Why Don't Doctors Feel Like Heroes Anymore?

In April 2020, as many Americans prepared to spend the Easter holiday in lockdown, pop star Mariah Carey released a video honoring the "sacrifices and courage" of frontline workers battling COVID-19 — her 1993 hit, "Hero."

"The sorrow that you know will melt away," Carey sang. "When you feel like hope is gone," the song continued, strength and answers can be found within, and "a hero lies in you."

For healthcare professionals, the reality of 2020 wasn't quite so uplifting. PPE shortages and spillover ICUs had many feeling helpless, exhausted, and overwhelmed. Few if any medical professionals felt their sorrows "melt away."

We can't expect depth and nuance from pop songs, but we can find in them the imagery that runs through our culture. The "hero narrative" — the idea that doctors, nurses, and others in healthcare have superhuman endurance and selflessness — has long been an undercurrent in the medical field.

Dr Brian Park

And yet, without a workforce willing to perform without adequate sleep, food, or time off, the healthcare system couldn't function, says Brian Park, MD, MPH, a family medicine physician at Oregon Health & Science University. At many academic health centers, for example, residents are "the bedrock of the workforce," he explains. If they didn't work 80-100 hours per week, those systems wouldn't exist.

So, how do we look at the healthcare system in a way that is both grateful and critical, Park wonders. "How do we honor extreme acts of heroism and also acknowledge that the system sometimes gets by on the acts of heroes to patch up some of the brokenness and fragmentation within it?"

Put simply: What makes "heroism" necessary in the first place?

Heroes Are Determined

Ala Stanford, MD, a pediatric surgeon in Philadelphia, has frequently been called a "healthcare hero." Given the title by CNN in 2021, she has received numerous other awards and accolades, featured in Fortune Magazine's "World's 50 Greatest Leaders" in 2021 and USA Today's "Women of the Year" in 2022.

In 2020, Stanford was sheltering in place and watching "way too much" cable news. "They would play solemn music and show photos of all the people who had died," she recalls. "I thought, ‘All these people are Black or brown. What is going on?'"

The standard explanation was that people of color were more vulnerable because they were more likely to be essential workers or have chronic health conditions. But Stanford believed this was only part of the story. The reason she saw that local Black communities had higher positivity rates was because people couldn't get a COVID test.

Dr Ala Stanford

Stanford got call after call from Philadelphians who had been turned away from testing centers. When she questioned colleagues, "they gave me every reason under the sun," Stanford says. "It was because someone took public transportation and they were only testing people in cars, or because they weren't over 65, or because they didn't have other comorbid health conditions, or because they weren't a healthcare worker, or because they hadn't traveled to China…" The list went on.

Stanford appealed to local, state, and federal health authorities. Finally, she took matters into her own hands. She found tests, packed a van with masks, gowns, and gloves, and drove across the city going door to door. Eventually, she organized testing in the parking lots of Black churches, sometimes seeing more than 400 people per day.

The services were funded entirely through her own bank account and donations until she was eventually awarded a CDC grant through the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 and began to receive contracts from the city.

Since then, Stanford's mission has evolved. She and her team provided COVID vaccinations to thousands, and in 2021, opened the Dr. Ala Stanford Center for Health Equity. The center offers primary care for all ages in underserved communities.

Still, Stanford doesn't think of herself as a hero and she stresses that many other people contributed to her success. "I think the world was on fire, and we were all firefighters," Stanford says. "Someone said to me, ‘Ala, you ran to the fire and everyone else was running away from it, and you didn't have to.' … I feel like I was able to galvanize people to realize the power that they actually had. Maybe independently, they couldn't do a whole lot, but collectively, we were a force."

Heroes Are Selfless

Nicole Jackson, RN, an emergency room manager and nurse at Advocate Trinity Hospital in Chicago, was recently honored as a Healthcare Hero by the American Red Cross of Greater Chicago.

Nicole Jackson

On June 23, 2022, Jackson's emergency department was understaffed and struggling with an influx of patients when three gunshot victims arrived. Two needed to be transferred to a trauma center, and one — with multiple gunshot wounds — required a critical care nurse in the ambulance. But the ETA for that transport was 90 minutes, which meant the patient might not survive. Although Jackson was already working beyond her shift, she rode in the ambulance with the patient herself and probably saved his life.

While this incident stood out to a colleague who nominated her for the Red Cross award, Jackson finds herself working extra hours fairly often. "Since COVID, that's pretty much been like any other hospital," she says. "We've had staffing challenges that we work through every day. So, the nurses come, they show up, and they do the best that they can with what we have to keep our patients safe."

