Militarised metaphors in medicine, which have been common in the pandemic, can be dangerous
Covid-19 has brought many changes to our lives. Some are beneficial, such as a much speeded-up approval of medicines and vaccines. Others are unhelpful, like the excessive isolation of older people.
One of the unhelpful concepts brought to healthcare since the pandemic hit in early 2020 is the metaphor of the ‘healthcare hero’. The militarised metaphor of healthcare heroes robs doctors and nurses of the ability to voice concerns for themselves and their patients. And militaristic metaphors in medicine can be dangerous to both doctors and patients. The danger of militarised language in medicine, even pre-Covid-19, is the promotion of aggression over receptivity, and the framing of doctors as soldiers, and disease, as well as patients, as the enemy.
Although it can be traced back centuries, the modern use of military terminology in medicine received a major boost when, in 1971, the then US President Richard Nixon publicly declared “war” on cancer and referred to it as a “relentless and insidious enemy”.
Yet how often do we read of the “collateral damage” of chemotherapy to describe the side effects of cancer treatments – a phrase defined as “the unintentional damage or incidental damage affecting facilities, equipment or personnel occurring as a result of military action directed against targeted enemy forces or facilities”?
Clearly military life cannot be distanced from the rest of the world, but do we really need terms like “killer virus” and “vaccine shots” when talking to patients about Covid-19? Covid-19 has produced a range of distinctly militarised gestures, and the consequence has been a social expectation for healthcare workers to unquestioningly serve their country while sacrificing their own health and, if necessary, their lives.
A more positive view of how Covid might change healthcare appeared in the Journal of the American Medical Association (JAMA). Written in the early stages of the pandemic by Dr Donald Berwick of the Institute of Healthcare Improvement, it framed a new post–Covid-19 normal not as predictions, but as a series of choices.
Of particular relevance when society was looking to identify healthcare heroes, he identifies health staff wellbeing as key: “Sadly, attention to healthcare worker safety has languished at far too low a level of priority for decades. Now it is evident how unwise that is, as millions of workers face personal risks that they would not encounter if protective equipment and preparatory procedures had been arranged in advance. Will the new normal address more adequately the physical safety and emotional support of the healthcare workforce in the future? Without a physically and psychologically safe and healthy workforce, excellent healthcare is not possible.”
Could we be better prepared for future large-scale health threats, Berwick asks? “The foundations of preparedness, most crucially a robust public health system, have been allowed to erode or have never been laid in the first place,” he notes. And while the Covid-19 toll may be the largest paid so far for this failure, without taking public health and preparedness seriously, it won’t be the last. Whether it turns out to be another pathogen, massive trauma, cyberthreats to the electric grid, the question is: Will public health finally get its due?
Probably the most notable wake-up call of all is inequality. Headlines about the unequal toll of Covid-19 on the poor, the underrepresented minorities, the marginalised, the incarcerated, the indigenous peoples bear this out.
Berwick writes that the “most consequential question in the new normal for the future of global health is this: Will leaders and the public now at last commit to a firm, generous, and durable social and economic safety net? That would accomplish more for human health and wellbeing than any vaccine or miracle drug ever can.”
Here are the choices he outlines: Will science and fact gain the high ground in guiding resources and behaviours? Will solidarity endure? Will compassion and respect be restored for all of the people who make civilisation feasible, including a guarantee of decent livelihoods and security for everyone? Will the frenzied world of commerce take a breath and let technology help simplify work without so much harm to the planet and without so much stress on everyone?
And probably the ‘six-million-dollar question’ among the choices Berwick enumerates is: “Will society take a break from its obsessive focus on near-term gratification to prepare for threats ahead?”
Lots of questions, but ones that need to be asked if our post-Covid lives are to improve.
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