1st Place - How Has 2020 Changed Attitudes Towards Medicine?
By Haneen Ali, Year 12, Watford Grammar School for Girls
2020 was a year of uncertainty, exhaustion, and changes in social and medical practice- which few of us envisaged to extend well into 2021. No other event has upturned healthcare and its perception by the UK general public as much since Aneurin Bevan launched the NHS in 1948. While it is easy to concentrate on the negatives, such as increased barriers to secondary care for non-Covid patients, it is worth noting that the pandemic may have sparked beneficial changes in attitudes of both patients and practitioners.
The most visible positive change in attitude to medicine has been that of personal hygiene. The public’s current concern with more frequent handwashing, sanitising and mask-wearing has limited the spread of more than just Covid-19. Hospitals have seen a sharp decline in paediatric admissions for respiratory illnesses such as influenza, respiratory syncytial virus, and human metapneumovirus (Nelson, 2020). These are some of the leading causes of respiratory infections in vulnerable patients, for which there are few treatments. Thanks to distancing measures and better hygiene, it is likely that many patients who would have otherwise suffered from these illnesses have been saved. Overall, this shift in hygiene standards is likely one of the more short-term changes in attitudes to medicine, but if we can maintain this increased sanitation over the next few years then many more lives will be protected.
Unfortunately, more frequent hand-washing can’t explain the drop in admissions for common emergencies such as heart attack and stroke (Sheth, 2020). Zoran Lasic, a New York based cardiologist, recalls a colleague’s worry for their husband, who had been suffering severe chest pressure accompanied by dyspnea and diaphoresis. An ambulance had been called, and after a seemingly normal ECG result, the patient- a 56-year-old whose father died of sudden cardiac arrest at 55- was told to contact his doctor. However, the practice advised him not to go to the hospital given the Covid-19 outbreak. Lasic advised and carried out urgent coronary angiography. The patient had a thrombus extending from his proximal-to-mid left anterior descending artery and became hemodynamically unstable during the procedure. Fortunately, revascularization was successful, and he was discharged the following day with preserved left ventricular function (Rosenbaum et al., 2021).
While Lasic’s patient was fortunately able to access treatment, many more patients like him were faced with barriers to healthcare due to the pandemic. An American study in May found that 42% of respondents felt uncomfortable going to a hospital for any medical treatment (ACHP, 2020). The fear of contracting and spreading the virus remains a high priority, and the fear of “bothering the doctor” has soared amid images of frontline workers risking their lives in hospitals. Patients are faced with a tortuous dilemma: should they remain defenceless at home without any care, or go to the hospital where they risk contracting the virus?
Self care and preventive medicine
For many non-urgent cases, there is thankfully a third option. Almost half of Britons surveyed plan to consult their pharmacist first for advice when suffering from smaller physical problems (GSK, 2020). The pandemic has changed patients’ attitudes to the way they access healthcare services, highlighting the importance of pharmacists in today’s shifting health system. As fewer patients come in due to seasonal coughs and colds, general practices and A&E departments remain under slightly less strain- for now.
Yet patients are faced with a further dilemma: how do the risks of leaving their homes and going to medical facilities stack up against the well-documented benefits of preventive care? The response for many has, understandably, been to put preventive medicine in the backseat. Childhood vaccines have fallen drastically, as have PSA tests and cancer screenings (Martin et al., 2021). The long-term result could be the risk of increased outbreaks for childhood communicable diseases and delayed diagnosis of cancer (Al-Kuwari et al., 2021).
It is easy to interchange ‘2020’ for ‘Covid-19’. However, in doing so we must not forget the other significant movements and achievements of the year. Malone Mukwende, a medical student based in London, created ‘Mind the Gap’- a handbook of images and descriptions of clinical signs and symptoms in black and brown skin. He said: “The aim is that in about 10 to 15 years we can look back and say that 2020 was the year that the shift to reduce some of these healthcare disparities and increase representation of images in medical education happened”. This was a huge step forward in attitudes to teaching dermatology, especially considering that the majority of medical students are only taught how to diagnose conditions on white patients (Cassata, 2020).
Quite ironically, the UK government report on race disparities hides behind a facade of false equality. The March 2021 report claims that “for many key health outcomes including life expectancy and overall mortality… ethnic minority groups have better outcomes than the White population”. Yet decades of peer-reviewed evidence and reviews have reached similar conclusions: that ethnic minorities have the worst health outcomes on almost all health parameters (Razai et al., 2021).
Rather than manipulating statistics to hide the clear ethnic disparities that exist in healthcare, it is imperative that we acknowledge and strive to abolish their fundamental cause: institutional racism. Only then are we able to attack its roots: by shifting towards a medical community that is representative of patients and staff at every level. This includes not only the healthcare system but scholarship, research, and teaching (Abdulrahman, 2020). Prioritising the implementation of these changes is the only way to permanently improve attitudes to ethnic diversity in medicine.
2020 has left no corner of medicine untouched. Though preventive medicine has benefited from the public’s attitude to hygiene and sanitation, standpoints on measures such as non-Covid vaccinations and cancer screenings have hindered it. Increased public awareness of the role of pharmacists could perhaps have the most significant impacts on medicine, by steadily reducing stress on GPs and A&E departments in the coming years. However, in terms of gender diversity, a change in attitude alone will not suffice: clear, achievable steps must be set out if we truly want to make a change to the system. Let us hope that from this year onwards, we can work to combat the negatives, and integrate these positive attitudes in our healthcare system.
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