Healthcare providers are finally getting their due. During COVID-19, patients exalted them with the deference afforded heroes. And yet clinicians are still haunted by an inability to stem the tide of coronavirus death. This has given rise to a sense of futility, which has put many on the brink of burnout, or of leaving medicine altogether.
Those dualities – a return to their calling of medicine mixed with fear of unrealistic expectations, new-found reverence offset by a rise in depression and anger – characterize the state of physicians in 2021, according to findings from a new study, The Truth About Doctors: COVID-19 Edition, findings of which were expected to be released on Tuesday.
“There is really a tale of two realities going on,” said Hilary Gentile, global strategy officer, McCann Health, which fielded the research.
Compare, for instance, the HCPs of today to their pre-pandemic selves. When McCann ran its original Truth About Doctors study in 2016, the conversation on the findings “was completely different,” Gentile recalled . “We had a trust issue going on. We had this severing of the relationship. And on top of that, the reverence and the authority was being stripped away.”
Indeed, McCann found that authority, trust, gratitude and relationships – the four key pillars underpinning what the agency terms “doctorness” – were all “under the gun,” Gentile said. Perhaps most striking: At the time, 32% of people aged 18 to 34 said they thought they could be doctors with little to no training.
Five years and an all-encompassing global pandemic later, the situation has reversed itself. “We realized this incredible moment of clarity where you need health experts to solve a health crisis,” Gentile continued. “You can’t have Dr. Google solving a pandemic. We need scientists and we need people who are trained and people who have the expertise to tackle this issue.”
That realization put doctors back on a pedestal – and many physicians feel reinvigorated by it. Today, two out of three people will consult a doctor before considering a COVID vaccine, the researchers found.
Gratitude and trust, too, have been galvanized. No longer taken for granted, clinicians are now celebrated. And while 25% of respondents trusted social media more than doctors in 2016, people cited their doctor as their most trusted resource in 2020.
The 2020 data – for which McCann employed a validated psychological model to derive pre- and post-COVID comparisons in the emotional state of HCPs – reveal an intensified sense of purpose, a feeling of stimulation and heightened curiosity. Whereas 53% of 18-34-year-olds believed that at some point technology would eliminate the need for doctors pre-COVID, last year saw a resurgence of the “tradition” of physicians helping others and in providing care.
The restoration of the four pillars of doctorness represent the positive side of the story. Still, there’s a lingering tension. In every country where doctors were publically venerated through, for example, nightly rituals of applause, researchers saw negative reactions to this symbolic act from HCPs.
It’s born of an achievement crisis, noted Daryl Somma-DiSalvo, EVP and director of strategy, McCann Health New York, and a study author.
“Because they saw morbidity and mortality at scale every single day, they don’t feel like they’re achieving the heroic status the public was thrusting on them,” she explained.
Researchers used qualitative interviews to validate the findings all over the world, and Somma-DiSalvo cited one quote from an NYC doctor. This M.D. couldn’t understand why everyone was clapping when they left the ER in the evening.
“I’ve seen more patients die in the last nine months than in the last 10 years of my career. So don’t call me a hero,” the physician said.
It’s not that they’re ungrateful, Somma-DiSalvo stresses. “On one hand, everybody appreciates being thanked. It would be anathema to human nature to not appreciate the gratitude they were getting,” she said. “But when you’re giving so much, you also need a sense of dutifulness.”
This “cognitive dissonance” as Somma-DiSalvo called it, was largely consistent across the world. It gave rise to a sense of anger among HCPs.
“Doctors universally hate the clapping,” she said, noting that they want people to hold their applause and instead wear masks and do what else they can to prevent winding up in the hospital. “People are saying clapping is simply not enough. Actions obviously speak louder, and you see this reflected in increased need for structure and stability.”
Indeed, COVID has magnified their experiences, for good and for bad. The rise in the “call to doctor” was offset by a doubling in fear from 2016 to today (from 12% to 24%) and a significant decline in joy (from 35% to 21%).
All of this should set off alarm bells for those who are concerned about public health and about doctors as people. “This has hit them in many ways in their emotional and physical bandwidth,” said Gentile. “We see that through ‘moral injury,’ which is a new way of talking about burnout.”
Moral injury, added Somma-DiSalvo, is a way of expressing the hurt doctors are feeling these days. “It’s more than just ‘I’m tired and burned out,’ which we can all relate to. It’s the fact that the burnout is so profound that it’s a fundamental insult to what drives you to do this in the first place. That’s pretty concerning.”
As an industry and a society, we have to think about how to help them to be more resilient, the executives said. But how can we demonstrate gratitude through action?
Consider that the study showed that the doctor-patient relationship has entered into a new phase, with a doubling versus 2016 in the “valuing of the tradition of patient care.” And technology, specifically remote care, deserves much of the credit for fueling the ability to forge more meaningful connections. That’s quite a change from the 2010s, when Dr. Google reigned supreme and IBM Watson was getting its feet wet in diagnosing rare cancers.
“In the 2016 survey, doctors felt that they were left out of that equation,” recalled McCann Health CEO John Cahill. “In fact, it kind of put them in an awkward position, because very often some of those patient-management programs were taking over some of the consultative care that the doctor thought that they should be issuing.”
Along with the aforementioned change in the primacy of the doctor as a trusted consultant – and because of the growth of “health-ready” consumers who are more participative – patients are getting more interested in how they manage their health and protect themselves.
“That kind of conversation of care has accelerated,” Cahill explained. “So now, it’s not a patient-management program. It’s a doctor-patient care program, where we can exalt the roles of each of the stakeholders and make that relationship and that conversation more fruitful for a better outcome.”
McCann Health, he added, has long been observing telehealth in China, where the phenomenon took off in 2019 but was transactional in nature. “For a telehealth consultation, you’ve got to actually engage in a far more consultative and conversational fashion,” he noted. “We know the doctors are struggling with that.”
Patient response, too, has been one of dissatisfaction, Cahill added, with many not quite understanding exactly what transpired and having to do much more follow-up outside the telehealth consultation. “Now, we have the opportunity to engage doctors in how to deal with a telehealth consultation, so that it’s both rewarding and informative for both.”
Moreover, given how technology has been thrust into the doctor-patient relationship in a better way than before, it presages perhaps a permanent shift to a mix of virtual and in-person care. Yet one in four Americans lacks access to broadband internet.
“If we’re moving into a world where we are receiving much more hybridized care, we certainly don’t want to exacerbate health inequities further by not having our services – our health communications – be neither tech- nor health-literate,” urged Somma-DiSalvo.
Playing a role in improving telehealth conversations, enhancing the health and digital literacy of patient-education materials and strengthening the doctor-patient bond all can help “redistribute the burden of care in new ways that give doctors the ability to practice the care they want to, even under difficult situations,” Cahill added.
“We have what perhaps is one of humanity’s most teachable moments right now for making the kind of disruptions that will lead to a better system, improve the partnerships in care way beyond when the pandemic has left us.”