Weaponized Professionalism in the Time of COVID-19

Ye Kyung (Yekki) Song is a soon-to-be MD, PhD in Medical Humanities. 

I’m a fourth- year medical student, and since March 18, 2020, clinical rotations have been suspended and third- and fourth-year students have moved to completing coursework online. Ever since then, I’ve seen numerous posts on my class’s Facebook group and talked to other students who wanted to help out and volunteer. I felt immensely guilty for not wanting to be on the “front lines,” since this was “what I signed up for.” When I drove by campus recently, my institution had posted a large banner near their Emergency Department parking garage – “Heroes Work Wonders Here.” [YS1] [LC2] The institution even has a dedicated COVID-19 webpage which features video interviews of staff describing their experiences. 

/r/medicalschool, a community on Reddit, a major news aggregator/anonymous forum helped me relieve some of my guilt and I felt less alone, less ashamed of being thankful. /r/medicalschool’s mega-thread on COVID and popular image macros centered around student concerns about the pandemic, often using the rhetoric of war – being on the “front lines” and early graduation of medical students as getting ready to “deploy more workers.” being reticent to be used as a “human meat shield,” and pointing to their limited capability to contribute to the team. What is particularly egregious is the numerous reports from medical students being told that they are “unprofessional” when they voice these concerns, as evidenced in a popular image macro below (4.5k upvotes, #4 most popular post in the last 30 days).

Deployment of Soldier/Hero Rhetoric

What does the deployment of the Hero/Soldier rhetoric do for those working in healthcare? Who primarily uses it, and for what purpose? Anonymous online discourse on Reddit reveals opinions on these issues, and the in-real-life discourse which is suppressed due to real concerns of retaliation. Reddit’s various medical subreddits (subforums) allows for healthcare professionals to come together and share their experiences. Seeing the vast number of people who identify structural issues with how their institution is addressing COVID, and also reject the Hero/Soldier rhetoric personally provided me with comfort – I felt less guilty for being afraid. For example, the creation of the image macro below provides insights into what the hero rhetoric does and has received 1.0k upvotes, however, the comments only state how true this is, rather than providing solutions. 

Roger Stahl argues that the rhetoric surrounding war time, such as the contemporary call to “support the troops,” functions as means of deflection and dissociation: by focusing on the individuals at the front lines, the focus is then on saving individuals, rather than the policy and systemic factors at play. This rhetoric also dissociates the citizen from questions of healthcare policy, and dissent against how COVID-19 is being handled by the administration is seen as immoral.

As one friend told me, firefighters sign up to put out fires, but no one asks them to do it naked; healthcare workers are rationed personal protective equipment, with some institutions only allowing for one mask a week. In hotspots, providers are resorting to improvising their own PPE: wearing trash bags and homemade cotton face masks. In many places, the community is taking the initiative to take care of the failures of the medical system. For example, my mother leveraged her connections in the Korean-American community in Houston to gather materials and funding to make masks at the alteration shop she works at.

Difficulties in Creating Change

According to some users on Reddit, revealing problems with their workplace, even on social media, can lead to retaliation from the institution, such as suspension or even termination of employment. A Name and Shame Google Doc was posted, which goes in depth into the mistreatment present, particularly in hotspots. This crisis has led to the call for physician unionization, but some are doubtful that anything will happen. The author of the post writes, “However – I may be come to realize that this is place, much like other parts of Reddit, is an echo chamber that we’re all screaming into.

“It’s the same cycled post about needing to unionize. There’s a brief upswell with a few upvotes, and then it dies down. Someone will comment about PPE. Someone will mention that they already have unions in ____ place. There will be a comment about how nursing is doing it/that’s how they’re getting their agenda passed. Rinse, and repeat,” and a commenter replies, “Our profession is quite selfish tbh. Once everyone gets past that resident threshold, we quickly forget the struggles of those below us with a “cut the rope” mentality. It forces us to turn fiscally conservative reallll quick because we’re scrambling to make up for lost time from our prime earning years. . . . We can keep talking about our clinical training hours, patient outcomes and yrs of training to no avail. Nothing we do or say is going to stop encroachment and they have momentum on their side. Can’t we just break down the outdated hierarchical structure of this profession and have some significant reform?” I desperately want this to happen, but I don’t know how to even begin. I imagine others know that change needs to happen, but we don’t have the tools or know-how to get this movement off the ground.”

This brings us to a question about social media use in general: while Reddit is beneficial as it allows for people to freely express problems with their institution and the culture of medicine, some theorize that online engagement promotes “slacktivism,” while others state that online engagement has no correlation with in-real-life political action for younger people.

