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Physician Identity and Physician Wellness Are Inextricably Linked


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Imagine a 70-year-old patient who is scheduled for a pancreaticoduodenectomy. On the morning of surgery, the patient is checked in at the front desk by the “data-entry provider.” The patient is taken to the preoperative area, where the appropriate formalities are completed by multiple “bedside-care providers.” The patient’s procedure is performed by the “surgical instrument–directing provider” who is assisted by the “surgical instrument–handling provider.” Anesthesia is provided by the “anesthetic-delivery provider.” After the successful procedure, the patient is taken to the intensive care unit, where he is tended to by the “bedside nursing–care provider.”

As he moves out of the intensive care unit, his ambulation and mobility are assisted by the “physical motion–improvement provider.” The patient has some problems with swallowing and is evaluated by the “speech and language–assessment provider.” The patient’s dietary needs are assessed by the “food monitoring and advice provider.” Eventually, the patient does well and is about to be discharged with some home help for his activities of daily living, for which we consult with the “activities of daily living–improvement provider.” Prior to discharge, all of his medications are reviewed by the “drug reviewing and dispensing provider.”


Every profession should be proud of its identity, its name, and the unique skill set it brings, because no other profession can duplicate it completely or effectively.
— Chandrakanth Are, MBBS, MBA, FRCS, FACS

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Thanks to the care of many dedicated providers from diverse professional backgrounds, the patient ultimately does well and is discharged home in stable condition. Imagine a world where all professional names and identities in health care are removed, and everyone is called a provider. It could provide some humor on a daily basis to call people by their descriptive identities rather than their nomenclature-based identities. (Who knows, this humor may improve our well-being.) And it certainly could be quite a bit confusing to our patients.

Or imagine this same patient, who for the nearly 70 years of his existence on this God’s green Earth is called John Smith. His identity is intricately linked to this name as far back as he can recall. His identity, both in his personal and professional circles, is tagged to this name. All the accomplishments in his entire life are highlighted by connecting them to this name. All of a sudden, on one fine morning, he wakes up after a pancreaticoduodenectomy to realize that he is no longer identified as John Smith, but only a human.

To begin with, John Smith would be completely lost in this world, as he would not know what to call himself. This may be followed by loss of confidence and self-esteem, which ultimately could affect his well-being. Now imagine how it would be if overnight, we changed the name of an entire profession, particularly one that is old enough to be related to Hippocrates. We seem to have done exactly that by replacing the profession of physicians with the profession of providers.

The Key to Existence

An identity is the key to the existence of every animate being or inanimate object in this world. And a name is one of the most important forms of providing that identity. Each profession is identified by its unique nomenclature, ranging from physicians, nurses, police officers, clergy, plumbers, etc.

A physician can have several forms of identity, some of which include personal, professional, and organizational identities. All these forms of identity intricately link and provide the physician an environment and a platform for self-esteem in all of those respective domains. Loss of identity in any domain can lead to the feeling of irrelevance of one’s importance in that domain. When there is loss of professional identity, it could lead to similar feelings of irrelevance at work and a certain degree of meaninglessness to the purpose of their work.

A Name by Any Other Name?

Loss of professional identity can also have an effect on professional accomplishments and burnout.1-3 Through multiple channels, some subtle and some not so, loss of professional identity can have a major detrimental effect on physician well-being. Although the name alone does not contribute entirely to burnout, it certainly can accentuate other factors contributing to burnout. Abedini et al noted that redefining a professional identity and role can be associated with recovery from existential burnout resulting from a loss of meaning in medicine and an uncertain professional role.4 The value of maintaining and retaining a healthy form of professional identity cannot be overstated while we tackle the issue of well-being for physicians.

In the preternaturally fluid lexicon of health-care professional identities these days, the name physician seems to have assumed an almost dubiously negative connotation. An increasing chorus of people tend to call a physician a provider rather than a physician. The word provider has entered into the lexicon of health-care professions and sits at an ambivalent crossroads. Some continue to call a physician a physician without any hesitancy. A few never do, whereas many physicians mutter under their breath that they would prefer to be called a physician and not a provider or any other designation. Decades of brutal, uncompromising, clock-defying, food-starved, and sleep-deprived hard work; countless sacrifices; unforgiving debt and unbridled passion were invested to answer the calling (not a job) to be a physician and not a provider.

