On March 14, students across the country plan to walk out of their classrooms to protest gun violence and urge Congress to act in response to the Parkland high school shooting that killed 17 people.
The American Academy of Pediatrics (AAP) representing the pediatric community released a statement on February 15 that called “for stronger state and federal gun laws that protect children, including a ban on assault weapons like the one used in yesterday's school shooting. We also call for stronger background checks, solutions addressing firearm trafficking, and encouraging safe firearm storage.”
As a pediatrician, I strongly agree with the AAP statement. But, the one area we aren't discussing nearly enough is how individual physicians can step into roles as activists on issues related not only to gun violence, but also health care, obesity, poverty and mental health.
Physicians, after all, are on the front lines and witness the impact on patients’ lives.
And why individual physicians might be reluctant to play a role in physician advocacy—that is, direct action by physician to promote social, economic, educational and political changes to improve health—is worth exploring.
In medical school at the very beginning of my career as a pediatric cardiologist and bioethicist, I was introduced to a famous painting titled The Country Doctor by Sir Luke Fildes. As parents watch and pray in the background, a doctor is sitting solemnly next to a dying child. This painting is classically used to depict the devotion of the doctor, and to remind young doctors in training of the importance of being present for the patient and the family, even when medicine can no longer help. But, what is missing in the painting is also worth discussing.
While physicians are taught to serve individual patients, their wider potential for advocacy is underrepresented, or sometimes ignored.
Physicians are trained to be objective and apolitical. Because the values of scientific objectivity are so prominent in the medical field, physicians are hesitant to join the sphere of advocacy.
Certainly, it may be easier to tell ourselves that these issues belong in the space of policy and politics—physicians should simply take care of their individual patients.
Many medical societies recognize physician advocacy to be a critical part of medical professionalism. The American Medical Association, in its declaration of professional responsibilities, has stated that physicians must “advocate for the social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being.” The American Board of Internal Medicine, in its charter on medical professionalism, called for a “commitment to the promotion of public health and preventive medicine, as well as public advocacy on the part of each physician.”
But despite this official recognition of physicians’ value in the political conversation, knowing how to put advocacy into practice remains problematic. There are thoughtful perspectives on what physician advocacy can look like, but no data exist on how many physicians actually participate in advocacy work.
One way to encourage participation and underscore the importance of such effort is to start early. As students begin medical school, we must introduce the theory, practice and modeling of physician advocacy at the same time they are learning basic anatomy and physiology. The Royal College of Physicians and Surgeons of Canada mandates health advocacy as a core competency. Early exposure to examples of how physicians interweave advocacy work into their clinical work may lead to higher likelihood of engaging young trainees.
In fact, the medical school where I teach has incorporated a health equity and advocacy curriculum in the first year of medical school. Yet, far more is needed to both train future physicians and stress the urgent importance of advocacy work to existing physicians across disciplines.
Having witnessed some physicians practice advocacy work has been especially important in my own growth and development as a physician advocate. This includes seeing physicians have a presence in the media, write opinion-editorial pieces, engage in local politics and testify to state and national lawmakers, write policy statements, create patient advocacy groups to increase awareness and impact legislation, and sit on national boards whose mission was to improve health care for all.
To be sure, some have argued that civic virtues are outside the professional realm of being a physician. There are real risks, which may include employer retaliation and being accused of not maintaining neutrality. And, taking on an advocacy role in addition to being a good doctor for your own patients can be daunting and time-prohibitive.
However, having a mission and potential to impact change on a larger scale can be fulfilling and life changing. For many of us, the words of Rudolf Virchow, the father of modern pathology, ring true: “Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution. The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.”
Fifteen years later, as I credit this painting for helping me understand my duties to my individual patient, and as I teach the next generation of physicians, I am equally compelled to bring advocacy into the realm of physician responsibility. All physicians have an opportunity, if not obligation, to play a clear role as advocate.
The medical profession must create a new painting for future physicians to look to for inspiration—one that incorporates the mission of civic duty and desire to be a voice in the national conversation.
Only by engaging can the medical profession realize the full potential of our expertise—not only for healing and curing disease, but also tackling the underlying societal issues that cause the harm in the first place.
If young teenagers can embrace activism and say #Enough by engaging in the political conversation, certainly physicians can too.