In this post, Anson Tong (studying MSc Behavioural Science) discusses two studies presented at the LSE-JHU Special Online Conference on Experimental Insights from Behavioral Economics on Covid-19 (February 2021), and explores the burden the pandemic has placed on healthcare workers. Anson suggests that mental health concerns must be addressed and the healthcare infrastructure supported to support the profession now and in the future.

A year into the pandemic, what can behavioural science tell us about how healthcare workers have been affected?

Healthcare workers have been at the forefront of the COVID-19 pandemic for over a year now, with the pandemic raising many questions about the future of the healthcare workforce. The traumatic experience of the last year, especially for emergency medicine physicians and nurses, may contribute to early retirements or career changes.

On the other hand, the vital role of this sector over the past year may have inspired a new generation of healthcare workers to pursue training and employment. It is important to understand what impacts the pandemic may have on the supply of doctors in the coming years as well as what medical specialties they choose to go into. The wellbeing of those who remain in the profession may also be precarious.

Back in October 2020, University of Chicago Law Professor Lee Anne Fennell wrote in The Behavioral Scientist about how COVID-19 could be thought of as a configuration crisis: “We face enormous challenges, but the primary problem is not that we lack the necessary resources and skills to address them. The hitch, instead, is that we have tremendous difficulty putting what we have into the combinations we need.” As a society, we had to reconfigure how school and work were conducted, how we queued at the grocery store, how we did (and did not) interact with one another.

Reconfiguration is a behavioural science issue at the systems level. Now, as we begin to emerge from the pandemic, it’s time for us to sit down with all the pieces and examine what worked, and what didn’t for the healthcare profession, and what we can retain as we move forward. Researchers have begun investigating questions surrounding the current and future role of the healthcare profession.

“How willing are you for your child to work in the medical field in the future?”

Lian Xue and collaborators at Wuhan University examined preferences regarding the medical occupation in post-lockdown Wuhan. They surveyed medical and non-medical workers in Wuhan and in other parts of China about their feelings about their children working in the medical field. Their main finding was that residents of Wuhan are much less likely to want their children to choose the medical occupation after the pandemic. Medical workers in Wuhan are significantly less likely than nonmedical workers. The beginning of the pandemic in many countries was characterized by hospitals overwhelmed by patients and undersupplied with PPE, which may be the negative impression of medicine that Wuhan residents are holding onto.

The medical workers in Wuhan also exhibited the lowest scores in risk-taking and prosocial attitudes. This trend should be studied further—lowered risk-taking and prosocial attitudes among particularly hard-hit communities may have ripple effects in many facets of life. It is unclear how long this change in preferences will last for. In an additional survey of medical students at Wuhan University, first year medical students exhibited higher prosociality than their peers in other fields of studies. These first-year medical students were also more prosocial than second-year medical students, who entered their studies prior to the pandemic. Further research should examine whether this difference in entering medical classes persists and is true across countries, and how it may impact future physician behaviour.

Pharmacies & COVID-19 Telephone Assessments

“Healthcare workers” is a term often taken to refer to doctors and nurses, but this can also include community health workers, physician’s assistants, care workers, and pharmacists. In low- and middle-income settings especially, pharmacies play a crucial role for patients as a community-oriented, faster, and less expensive place to seek out health advice.

One study done at the Universidad del Rosario, Bogota examined how pharmacies dealt with telephone symptom assessments in Colombia. The researchers called 262 pharmacies and reported symptoms. The control group reported headache, fever, and sore throat. The COVID group reported these symptoms and anosmia, loss of smell, which has been a notable symptom in a large portion of symptomatic COVID-19 cases. Four outcomes were recorded: reporting to the COVID phone line, suggesting medical care, suggesting coming to the pharmacy, and recommending a prescription. They found that the mention of anosmia induced more cautious behaviour among pharmacies. Interestingly, two of the three departments in Colombia that they sampled from are also endemic with dengue fever, which has similar symptoms to COVID except for anosmia and found no difference in behaviour between the dengue endemic and non-dengue endemic areas. This study evaluates how well pharmacies were able to direct patients to appropriate resources based on their reported symptoms, and draws attention to how pharmacies fill a gap in access to healthcare. As countries examine what went wrong and what went right in healthcare in the last year, it is crucial that they look beyond the hospitals and learn to better leverage institutions like pharmacies in tackling other health-related issues.

To Determine Treatment, We Need Diagnoses

The long-term impacts of the past year are widespread and complex. Health systems around the world were pushed to their limits in responding to the COVID-19 crisis. At the core of every health system is the people working in hospitals, clinics, pharmacies, and community health settings. The pandemic has exacerbated issues that have been around for a long time, like the burnout and attrition of overburdened doctors, doctor shortages in many countries, and health disparities in marginalized groups. Our healthcare workers worked harrowing hours, in emotionally traumatizing situations, often without enough PPE, to care for patients. Part of thanking our healthcare workers for their sacrifices is understanding and addressing their mental health concerns, supporting the strengthening of our healthcare systems through funding and restructuring, and making the profession better for current and future healthcare workers.

Notes:

• The views expressed in this post are of the author and not the Department of Psychological and Behavioural Science or London School of Economics and Political Science (LSE).
• Featured image Ehimetalor Akhere Unuabona via Unsplash.

Sources

These studies were presented as part of the LSE-JHU Special Online Conference on Experimental Insights from Behavioral Economics on Covid-19 on February 12 and 19 2021 and can be found linked below:

César Mantilla, Universidad del Rosario, Bogota. Information and symptoms assessment in community pharmacies during the COVID-19 pandemic: an audit study in Colombia.

Lian Xue, School of Economics and Management in Wuhan University. Medical Occupation Preference under the Influence of the COVID-19 Epidemic: Evidence from post-lockdown Wuhan.