Blog | Friday, June 5, 2020

On not being a hero

Health care workers come in for a lot of deserved praise during this pandemic age. I find much of it misplaced—at least in my case. As a physician, preparing this week to venture into the hospital (where usually I spend a minority of my time), I am not to be grouped with the emergency room clinicians or intensivists who take care of the sickest. But even more: Most doctors don't spend as much time at the bedside as nurses (who are at higher risk, with less respect and less pay)—not to mention janitors, who prop up the whole system on their backs while often not able themselves to bargain for better conditions.

Another reason I don't want to be a hero? The notion implies the individual is savior. Whether your tradition is Greco-Roman (Odysseus, Jason) or Jewish (Deborah, Moses), you don't lack stories of the Anointed who comes in to stop the plague, defeat the enemy, or bring the Glorious Kingdom.

Naturally, the backlash against the hero came to medicine. We practitioners are most familiar with the theories of patient safety, which were born in the 1950s and 60s (from a long historical pedigree) according to which the hierarchy of old should be leveled out. Each should be empowered to speak up to prevent error and promote quality.

But this too is incorrect. Yes, we don't bend the knee to the individual savior. But the leveled-out hierarchy of patient safety doesn't actually exist. Individuals with privilege and power (such as physicians, such as I) must do more than function within imperfect and immoral systems. We must speak out to bring those systems into better alignment with morality and politico-economic justice. That is not heroic, but it is a small, strenuous rectification of functionality much like the restoration of homeostasis doctors and nurses strive towards every day.

Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.