If calling professionals by their established names is posited by some to perpetuate historical hierarchies that prevent effective team-based care—then we are at fault. We need to highlight the fact that every profession in health care brings a quantum of very unique skill sets that ultimately contribute to the complete picture of patient care. Every profession should be proud of its identity, its name, and the unique skill set it brings, because no other profession can duplicate it completely or effectively. Although all these skill sets are valuable, failure to acknowledge that each skill set is different can be detrimental to patient care.

Richness of Diverse Skill Sets

We need to ensure that all professions in health care are respected equally and the unique skill set they bring is regarded as invaluable to patients. What we need to focus on is “flattening hierarchies in respect but not hierarchies in skill sets.” If we mistakenly attempt to flatten hierarchies in skill sets, the ultimate casualty of this misguided egalitarian approach will be patients, because they will miss out on the richness of the diverse skill sets of the equally diverse professions in health care. Whereas when we flatten hierarchies in respect, every profession can continue to maintain their dignity and identity, which helps to bring their unique and highly valuable skill set to the table to ultimately benefit patients.

Once our professional identity is restored, we should not be surprised if team-based care works better and well-being is restored as well to some degree.
— Chandrakanth Are, MBBS, MBA, FRCS, FACS

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Another probably more important reason to maintain a modicum of clarity in professional identities is our moral and ethical obligations to our patients. Our patients are already confused in the modern-day health-care system, where care is delivered in gleaming megapolises with too-many-to-count professions. Our patients need to know and rightfully deserve to know who is providing their care. It is not uncommon at all for our patients to be completely confused about who they interacted with and who is providing their care. By knowing the identity of the health-care professional they are interacting with, patients can at least have an idea of the care provided based on their knowledge of professional identities in health care. Anything less is equivalent to shirking our truthful responsibilities to our patients.

If you were a patient, you certainly would want to know who you are interacting with and who is treating you. So, it should not be any different for our patients. An unintended benefit of that might be an uptick in our HCAPHS (Hospital Consumer Assessment of Health-Care Providers and Systems) scores.

Call a Physician a Physician

Since when did calling a physician a physician offend anyone? Since when did we as physicians start to have a fleeting moment of hesitant political correction every time we utter the word physician to identify ourselves? With all due respect and the highest regard to every health profession that provides patient care—let us call a physician a physician. Well-being is a mushrooming cottage industry now with millions invested and likewise millions to be made. Instead of sprinkling money on many well-being initiatives with an unpredictable return on investment, how about we invest in a cost-free, soul-satisfying, simple well-being initiative that is likely to improve physician well-being? That is call a physician and physician. This will retain the hard-earned professional identity of the physician and the standing of the noble profession that dates back to the days of Hippocrates, Sushruta, and Charaka.

Once our professional identity is restored, we should not be surprised if team-based care works better and well-being is restored as well to some degree.

Dr. Are is the Jerald L. & Carolynn J. Varner Professor of Surgical Oncology & Global Health; Associate Dean for Graduate Medical Education (DIO); and Vice Chair of Education Department of Surgery, University of Nebraska Medical Center, Omaha.

DISCLOSURE: Dr. Are reported no conflicts of interest.

REFERENCES

1. Monrouxe LV, Bullock A, Tseng HM, et al: Association of professional identity, gender, team understanding, anxiety and workplace alignment with burnout in junior doctors: A longitudinal cohort study. BMJ Open 7:e017942, 2017.

2. Miyasaki JM, Rheaume C, Gulya L, et al: Qualitative study of burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology 89:1730-1738, 2017.

3. Lammers JC, Atouba YL, Carlson EJ: Which identities matter? A mixed-method study of group, organizational, and professional identities and their relationship to burnout. Management Communication Quarterly. Available at https://journals.sagepub.com/doi/10.1177/0893318913498824. Accessed April 15, 2019.

4. Abedini NC, Stack SW, Goodman JL, et al: ‘It’s not just time off’: A framework for understanding factors promoting recovery from burnout among internal medicine residents. J Grad Med Educ 10:26-32, 2018.


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