In recent weeks, a flurry of headlines about healthcare workers treating people with COVID-19 have utilized a wide array of military metaphors: Doctors are fighting on the frontlines without sufficient ammunition. They are battling the enemy. They are at war.
But we are not at war. And we certainly have not enlisted. We are doctors. What we are doing is working extraordinarily hard to keep our patients alive.
Are there similarities between treating an enormous number of patients with a rapidly spreading, potentially fatal virus and armed conflict against an enemy invader? Perhaps. But the differences are just as, if not more, important.
To adopt a wartime mentality is fundamentally to allow for an all-bets-are-off, anything-goes approach to emerging victorious. And while there may very well be a time for slapdash tactics in the course of weaponized encounters on the physical battlefield, this is never how one should endeavor to practice medicine.
Of course, we all want to contain the virus, posthaste, and to treat as many as patients as we possibly can. But to do so under the banner of war implies the necessity of a heedless approach that leaves both doctors and patients open to an indefensible level of risk.
In medicine, emergencies—even pandemics—are never an excuse for shortcuts. If the careful study of our own mistakes and oversights has taught us anything it is that, even in the most critical of situations, we must confirm the birthdate on every wristband and review every item on the checklist. In day-to-day practice, these procedures may begin to feel redundant and banal, but they are what keep us from operating on the wrong limb or ordering insulin for the wrong patient.
In times of crisis such as this when levels of the stress hormone cortisol are high and health care workers are particularly susceptible to distraction and exhaustion, our reliance on basic safety protocols is more important than ever.
Wartime rhetoric, the kind that pervades nearly every news article about those of us who are involved in the care of COVID-19 patients, calls this logic into question. It makes a desperate appeal to the necessity of chaos. It argues for the inevitability of abandoning the rule of law in exchange for the promise of a swift resolution. And, in so doing, it sends a precarious message.
Furthermore, using militaristic diction to describe doctors' sense of duty conflates and confuses the reality of our responsibilities. Until a few months ago, those involved in the practice of modern medicine could be reasonably confident that, regardless of the patient's ailment, the provider was not putting their own life at risk in the process of proffering treatment (although of course, with regard to infectious, communicable diseases, some chance of contagion always exists).
Now, doctors from every specialty have been redeployed. And while every health care worker involved in efforts to mend the afflicted deserves the utmost in admiration and accolades, it is incumbent upon the media to tread lightly with language suggesting that giving our lives to this pandemic is in any way our charge.
A wartime mindset demands death, suffering and sacrifice in the service of one's country. But a global pandemic should not demand the same of its medical workforce. Young doctors who have not yet finished school should not feel pressured into risking their own lives in response to the promise of martyrdom or glory. Older doctors, or those with conditions that put them at greater risk of becoming seriously ill, should be encouraged to stand up for their own needs without fearing any form of “dishonorable discharge.” In times of war, following orders may mean every single recruit charging ahead, even in sub-optimal conditions, even without proper equipment. But applying such a framework to our current situation would do more harm than good. War is dangerous by definition, but danger should never be inherent to the hospital.
Of course, it is important to acknowledge that the linguistic militarization of modern medicine is hardly a novel phenomenon. The British physician Thomas Sydenham (posthumously annointed the “English Hippocrates”) is credited with inviting armor into Western medical discourse by writing, in his 1676 Observationes Medicae, that a "murderous array of disease has to be fought against, and the battle is not a battle for the sluggard."And this pandemic is not the first to borrow language from the special forces. In 1918, the flu outbreak that ravaged the United States took place while this country was also, quite literally, at war. It is unsurprising, then, that the sudden arrival of a deadly and unbridled illness was characterized as an “invasion,” an “attack,” and “as dangerous as poison gas shells.”
In spite of their age, however, these military metaphors are not dead. And, the problem with the inexact use of living metaphors is that they have the potential to influence the ways we think and behave. As George Lakoff and Mark Johnson write in Metaphors We Live By, “The heart of metaphor is inference…[and] because we reason in terms of metaphor, the metaphors we use determine a great deal about how we live our lives.”
Thus, we must be extremely careful about the words we, and others, use to describe the job we do.
None of this is to suggest that doctors are not brave. Every medical professional I know is eager to assist, in every possible capacity, in tending to the ill and taming this outbreak. And, indeed, we are more than willing to fight—with insurance companies, hospital administrators and lawmakers—in order to get what we need to care for our patients.
This evening at 7 PM, a collective roar of gratitude, composed of drums, chimes, and all manner of vocalization, sprang forth from thousands of balconies, windows, roofs and fire escapes, briefly enlivening the all-but-empty streets of New York City. I listened from inside my bedroom, where I have been quarantined for almost a week, recovering from the virus that has tormented the hospital where I work for more than a month. I was still too weak to join in the appreciative outcry, but I am in full agreement with the sentiment. After all, there is undeniable strength, great honor and inconceivable sacrifice in what we do.