番茄社区

Some words become so overused or misused that they lose their original meaning. I think this has been especially true for superlative words like "amazing," "awesome," "iconic," and "incredible." Overuse has greatly diminished their meaning to the point that they've become mere positive descriptors for relatively mundane things. Lately I've been wondering if the word "heroic" might be one of the next to lose its true relevance.

Since the onslaught of COVID-19 in early 2020, the media has been replete with stories of the tireless, stoic healthcare professionals working multiple shifts in emergency departments and intensive care units across the country. For more than a year, headlines have proclaimed them as "heroes." Public appreciation of their service often references their heroism -- from New Yorkers' nightly cheering and noise-making to show support, to the Blue Angel flyovers, to morale-boosting banners and free meals.

But, is "heroic" the right adjective to describe the clearly laudable behavior of healthcare professionals during a pandemic?

I came across an interesting response to that question in a . The authors argued that such demonstrations and heroic narratives ultimately do not serve either the courageous healthcare workers or the health of the public.

They begin with a look at heroism in the context of medicine. The term "heroism" implies an exceptional feat -- e.g., taking action to help others at considerable personal risk -- and heroic stories emphasize how much an individual can accomplish in response to a challenge or threat. The culture of medicine aligns with three traits inherent in heroism -- individual skill, willingness to sacrifice, and stoicism in the face of physical and emotional hardship.

Medical training rewards individual achievement (e.g., correct diagnosis, performing a procedure) and celebrates those who sacrifice by giving time beyond their job requirements. Medical training demands physical endurance; 80-hour work weeks and long shifts remain the norm, and in clinical settings (such as operating rooms and intensive care units), physical and emotional demands are accepted as part of the job. Many medical training programs also unwittingly promote stoic responses to the emotions experienced by medical and surgical residents.

Next, the authors described how these three heroic attributes actually undermine efforts to transform the dysfunctional U.S. healthcare system. The individualism inherent in heroism runs counter to the team-based, problem-solving approach that is necessary for improved healthcare delivery and higher quality of care. The authors reasoned that if physicians and other healthcare professionals continue to make personal sacrifices as a workaround for system shortcomings, leaders may not take action to address inadequate staffing and other issues.

The heroic trait of stoicism may actually increase the risk of burnout for clinicians. Stoicism leads clinicians to "underrecognize their physical and emotional needs or to conceal perceived vulnerabilities," the authors noted. Sustaining the highly activated state of mind required for meeting heroic expectations can result in extreme distress for healthcare professionals.

A on clinician well-being suggested reframing the medical culture to emphasize "humanism" over heroism. "Rather than envisioning medicine as a province of brilliant individuals saving lives without a thought for their personal regard, the aim should be to achieve a culture of teamwork that acknowledges the human needs of clinicians and does not ask them to sacrifice their wellbeing on a routine basis," the authors wrote.

COVID-19 cast a spotlight on our woefully unprepared healthcare system and on the heroic responses of physicians and other healthcare professionals who put their own health at risk to care for overwhelming numbers of patients. I believe that the nation should be forever grateful to our courageous healthcare workforce. But I think we need to shift our perspective from heroic stories to acknowledging and addressing the systemic shortcomings that made heroics necessary.

For example, while physicians and other healthcare professionals were laser-focused on saving the lives of infectious patients in the face of inadequate staffing and equipment shortages, the . The hospital-acquired infection rate soared; central line bloodstream infections in the third and fourth quarter of 2020 were 46% to 47% higher than in 2019.

A focus on individual "heroism" perpetuates the notion of the autonomous physician -- a concept that is neither valid nor sustainable in the 21st century. I wholeheartedly agree with the authors that, going forward, what we need is support for a system in which skilled professionals "have the resilience to respond heroically in an emergency because they would not have to do so every day."

, is founding dean emeritus and the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy at the Jefferson College of Population Health. He serves as special assistant to Bruce Meyer, MD, MBA, president of Jefferson Health. He is also editor-in-chief of the American Journal of Medical Quality and of Population Health Management.

Comment