From physician to provider to health care worker: Names matter, even in a pandemic

I have been reading, thinking and consulting for a while about the occupational health syndrome commonly referred to as burnout. As initially defined back in the 1970s, burnout is a state of mental and physical exhaustion caused by one’s professional life. Extensive research shows that burnout (also called work “strain”) is the result of working conditions in which people have too much work, too little control, and too few resources.

Despite the fact that burnout is caused by conditions in the work environment, most workplace intervention programs have focused on the individual in terms of various forms of stress management (now called mindfulness/resilience) programs. This focus has been largely a management decision designed to keep the focus on individual “symptoms” rather than the real culprit of toxic work environments.

I have always been interested in how language and words channel our thinking and action. In studying the natural history of burnout, especially in the health care sector where things have gone from bad to much worse over the past 20 years, I have noticed an interesting transformation in the words we use to define the people who treat patients. Back in the “good old days” (well, good for certain people), we talked mostly about doctors; nurses and others were all relegated to an ancillary “everybody else” category, reflecting the reality that the health care system was largely MD-centric. Physicians had most of the power and got most of the money. Life was good for the docs (mostly male); nurses (mostly female) burned out, but nobody cared.

As various health professions (nursing, PT, OT, psychology, etc.) pursued greater status and autonomy within the health care system, we began to see the term health care professional emerge as a generic form of reference. Then, as insurance companies inserted themselves more and more as an intermediary and ultimately as a decision-maker in the health care sector, the term health care provider gained currency in the conversation. While appearing to be just a little change in language, the shift from professional to provider subtly strips out the status embedded in the notion of a professional with valuable knowledge and expertise. The status downgrade affected by revisioning health professionals as “service providers” like any other provider of any other service (auto repair, carpet cleaning, dog walking) served the strategic intent of shifting power from the health professional to the corporate profit-taking class.

The final and current chapter in this name-change story is the further degrading of professional status/power by the adoption of the term health care worker. Now the transformation of the high-status/value professional to the more pedestrian worker moves us finally and fully into the capitalist drama of management and labor’s battles over the distribution of the asset pie. As capital secures its dominance over labor (see work by Thomas Piketty and Joseph Stiglitz), people in all sectors are working harder and harder for less pay. We now live in a market society/culture where investors are called “job creators,” and workers are viewed as a cost/expense line to be squeezed on the balance sheet. Burnout becomes an equal-opportunity destroyer of the health and well-being of people working on the auto assembly line, in Amazon warehouses (or “fulfillment centers,” another use of language to obscure and reframe), and now in hospitals and medical offices.

As the current COVID-19 pandemic crashes into an already burned out and chronically under-resourced health care system, we may find that the corpus of health care professionals is too weakened to fight off this modern plague even as it tries to save its patients. It will be a bizarre form of justice if our current vector of unrestrained capitalism (where states end up competing with each other and bidding up the price of life-saving ventilators and protective equipment) ends up infecting/destroying the very professionals who function like a precious immune system protecting society’s health and survival.

Remember: Words matter, so choose and use them carefully.

Baird Brightman is a behavioral scientist and can be reached at his self-titled site, Baird Brightman PhD.

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