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What does society expect from health workers? Viewpoint of sociology

What do patients think about doctors and medicine? What does society expect from people in white coats today? What trends in professional community should be given special attention? We invited Svetlana Aleinikova, analyst of the Belarusian Institute of Strategic Research, Candidate of Sociological Sciences, to discuss matters that are important for the medical community.

Svetlana, could you please describe the current level of trust of Belarusians in medical workers and the health system in general?

First of all, I wish to thank "Medicinsky Vestnik" for the invitation to discuss issues that, without exaggeration, are relevant both to medical workers and each of us. Medicine touches all aspects of our lives, we all somehow encounter the need to visit clinics, hospitals, and other health centers.

Speaking about assessment of health system activity, according to polls held by the Institute of Sociology of the National Academy of Sciences of Belarus, the population in general commends the quality of medical services provided, especially the work of ambulances, household doctors, private medical centers, there is a sufficient number of pharmacies and drugstores. At the same time, as polls show, people are concerned about staffing and equipment of medical institutions, professional development of medical staff, and the availability of medicines. Even before the pandemic, the problem of long waiting lists, especially for narrow specialists, was mentioned among the most urgent.

At the same time, the growth in the number of polyclinics (from 1,622 to 2,288 over 1995-2019, according to the National Statistical Committee of the Republic of Belarus) and the measures taken (introduction of electronic queues, the priority referral of young specialists to primary care, introduction of general practitioners, etc.) contribute to addressing the queues problems in polyclinics. Describing the current situation, the pandemic period has become a major stress test for the work of the health system, highlighting both its strong and the most acute, but to some extent obsolet problems, addressing which will contribute to more efficient work of the industry.

How has the level of trust and attitude towards the medical profession changed over the past decades? Many doctors note the decline in the profession credibility. When did it start? Maybe, when transiting from "medical care" to "medical services"? Or with the emerging of "Dr. Google", when patients began to question the doctor's competences?

Here you need to clearly distinguish between two phenomena: the first is the status of a doctor in community (it is precisely measured by the level of trust, satisfaction, etc.), the second is his sense of self. It would be a mistake to equate these two phenomena with each other. Speaking about sociological measurements, the level of trust in doctors in the Belarusian society is consistently high, and recently, amidst a certain decline in the popularity of the main social institutions, on the contrary, is almost one of the most significant.

The same can be said about the level of income. People have always assessed and will further assess, the professionalism and status of the doctor not by salary slip but by how qualified he is in providing a medical care. But if the self-esteem and self-identity of medical workers are reduced to "decline in the profession credibility", this is a clear signal to society. In the context of general shortage of resources, I think, we need to expect the gradual introduction of insurance medicine, upgrading the competitive-permitting environment for the provision of paid medical services, medical tourism, etc.

On the whole, I would say, that the cases of population's dissatisfaction with the work of the health care system are mainly related not to the quality of medicine, but to the mismatch of reciprocal expectations in the "doctor-society" framework, i.e., to the quality of interaction. Doctors expect the society and the patient to respect their status, the patients – accessibility of medical assistance, attention to themselves, i.e. the higher level of service. A change in the parties' attitudes towards each other is a critical condition for such interaction.

What trends in attitude towards doctors have developed over the past year? The fight against the pandemic has made doctors and nurses heroes, and people are commited to helping them with their own efforts and money. How long do you think this effect is going to continue?

It's a hard question. On the one hand, the first wave of coronavirus entailed a burst of rare solidarity and self-organization of the Belarusian society in combating the virus. We could see the development of a new tradition of social interaction manifested in social initiatives from below: inclusion of private business in humanitarian activities, informal patronage of the elderly, hospitals, etc. On the other hand, coronavirus is gradually becoming a daily thing, reducing the sense of urgency and, as a result, the will to active assistance. Hence it is no surprise if surges of enthusiasm would grow weaker — it is always moving along a sine, these are the laws of society. In this regard, I assume, it is important to consolidate the effect by establishing long-term interaction with those volunteer organizations that have proved themselves as permanent and reliable partners, working not for image, but for the overall outcome.

A doctor is a complex profession that requires long training and continuous professional development. Entry to medical universities is highly competitive, only the best are enrolled. But the reality is that doctors, especially young professionals, work for little money, and the absolute majority for 1.5-2 times the official work rate... In your opinion, can this affect the mental well-being of an individual in the future? What are the short- and long-term consequences of such overloads, both for health workers and society on the whole? How many medical graduates remain in the profession after obligatory practice?

Unfortunately, I do not have statistics on how many medical graduates remain in the profession, I can only say this is a general trend for many areas, not only medicine. People leave for various reasons: material considerations, will for career progression, some realizes that the chosen path is "not his".