A 2022 survey by McKinsey estimated that by 2025, there could be a gap of 200,000 to 450,000 nurses in the United States. A two-year impact assessment from the American Nurses Foundation found that among more than 12,500 nurses, 40% were considering leaving their positions before the pandemic. By 2022, that number had jumped to 52% with the top reasons being insufficient staffing and negative effects on health and well-being.

Can the "hero narrative" help that situation? Jackson says she doesn't see herself as a hero, but the supportive environment and gestures of recognition by staff do make her feel appreciated. These include daily messages offering "kudos" and nominations for the DAISY Award, which she herself received in 2022.

"I have people who I have encouraged to become nurses," Jackson says, "and when they saw [the award], they were really excited about becoming a nurse."

Heroes Are Strong

Jasmine Marcelin, MD, an infectious disease physician with Nebraska Medicine in Omaha, understands the need for heroes as symbols and sources of inspiration. Marcelin is a fan of the superhero movie genre. There is value, she says, in feeling hope and excitement while watching Superman or Wonder Woman save the day. Who doesn't want to believe (if only briefly) that the good guys will always win?

In reality, Marcelin says, "none of us are invincible." And it's dangerous to forget that "the people behind the symbols are also human."

Dr Jasmine Marcelin

In 2021, Marcelin gave a TEDx talk entitled, "The Myth of the Healthcare Hero." In it she discussed the extreme physical and mental toll of the pandemic on healthcare workers and urged her audience to think less about extravagant praise and more about their personal responsibilities. "We don't want or need to be called heroes," Marcelin said. "Right now, our love language is action. We need your help, and we cannot save the world on our own."

Marcelin also sees links between superhuman expectations and the high levels of burnout in the medical field.

"It's a systemic issue," she explains, "where it requires a revamping and revitalization of the entire psyche of healthcare to recognize that the people working within this profession are human. And the things that we think and feel and need are the same as anybody else."

Heroes Are Self-Sacrificing

Well-being, burnout, and disengagement in healthcare has become a focus for Oregon Health & Science's Park, who is also director of RELATE Lab, an organization that aims to make healthcare more human-centered and equitable through leadership training, research, and community organizing.

For him, hearing neighbors banging pots and pans during the early pandemic was complicated. "The first phase for me was, ‘Thank you. I feel seen. I feel appreciated,'" he says. "Yes, I'm wearing a mask. I'm going in. I'm changing in the garage when I come home, so my kid and my partner don't get sick."

But after a while, the cheers started to feel like pressure. "Have I done anything heroic today?" Park asked himself. "Have I been as heroic as my friend who is in the hospital in the ICU? I don't deserve this, so don't bang those pots and pans for me."

When your identity becomes about being a hero, Park says, when that becomes the standard by which you measure yourself, the result is often a sense of shame.

"I think a lot of people feel ashamed that they feel burnout," he says, "because they're supposed to be heroes, putting on their capes and masks. They're waking up and saying, 'I'm exhausted and I can't play that part today. But I know that's the social expectation of me.' "

Heroes Are Noble

There may not be a clear solution, but for many healthcare professionals, symbolic gestures alone are inadequate, and in certain cases insulting.

On Doctor's Day 2023, Alok Patel, MD, a pediatric hospitalist, tweeted a photo of an appreciation "gift" for staff from an unnamed hospital. The small items had metaphorical meanings — a rubber band "as a reminder to stay flexible," a quarter "as a reminder to ‘call' for help," etc.

"Welcome to how you give thanks to 'healthcare heroes,' " Patel tweeted.

Dr Alok Patel

For Patel, the issue is not lavish gifts, but an attitude shift. He recalls colleagues who felt ashamed asking for mental health services or time off, "because they were bombarded by the hero narrative, by the manufactured pressure that they needed to put their jobs above their own health — because that's what 'heroes' do. I'm willing to bet most physicians would rather receive a sincere email with a transparent plan to better support healthcare workers than any Doctor's Day gift," he says.

In Marcelin's TEDx talk, she quotes Spider-Man's classic adage, "With great power, comes great responsibility." She argues that this motto doesn't just apply to those who can fly or deflect bullets; that's not what heroism is. In fact, most people have their own definition of the word.

For Stanford, a hero is "someone who is selfless, putting the needs of others before their own." Park believes there are no individual heroes. "It's the work of the collective that's truly heroic."

By those standards, clearly anyone can step up, offer help, act with courage and kindness, and be heroic. "We humans, as ordinary as we are, can be extraordinary by using our power to do what's right," Marcelin says, "because there's no such thing as healthcare heroes, just good people doing the right thing."

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