Systemic Vulnerabilities

What is more alarming is my particular institution, despite stating that “heroes work wonders here,” is asking for those same heroes to take a day off a week, using personal leave/vacation/sick days, to help alleviate the 40 million dollar deficit, and for faculty to contribute part of their salary toward the COVID relief fund. These measures are part of a plan to reduce the number of layoffs. Other institutions have already cut staff and physician salaries, furloughed workers, prior to cancelling the planned salary increase for resident physicians.

Residents and trainees are the most vulnerable, who have very little negotiating power as far as salary, hours worked, and where they are being asked to practice. As their training is tied to their employment contract, residents are afraid to voice their concerns because they fear being terminated from their training position. One bright spot in this sea of bleak news is that the American Medical Association recently acknowledged issues with residency, such as that resident salaries are low compared to those of other healthcare workers, and recommended that residents should be candidates for hazard pay, and granted forgiveness and/or forbearance for all or portions of their student loan debt. This acknowledgement is a small step in the right direction.

Conclusion

The heroes feel compelled to contribute – without a financially solvent hospital, they would also be unemployed, and their sacrifices would be even more in vain. The institution’s plea for its employees to help shoulder some of the financial burden is just another representation of the system level failures present in today’s healthcare system, such as how expensive medical care is, and how requests for federal and state funding were inadequately answered due to their own lack of funds. We need to look past the hero/soldier rhetoric which deflects from these larger issues, while still working to support individual healthcare workers during this crisis. So – how do we get this movement off the ground? 

Author Bio:

Ye Kyung (Yekki) Song is a soon-to-be MD, PhD in Medical Humanities. Her PhD dissertation analyzed expressions of medical student burnout online on Reddit, and her research interests include physician/trainee education, mental health, and netnography on social media sites. She will begin her Psychiatry residency at Duke University in July.

Articles: 

Memes in Medical Education (Medical Anthropology Theory)
The Medical Student Manifesto (Pedagogy and Theatre of the Oppressed Journal)


2 thoughts on “Weaponized Professionalism in the Time of COVID-19

  1. A thing that should be emphasized that is that these systemic issues (high workload, residents being treated poorly, etc.) have been present for years. This crisis has only intensified and place light on these issues.

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  2. Hello Yekki,

    Your article offers an interesting perspective. Nurses and physicians often share similar challenges in health systems. We are often asked to sacrifice our own physiologic, emotional, and financial needs for patients or for our employers. COVID is the most recent crisis, but there always seems to be one crisis or another going on. I hadn’t previously considered the effects of the ‘war time’ vocabulary that we tend to use in the hospital. When I worked on the ‘frontlines’, I enjoyed the war time vocabulary because honestly many days felt like barely managed chaos. I often worried the day or night before about whether anything terrible would happen on the next shift. You could not rely on things running smoothly, having sufficient staff, appropriate patient load, eating/drinking, etc. You hit the ‘frontlines’ with your fingers crossed every day hoping that things would go ok and relied on fellow ‘soldier’s’ to rescue you if things went downhill. I’ve no idea why the PPE shortage has not been addressed at a national level, isn’t there a weapons factory somewhere that could be converted to make PPE for for a while?

    COVID is an external crisis. Most of the crises we see are a result of our own healthcare system goals, usually attempts to improve quality without providing sufficient resources. The crisis before this was emergency ‘continual readiness’ for our pending Joint Commission survey, the crisis before that was an reorganization of our entire leadership structure (everyone’s old jobs went away and they were shifted into new jobs in different departments with a new hierarchical structure).

    Caregivers who advocate for healthy, legal working conditions (regular breaks, sufficient staffing, pay for all time spent working) are often labeled as unprofessional. It seems that many define professionalism as the ability to smile while you undermine your own health to reduce the workload of management while improving nationally reported statistics.

    At my place of employment, all employees are required to sign a contract promising not to discuss any proprietary information outside of work. This is further defined as any information about our operations that would not already be known to the general population. I feel this limits our abilities to communicate and share learning with nurses from other organizations. We are specifically advised to use caution on social media and we have employees who monitor Google for communications about our healthcare system. I once was chastised for publishing in a professional journal without running the article through PR first, even though it contained no information specific to our organization.

    We are often asked to donate back to our employer at least annually. I have mixed feelings about this. We are classified as a non-profit organization and our leadership does set the standard by making their own donations first. I’ve heard it reported that making over 70,000$ a year does not increase happiness, I guess that’s for each person to decide on their own. I feel that people who make earn less than what their happiness costs should not feel compelled to donate. I appreciate that we are able to channel our donations to specific projects that our non-profit is engaged in rather than making general donations to the organization.

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