But the number of medical vacancies is gradually increasing, and this is an ominous sign indeed, given that most doctors work for 1.5 times the official work rate. Continuous overload and high stresses bears the risk of accelerated professional burnout of any specialist, and for medicine this is also an increased risk of malpractice. At the same time, sociologists, examining the opinions and assessments of both Russian and Belarusian medical workers, agree that their social well-being is not only related to the wages level.

Apart from income, these are a multi-layered reporting, not always well-organized internal logistics, overloading of doctors, assaults of "tough" patients who even before visiting the doctor have decided everything on their own by consulting the said "Dr. Google", etc. A certain role is played by some media which use single examples to launch a stereotype about the alleged lack of professionalism and corporate solidarity of doctors. This is a painful matter but it is impossible not to mention it, since pleasing someone's "hype" interests means the entire industry starts to suffer.

With the reduced workload and improved instruments of legal protection (for example, insuring medical risks), the opportunities for professional progression, doctors' attitude towards working conditions, and the population's attitude towards the work of the health system, can substantially increase.

The essence of the matter is that state subsidies for medical services ensure their high quality and accessibility, creating the ground for consumer attitudes of the population, the major part of which interprets the word "service" as "they owe me". The consequence is that in some cases a patient, when consulting a health center, perceives a medical specialist as a service staff, and himself as a client who is "always right". A redundancy of proceedings at polyclinics also needs to be optimised as they take a considerable time of household doctor's appointment, sometimes to the detriment of a patient.

Another tendency that may be mentioned is that people are not always responsible for their own health and do not find it necessary to fully follow the prescriptions (maybe, one of the most typical examples is giving up antibiotics on the third day, because "why take if I feel better"). But if the feel worse, they make claims to the doctor who prescribed "the wrong medication". Of course, the doctor is obliged to provide the required assistance whether he likes the patient or not, but the patient as well has to monitor his health, follow recommendations, and not self-medicate. Society needs to comprehend that in the "doctor-patient" interaction, it is the doctor who is the chief.

From the sociological standpoint, what processes emerging in the health care system are the most important and decisive? What trends would you recommend paying special attention to?

In any industry, one of the main issues is the staff training, the succession of generations, and the transfer of experience. The demand for our doctors abroad demonstrates a high level of national education, but its necessary component is also to ensure the professional growth of a medical worker (re-training, professional improvement, internships, etc.).

From the sociologist's viewpoint, the social aspect of the disease — how it is treated by society – is an important issue. This applies not only to the preventing diseases or medical rehabilitation, but also to the patients adaptation after serious illnesses. In the case of premature disability (for example, when receiving a non-working disability degree), a person is often left overboard of active life, nor he can support himself. This increases pressure on pension and social services.

According to the National Statistical Committee of the Republic of Belarus, for many years cardiovascular diseases and oncology have invariably been two main mortality causes in the country. The situation is aggravated by the fact that these diseases bring down not only the patients themselves, but often their close ones who have to look after seriously ill patients or seek funds for their treatment and rehabilitation. Such diseases, apart from mere treatment, address pressing social issues: improving the hospices and rehabilitation system, social and professional adaptation, retraining, employment to easier jobs for those who need post-illness recovery. A person who has survived serious illness has the right to expect an acceptable quality of life — and this is one of the key areas of the health system development. Besides, given the trend of the general aging of the population, the importance of the "geriatric medicine", the development of gerontology centers and other social services promoting active longevity, will be increasing.

Let's talk about moral and ethical side of the relationship between doctors and society. Recently, one of the most pressing issues discussed in health workers private chats rooms is the public expression of their citizenship. For many, this is what society expects from them. To counter this, there is an opinion that doctors should first of all remain professionals – to focus on their duties being impartial. What is the measure of a doctor's professionalism?

I can't speak from the standpoint of medical ethics, but as a sociologist, that is, a person who studies the needs and expectations of society, will say the following.

Society expects from the doctor, first of all, the medical assistance, and from the healthcare system — its continuous operation, which condition the health and lives of hundreds of thousands of people. After all, in case of an illness, a person simply has no one else to seek help from, except a doctor. Moreover, our society has already been hit during coronavirus, when many health centers were re-profiled and limited the provision of a planned care. That is why all other expectations are secondary, and the thesis "the doctor is out of politics" remains valid. At the same time, I do not fully agree with the thesis that to remain a professional means to be impartial. We are all citizens of our country and to stay indifferent to our common future is difficult.

What measures can now reduce tensions in certain circles of the medical community?

If we do not focus on today and look from the standpoint of developing the social processes, the ongoing politicization of society, including medical community, is quite understandable and predictable. Doctors, like no other, by virtue of their special profession, are able to analyze cause-and-effect relationships and recognize "side effects" of immediate measures.

Medicine is the health of the nation, the matter of the future of any country. Perhaps it is time to start working together on a long-term National program for the health system development and involve not only doctors, but also lawyers, sociologists, social workers, managers, IT specialists, etc.m to this job. The national scale of such document will contribute to the solution of both long-standing issues of the industry and the definition of strategic directions for developing its future.