#HealthcareHeroes Rock– But We Shouldn’t Need Them

It’s Christmas Eve 2021, and our COVID numbers are nasty:

From CovidActNow

This is happening all over the country. It’s another surge, worse than the last few surges, and healthcare workers operating on the front lines are beyond tired. They’re exhausted, and my heart goes out to all of them. My social media feed is saturated with posts like this:

Many emergency rooms and ICUs and inpatient wards across the country are beyond full, strained and straining and near collapse, or already collapsed. So many healthcare workers of all kinds and at every level are working Extra. Double shifts, triple shifts, 24 hours or more without sleep, taking care of those most in need, ignoring their own needs, and their families’ needs.

But is that okay? Is that really necessary, almost two years into a pandemic, heading into winter, which has ALWAYS been overflowing with influenza and RSV and paraflu et cetera? This situation is not new.

What IS new is this:

It’s pushback on the whole stupid situation. This resonated with me. “We shouldn’t need healthcare heroes” is the truth.

What does this mean, exactly? Someone is calling for healthcare professionals who are well-rested and supported in their work so that they can take good care of patients. It is hard work, all of it, I don’t care the title or level, it is DAMN hard work to be caring for very sick human beings in a crisis-level hospital environment. Brutal, even. (And, I will add the obvious: It’s DAMN hard to get through all the education and training to be able to do this hard work. Brutal, even.)

This is a very reasonable ask. Since this overflow respiratory infection situation has essentially been happening every flu-ey winter anyways, and we’re now year 2 into Covid, shouldn’t hospitals be prepared, like, be well-staffed well ahead of time?

And then, there’s this:

This is real, I’ve seen a lot of these, healthcare workers expected to work Extra, and for Free. I personally know hospitalists, pulmonologists and intensivists who have had to fight hospitals for backpay to cover their Extra shifts. And, some of these folks were guilted into volunteering their time. After all, the entire healthcare system depends on healthcare workers working Extra, for Free. This is not news, either.

But there are definitely problems with this model, and I’ll let the Twittersphere share some of them:

Basically, volunteering our time and expertise enables an exploitative system.

We know that healthcare systems count on their clinical staff working Extra for Free, and letting them get away with this doesn’t help anyone in the long run:

Danielle Ofri’s 2019 OpEd in the New York Times rings ever true today.

But whose fault is this? No doubt ballooning healthcare administration (including insurance company bureaucracy) has something to do with it. All those middlemen aren’t working Extra, for Free, that’s for sure:

Yup, between 1975 and 2010, the number of doctors increased 150%, while the number of healthcare administrators increased 3200%.

But you know what? It’s our fault too. Let’s face it, folks, many clinicians have a hero complex. (This is not news, either, I suspect…)

What is a hero? Usually someone with significant insecurities who feels validated and empowered by appearing superhuman and special. I personally know many many many doctors who fit this description, and I may include myself in that batch as well, if I’m being honest.

Heck, Brené Brown could write a whole book on the psychological motivations behind the typical medical martyr. Oh look, she actually did a podcast on this titled “Dr. Brené Brown on Physician Courage and Vulnerability: Our Biggest Shame Fear is What Our Colleagues Will Think“. Wow, at 23:29, she hits the nail on the head: We’re trying to impress everyone, but especially our colleagues. I may write a whole post about her observations and findings around shame in medicine…

Meanwhile, the whole “healthcare hero” mindset is well-known to lead right to burnout:

By Sarkar and Cassel JAMA 2021

So what do we do about it? Personally, I walked away from it all. I feel guilty for leaving my colleagues on the lines in the midst of this mess, but I do not feel shame. Here’s what I am doing, though. I’m vaccinated, my whole family is vaccinated, and I encourage everyone to be vaccinated. I’m masking in public, my family is masking in public, and I encourage everyone to mask in public. It’s what those still working on the front lines want:

And because this question STILL comes up, even after all the decades of having the flu vaccine available with the same principles: YES you can still get covid after you’re vaccinated, but you’re far less likely to transmit it to others, and FAR FAR FAR less likely to get sick enough to be hospitalized and/or die, and that’s the whole point:

As always, for really solid and well-written up-to-date COVID information, turn to MGH physician Robin Shoenthaler’s regular posts.

Stay safe folks, let’s protect each other, and let’s definitely move towards a healthcare system whose baseline functioning doesn’t rely on #healthcareheroes burning themselves out.

4 thoughts on “#HealthcareHeroes Rock– But We Shouldn’t Need Them”

  • 3200%? Sounds like a metastatic cancer, which describes administration perfectly. And don’t think for a minute they didn’t get bonuses last year while they were “working from home” while doctors and nurses were “volunteering” those extra shifts.

  • A-freaking-men. I am a clinician who reduced my work intensity to save myself–I agree with all of this. I do feel badly to see so many of my colleagues suffering on the front lines but you know what? No one is coming to save us but ourselves. Things will only change when clinical folk say ‘enough is enough’ and set clear boundaries with our overlords. I talk about this with trainees. I value the intensity of my own training experience, but I worry that the years–years!–of overwork we put our junior doctors through creates a sense of learned helplessness and starts us off on a path of endless Extra work for Free, instead of creating empowered, hardworking professionals who know how to say ‘no’ when appropriate.

    • Wow. I never thought of the effect our training may have on creating this unhealthy dynamic but you really are on to something there. Learned helplessness is a very accurate description.

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