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Subject: qotd: Physician advocacy, activism and politics
Date: Mon, 15 Oct 2012 13:39:50 -0700
From: Don McCanne <email@example.com>
To: Quote-of-the-Day <firstname.lastname@example.org>
Medicine and Social Justice
October 13, 2012
Physician advocacy: for patients and for social change
By Josh Freeman
A recurring question for physicians and others in the health profession
is what degree of health advocacy is expected or appropriate. For those
of us in medical education, the question becomes how much of the
training (and evaluation) of medical students and residents should be
based on advocacy for their patients or populations.
In the United States, the clearest expression of the role of advocate is
in the American Medical Association's (AMA) Declaration of Professional
Responsibility: Medicine's Contract with Humanity, which contains, as
item #8, "Advocate for social, economic, educational, and political
changes that ameliorate suffering and contribute to human well-being."
Dobson and colleagues propose a parsing of the concept of advocacy into
two components. They call these "agency", working on behalf of the
interests of a specific patient, and "activism", which is more directed
toward changing social conditions that impact health, and whose effect
is seen on populations more than individuals.
They note that "...several studies have concluded that although
physicians generally endorse the idea of advocacy, they rarely engage in
it." They summarize the difference between agency and activism by saying
"...whereas agency is about working the system, engaging in activism is
about changing the system."
There are, however, many physicians who do act as social activists, and
we need more of them. The source will be medical students who then
become residents. Luckily, there seem to be no shortage of entering
medical students with this commitment. They demonstrate it by community
volunteer work, creating and working in free clinics, volunteering their
time to work in schools, and pursuing training in public health, public
policy, and community involvement. Sadly, however, along with empathy,
which has been shown to dramatically drop as medical students enter
their clinical training (Hojat, et al., and this blog, "Are we
training physicians to be empathic? Apparently not.", September 12,
2009), so does volunteerism and commitment to social change.
When we look at the American political landscape, we see a fair number
of physicians involved in politics. It could be argued that, in these
roles, they are advocating for social, economic, educational, and
political changes. What is disconcerting is that the majority of these
physician politicians seem to ignore the second half of that sentence,
"...that ameliorate suffering and contribute to human well-being". They
are often found among, and sometimes as leaders, in advocating policies
that slash the social safety net, decrease funding for public education,
and oppose universal health insurance. Too frequently, they act as
agents of their own social class than as advocates for those most in need.
That doctors will most often adopt the "agency" role when it comes to
issues that most directly affect the health of their patients, that can
be arguably seen as "medical", is very reassuring.
The advocacy role is more complex. Not only are many physicians socially
conservative and not, perhaps, in support of policies "…that ameliorate
suffering and contribute to human well-being," physicians are busy
people who mostly see themselves in the role of providing direct patient
care, not advocating for systemic societal change.
I would like to think that all physicians manifest advocacy in the
"agency" sense for their patients. It may be wishful thinking to hope
that all physicians will manifest advocacy in the "activist" sense, that
they will fulfill the AMA's Declaration by actually advocating "...for
social, economic, educational, and political changes that ameliorate
suffering and contribute to human well-being." But if we do not make
this a core value for physicians that is ubiquitously taught in medical
school and residency, if we do not select students because of their
commitment to advocacy, we will have much less of it.
And we need it badly.
(Joshua Freeman, MD is Chair of the Department of Family Medicine,
University of Kansas Medical Center. These excerpts are from his blog
and do not represent the views of the University of Kansas.)
GOP Doctors Caucus, U.S. Congress
True health care reform can only begin with a complete repeal of Obamacare.
The Doctors Caucus is committed to ensuring that all Americans have
access to quality health care. Doctors believe that chronic illness and
cost are two main barriers between patients and quality coverage.
Consumer-driven health reforms that seek to put the patient and their
physicians in control of how care is accessed can greatly increase a
patient's access to quality health care.
21 members of the GOP Doctors Caucus:
Comment: What is the disconnect between the activism of physicians who
serve in Congress advocating for social, economic and political changes,
and physicians in the community who advocate for ameliorating suffering
while contributing to human well-being? Didn't they all enter medical
school with the same altruism? Apparently not.
We now have a politically polarized nation. The medical profession has
not escaped this dichotomy. In Congress, it is not as balanced as it is
throughout the nation. The GOP Doctors Caucus has twenty-one members,
whereas there are only two Democratic physicians in Congress and one of
those, as a delegate, is not even allowed a vote on the House floor.
When you read the Priorities of the GOP Doctors Caucus, it is loaded
with warm, fuzzy, feel-good language. But if you are a student of health
policy, you recognize that they support policies that would greatly
increase the numbers of uninsured, and would expand a market of
"affordable" health plans that really just shift costs to users, making
health care access unaffordable for far too many. That might meet the
social, economic and political goals of the GOP Doctors Caucus, but at
the cost of exacerbating suffering and further impairing human well-being.
We wish that the partisan divide wasn't a chasm, but it won't go away.
Voters do bear some responsibility for having selected these physicians
to be their senators and representatives in Congress, but it is
difficult to blame them when the GOP Doctors Caucus stated mission is
"Utilizing medical expertise to develop patient-centered health care
reforms focused on quality, access, affordability, portability, and
choice." That sounds pretty good. How could the voters be expected to
understand the nefarious policy positions behind that statement?
For health care, many would agree that the filter should be at the
medical school admissions committee. Medical schools should select
students for whom ameliorating suffering and contributing to human
well-being is a part of their soul. The problem is that it may be
difficult to find enough admissions committee members who can pierce the
obfuscating feel-good language used by too many of the applicants - the
type of language that is so effectively used by the GOP Doctors Caucus.
(I apologize to Republican single payer supporters who might object to
what seems to be a partisan message. In my defense, the message is about
physician politicians and health care justice. It is the Republican
physicians in Congress who have made it partisan.)