Throughout the COVID-19 pandemic, healthcare systems worldwide faced extraordinary challenges, primarily due to severe resource shortages and widespread concerns about substandard patient care. The primary objective of our research was to examine the viewpoints and firsthand experiences of inpatient physicians regarding healthcare delivery during the COVID-19 pandemic under conditions of limited resources. This study employed a detailed 24-item electronic survey titled “Reflections on the Provision of Healthcare during the COVID-19 Pandemic” to explore the real-world experiences of 938 physicians working in the Czech Republic. More than half of the respondents reported observing a “lower standard of care” relative to the pre-pandemic period. Physicians held differing views on whether the basis for such decisions was medical, ethical, or legal. A distinct gender difference emerged: male physicians predominantly adopted a medical viewpoint, while female physicians placed greater emphasis on ethical considerations. Decisions to restrict healthcare required consensus among the physicians on duty, interdisciplinary teams, or shift supervisors. The extent of patient or family involvement in these healthcare decisions varied considerably. Factors including patient age, pre-existing medical conditions, and estimated life expectancy played a significant role in shaping care decisions. Notably, half of the physicians reported instances in which patients were denied transfer to better-equipped facilities due to resource limitations. One-third of the physicians stated that they never discussed care limitation decisions or alternative options with patients or their families. Consequently, nearly half of the physicians rarely or never communicated information regarding care limitations to patients. The survey illuminated the deep ethical challenges confronting hospital physicians across different healthcare settings during the pandemic. It highlighted the urgent need for transparent dialogue and academic discussion on resource allocation strategies, along with greater emphasis on involving patients and their families in care-related decisions during future public health emergencies.
