A guest column by the American College of Physicians, exclusive to KevinMD.
Since the beginning of the COVID-19 pandemic, the signs have been everywhere – celebrating the heroism of health care workers. It’s a wonderful sentiment that as a physician personally makes me feel very good about our profession and what we do. It’s also nice to hear people who know I’m a doctor spontaneously say, “thank you for your service.” But what does being a “hero” during these extraordinarily unusual times really mean?
The term hero is derived from the Greek hērōs, which literally means “protector” or “defender.” As commonly used, a hero is a person admired or idealized for courage, outstanding achievements, or noble qualities, and their actions are considered to be acts of heroism.
Although functioning as a protector and defender of patients is a core value to which each of us subscribes when entering medicine, I don’t think most of us perceive caring for patients as being something that would be considered truly heroic. But in this time of medical crisis that has unexpectedly and profoundly stretched the very fabric of our society, it is clear that many on the receiving end of the care we provide do believe that what we do rises to that level, and it seems important that as physicians we also recognize the true heroism of our individual and collective actions.
In thinking about what constitutes heroism in medicine in these times of pandemic, it’s easy to see the many acts of courage by those health care workers who place themselves directly in harm’s way when caring for an overwhelmingly large number of very sick patients afflicted by a new and poorly defined contagion. This is particularly striking because it is occurring in the context of a poorly organized national response to the outbreak and a woeful and unacceptable shortage of personal protective equipment needed to keep these individuals as safe as possible when doing this critical work. Yet each has assessed their own personal risk and the risks to their families and significant others against the commitment they’ve made to serving the sick, and chosen to step-up and care for those in their charge despite the potentially cataclysmic implications for themselves and their loved ones. And in making this choice, multiple colleagues I know have become infected, and we are all aware of health care professionals who have died in this service to others. These individuals would be considered heroes by any definition.
But in watching medicine’s response to this health emergency, I’ve also witnessed countless acts by physicians (and many other health care professionals) that, while seemingly less dramatic or risky than direct care of patients with COVID-19, are nonetheless just as heroic.
There are primary care physicians who have experienced the frighteningly rapid deconstruction of their practices due to the pandemic which, coupled with the underlying flawed structure of our health care system, threatens not only their current livelihood but also their longer-term ability to continue caring for patients once the infection is better controlled. Yet even with this existential threat and unknown future, they have rapidly shifted to other ways to make sure patients get the care they need despite the inherent risks of being exposed to the infection in either asymptomatic patients or those with vague complaints. And this is added to the complexities of managing the broader implications of the pandemic. These include addressing the fears of older, highly vulnerable patients who are rightfully terrified of contracting and dying of the disease, and dealing with the sad outcomes of the many who have been afflicted. As an example, I’ve watched my wife, a primary care internist, spend hour after hour having truly gut-wrenching end-of-life discussions via telemedicine with the families of the nursing home patients for whom she cares, many, many of which eventually succumbed to the disease, often alone.
There are the many different medical specialties that have abandoned the traditional professional boundaries that often separate and fragment us, and pulled together to do what has been necessary during the pandemic – rapidly re-tooling to do things outside of their particular skill set and comfort zone, such as providing emergency and critical care or other essential activities such as screening potentially infected patients and calling them with their test results. And all of this is in addition to managing their own patients and practices.
Then there are those in training. Residents and fellows often bear a disproportionate role in direct patient care during times such as these, and it has been heartening to watch them willingly rise to the challenge and accept the risks of caring for large numbers of very sick patients with an extremely contagious and potentially fatal disease. And this is despite sometimes massive disruptions in the normal educational processes that are essential to them at this stage of their careers. There are medical students who, in many ways, have been sidelined in their educational and clinical training by the pandemic. Yet, they also have stepped-up and contributed in extremely important ways, ranging from graduating early to join the ranks of resident caregivers, spending time talking to patients and families, and providing support for other medical professionals actively engaged in front-line care in any way they can, even if that is something as simple as providing child care. For anyone who has ever had concerns about the future of our profession, I truly believe the pandemic has demonstrated that medicine is in good hands going forward.
And finally, there is the medical profession as a whole. Medicine has never seemed, at least in my career, to be as cohesive and able to take on the steady, stabilizing role it has over the past several months, serving as a collective source of reliable scientific evidence and practical guidance that individual patients and society trust and find reassuring.
Few of us in medicine consider what we have committed ourselves to and been trained for to be heroic. But if heroes are those who seek to protect by selflessly serving others, defend the vulnerable by acting on their behalf, and choose to intervene during times of emergency to help people make it through extraordinarily difficult times, then perhaps by doing these things we are heroes, each in our own way.
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