The risks of being a physician advocate

As a future doctor, I believe that digital dialogue affords medicine a powerful responsibility to educate and engage. I believe physicians have a responsibility, as daily witnesses to the gaps and failures of public policy, to advocate for social justice and policy reform. I believe that medicine should extend beyond the proximate effects of illness and injury to address their root social etiologies.

I’ve always held these beliefs with firm conviction. I’ve always been passionate that the doctor’s role transcends the walls of the clinic and optimistic that the public physician holds the keys to better health and better care. Until now.

The NRA’s uproar surrounding Vivek Murthy’s confirmation as surgeon general brings to the forefront the risks of being a physician advocate. Public communication can engage patients, inform popular debate, and shape policy. Unfortunately, it can also draw attention, incite controversy, and alienate others, raising challenges that represent untested waters for the rigidly hierarchical, ‘keep-your-head-down’ culture of medicine.

It’s easy to be intimidated by stories like Dr. Murthy’s. To any student or young physician, the lesson is obvious: Shut up and stay in line, or face the risks.

No wonder so many physicians avoid the spotlight. Today, it’s the NRA discrediting Vivek Murthy for taking a stance on gun control. Tomorrow, it could well be a patient who disagrees with my views on abortion. Or a residency director who takes offense at my blogging on the Affordable Care Act. Or a hospital administrator who dislikes my tweets on abortion rights.

If medical students are concerned about communicating publicly, they have every right to be.

Do I value candor and integrity as an aspiring physician? Absolutely. But are those values worth the costs of alienating a patient, a residency director, or the powers that be who might impede my professional goals?

For the first time, I’m not so sure.

Amol Utrankar is a pre-medical student who blogs at Slackadem.

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  • kristyhawley

    This post is pretty discouraging for medical students and I hope that others do not agree with your assertion that this appointment convtroversy should guide our ability to be outspoken patient advocates. I do not interpret the resistance against his appointment from multiple different groups because he is a physician advocate. The resistance stems from the fact that he decided to become extremely politically aligned early in his career. If you are the founder of an organization originally called “Doctors for Obama” that helped Obama generate enough support from the medical establishment to push the ACA through, it’s no wonder that you are going to get politically attacked from the right. If you want to play the political game, be prepared to deal with the political machine, which is never pretty. If becoming the Surgeon General to promote public health was his primary career agenda, someone should have advised him to have some patience and take a longer and more calculated approach. Rather than get the nomination through political means (and yes, some limited public health experience and impressive academic credentials), he should have truly earned the nomination from 20-30+ years of practicing medicine and public health. I think if we start choosing Surgeon Generals based off their political abilities and self-promotion, rather than their proven dedication to public health through years of work on the ground (think: public health commissioner for a large city, hospital administration in primary care, medical director for a clinic in an underserved area, etc.), then we truly do a disservice to the position that is supposed to drive the nation’s public health agenda, not a political agenda. Dr. Murthy’s talent to bring physicians together through his work with DFA is impressive, but I fear that this talent alone will not make up for his limited work on public health efforts in the United States. Students should not fear being an advocate or speaking up for what is best for their patients or the profession. Students should just be weary of being too connected to the political machinery so that others may think that this could cloud your judgement as the “nation’s physician”. If you’re willing to take a strong political stance, this may in fact benefit the public health, but don’t be shocked when you have to deal with the political aftermath — physicians are not immune to it and nor should they be.

  • azmd

    Medical students should definitely not be concerned with communicating publicly. They should just be concerned about how easy it is to fall into the trap of confusing the ability to communicate with a wide audience and engage on political topics, with the ability to practice medicine proficiently, and have the kind of extensive systemic experience that is required to for someone be an effective leader (in any discipline).
    An unfortunate consequence of the rise of social media is that anyone who can tweet or blog can present themselves as an expert, and be believed by a certain number of people. But having people believe you’re expert at what you do is not the same as actually having the expertise that is required of a true leader.

  • Patient Kit

    I agree that there are serious risks for doctors speaking up and advocating for your patients and for yourselves. Each individual must decide for themselves just how much they are willing to risk and what and who they are willing to put something on the line for. In doctor terms, do the risk/benefit analysis and make a decision.

    But it should also be acknowledged that there are equally serious risks to doing nothing, not speaking up, not advocating for yourself or your patients, not rocking the boat, laying low and hoping someone else will take the risk and do it for you. We’re all currently living with the result of nobody speaking up as Big Health in the US becomes a bigger and bigger profit-driven business with big benefits for the few at the top of those corporations and major problems for both doctors and patients down below.

    The best way to minimize the risks to individual advocates is to start advocating together in a group more. But there will always be risks attached to both what we do — and what we don’t do.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Well, yes, advocacy carries lots of risks, and it always did. People used to be ostracized, tortured, and killed when their advocacy ran contrary to the views or interests of the ruling elites. If I’m not mistaken, entire religions were born this way….
    Things are better today, since all you stand to lose is an illustrious career in the public sector. Try getting an appointment to a Federal bench, for example, after advocating against the death penalty. Try a Supreme Court appointment if you are advocating against/for a woman’s right to choose, privacy rights, or any number of public health issues.
    We had some periods in this country when intellect and brilliance were at least part of the considerations, but right now bland mediocrity carries the day every single time, and it shows.

  • John Henry

    Vivek Murthy should not be surprised by the reaction of the NRA to his positions on gun control. He has used web social media and has created a record that serves as a reference for his opinions. Unfortunately, what he does not have is a substantial career as an expert on public health. He has a nice academic pedigree, but his relative youth and his very clear affiliation with this administration and its political organizing makes him someone difficult to separate from the administration’s political positions, and particularly those positions that are most divisive. Dr. Murthy takes on gun control and the gun lobby. He has done so in a way that has shown disdain for his opponents, and has left a trail of twitter quotes to prove it. Even if Murthy disdains the NRA and its predictable public advocacy, he apparently forgets that the issue of gun control is something of a foil for a larger culture division in this country, one that divides the affluent from those who are not, those who are educated at certain institutions from those that are not, those who live in centers of urban affluence on the coasts from those who live elsewhere. When you don’t have an independent, distinguished and substantial career of your own behind you to fill out your qualification as a public health leader, and you take on third-rail issues, it’s hard not to look like an over-educated shill for the most liberal and most divisive element of this administration.

    • guest

      Exactly. I am not sure we want a Surgeon General with such a clear track record of divisive behavior. The gun lobby is extremely influential; the kind of “cheap-shot” political posturing that President Obama has popularized is not at all statesmanlike. Even worse, it is an ineffective approach, but people like Dr. Murthy are just too young to realize that.

  • Eric W Thompson

    When you start telling people how they are to live, you become a target. People die by guns, cars, smoking and a host of other things. Many lifestyles are unhealthy and have negative outcomes. Promiscuity is not healthy. Children raised in single parent households are at much greater risk in life. Would it be right to make promiscuity illegal? Single parents? He chose one politically correct issue to push forward and ignored other obvious issues. There are many more like these on which he would not dare to voice an opinon. Telling people how to live is a favorite past time of both the right and the left.

  • Justin Berk

    Hey man – yes keep writing.

    “But are those values worth the costs of alienating a patient, a residency director, or the powers that be who might impede my professional goals?”

    Yes. Yes they are. Ideals, values, and truly fighting for the patient are worth the possible costs of offending a close-minded residency director.

    Medical students should be worried about what they write as it may come back to them, but all the more reason to find a cause that is truly worth such passion and support the movement.