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A conversation with Cat Cox: Why we need to be careful about calling healthcare workers ‘heroes’

Cat Cox recently published a paper that explores the limitations of praising healthcare workers as ‘heroes’ during the COVID-19 pandemic. Kate Bendall spoke to Cat to find out more.

THIS Institute is delighted to welcome Dr Cat Cox, who was recently awarded an NIHR Academic Clinical Fellowship under the supervision of THIS Institute fellow Dr Zoe Fritz. During her tenure, Cat will divide her time between clinical practice and carrying out academic research into her strong interest in ethics.

Cat recently published a paper in the Journal of Medical Ethics that explores the limitations of praising healthcare workers as ‘heroes’ during the COVID-19 pandemic. Kate Bendall spoke to Cat to find out more about her work.


What attracts you to ethics as a research area?

As a medical student I noticed we would explain patients’ conditions to them in a certain way. And then after we’d left their bedside we would sometimes as clinicians discuss something among ourselves that we weren’t fully sharing with the patient. Often it was quite sensitive information, perhaps what a scan has shown, or whether we think a treatment is going to work. I’d wonder whether we should have told the patient more, and I’d feel uncomfortable about it.

As doctors, we hold the information about a patient’s condition and we have to decide how and when to share that information with the patient. The term “non-lying deceptions” can be used to refer to those occasions when doctors do not lie outright to their patients, but are perhaps a little economical with the truth, or at least a bit cagey. I did a project with Zoe Fritz to explore whether we should be more critical of this type of approach.

I am especially interested in communication between doctors and patients because I have a long-term health condition myself. I’ve thought long and hard from a patient’s perspective about how doctors communicate and the impact it has on the patient’s experience of being in hospital. Now, as a doctor, it’s fascinating to me to think about communication from both perspectives, the doctor’s as well as the patient’s.


What led to your interest in how the public refers to healthcare workers during the current COVID-19 pandemic?

A lot of my colleagues are working in intensive care or on COVID wards. We have weekly chats, and I noticed that the heroism narrative sat quite uneasily with a lot of us. I started to look into it a bit more.

Earlier epidemics prompted academics to explore the obligations that healthcare professionals have towards their patients. For example, when AIDS started to spread, it wasn’t very well understood and there weren’t any treatments. That meant some doctors were reluctant to treat patients with AIDS, which led to discussions about whether healthcare workers could justifiably withhold treatment due to concerns about their own health. The question came up again during the SARS epidemic in 2003 to 2004. I found the literature really interesting and I started to think about the implications for the current pandemic.


Why do you think the language of heroism has become so widely used to refer to healthcare workers during the COVID-19 pandemic, and what concerns you the most about it?

The heroism narrative became engrained very quickly. I think it’s partly because news spreads so fast on social media. People shared their videos of the weekly clap and so on. And the pandemic has affected everyone’s lives.

But it really can be quite unhelpful as an approach. Just as healthcare workers have obligations to treat patients, society has obligations towards healthcare workers. I talk about those reciprocal obligations in the paper, and about how the heroism narrative distracts attention away from those obligations. Healthcare workers find the language quite uncomfortable. They also find it incredibly hard to cope with being referred to as heroes at the same time as seeing some people breaking lockdown rules.


What will you be focusing on next?

I hope that I’ve made a contribution to making people a little more aware of the heroism issue, and perhaps they will reflect a little more on society’s obligations towards healthcare workers.

More broadly, in my clinical work over the next couple of years I’ll be working in internal medicine across a range of specialties, such as cardiology, or geriatrics. And ethics applies across all parts of medicine, so I’m looking forward to using my clinical experiences to feed into my research on ethics. I’m going to be working on a project looking at how doctors communicate uncertainty to patients, which I’m really excited about.

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