and when you go [home] you start, how come I signed like two, three DNRs in a shift?’ -P10

  • ‘It’s a hard decision. You see a patient in cardiac arrest, you(can’t perform)CPR because you don’t have N95 masks, or you don’t have PPEs. You feel guilty for letting this happen. The justification obviously is the safety of your team, the safety of yourself, family and loved ones.’ -P8

  • ‘We were involved in ICU, we are not 100% qualified to lead care in that area but we were in a very difficult and tight situation …we accepted as Internists to do a job that we are not experienced in for the sake of patients.’ -P9

  • ‘Steroids, which in recent literature, was debated and actually discouraged, but you know, I had to do something for my patients so… in that aspect I’m trying to, you know, make my patients better. I’m one of those who started this regimen of giving high dose steroids.’-P4

17Professional environment
  • ‘We talked about the importance of shaving, but [a few residents under my supervision] were not convinced. We said you will not see patients in the Emergency [Room] and they were ok with that! Maybe when I was younger, I would have felt the same but religious necessity permits prohibitions. One said something weird: ‘It’s not my fault. It’s the fault of the hospital. They should provide me PAPR [Powered Air Purifying Respirators] so I don’t have to shave.’ Do you understand? He threw responsibility on the hospital, not on the hard situation we are in.’ -P9

  • ‘Okay I understand you’re afraid of seeing that patient, but this is your job, this is something that you signed up for so you should not…as long as you’re protected and doing the right thing then you should not be avoiding seeing patients.’ -P8

  • ‘I’ll be honest with you. I am ashamed for those who were running away… Just leave it for the others, just leave it for the service, I am sorry, I didn’t become a physician to be like this.’ -P15

  • ‘You see your nurses suffering as everyone is avoiding them as if they already have something that could impact everyone’s health.’ -P1

  • ‘Managing people is tough…Managing expectation is really tough.’ -P12

  • ‘At one point we had to say we may suspend your practice for one year if you are not going to see patients. That means you are not doing your job.’ -P9

  • ‘We have provided you with fit testing, the N95 mask is available, the goggles are available, the PPE is available. You know what? You are a doctor, you have to provide care, as long as we have provided you with the PPEs and the guidance, then you’re committed because you are an employee of the hospital, you are a doctor, this is your job. And nobody said that being a doctor doesn’t have its risks.’ -P11

  • ‘I think we learned as time passed. We learned a lot and we made a lot of decisions on the fly which is typical crisis management. You don’t need a lot of information, to wait for all the information that you need to make a decision, you just call the shot and then deal with the consequences … to make sure people they feel that they’re taken care of, they are my primary focus, their safety.’ -P12