If all politics is local, then Washington’s health care debacle has brought politics to the front stoop of every health care provider in America. There is no escaping it – debates taking place on Capitol Hill are set to affect the very survival of our patients. Irrespective of political leanings, doctors, nurses and providers of all stripes have ethical and professional obligations to speak up and become engaged in order to protect their patients.
While politics have always affected medicine – obstetricians and gynecologists have long fought for women’s health issues, for example – current political events have pushed this into overdrive. In our current political climate, it no longer even makes sense to distinguish between events in Washington and my patient in front of me.
Earlier this year, Congress put forth a bill that among other things would strip 23 million patients of their health insurance, allow insurance companies to exclude people with preexisting conditions, eliminate essential health benefits such as pediatric services, ambulance rides, and lab tests from their plans, and increase costs, especially to older Americans.
Politicians are speaking frankly — even eagerly — about stripping services away from patients who currently have them. Each patient I see becomes another example of someone whose life could be at risk should any of the measures debated in Congress pass into law.
My elderly patient’s infected bedsore, for example, could only worsen, leading to sepsis and even death if she could no longer fill her antibiotic prescription. My patient with breast cancer, if unable to obtain chemotherapy due to her “preexisting condition,” would inevitably die. And any pediatric patient I see could suddenly be at risk of entirely preventable illnesses if left unimmunized due to the elimination of their essential health benefits.
Suddenly, being a physician and ignoring politics has become a lot like being an airplane pilot and ignoring the fact we are flying with the cabin doors wide open. Patients are about to be whisked into the sky with no parachute – it is just as unethical to ignore politics as it would be to continue flying that plane pretending everything was OK.
The truth is that avoiding politics is not only unethical, but also unprofessional. While many doctors, scientists at heart, find political advocacy uncomfortable, it is in fact a required part of the job.
In order to be allowed to practice independently, physicians must graduate from a residency training program and demonstrate proficiency in six “core competencies”. Most of them, such as medical knowledge and patient care and procedure skills, are well known. It is the sixth – systems-based practice – that is often overlooked, but equal in importance.
To quote the governing body that mandates these requirements: doctors “must demonstrate an awareness of and responsiveness to the larger context and system of health care … and are expected to advocate for quality patient care and optimal patient care systems”.
In other words, to practice independently, we must not only know how to prescribe our medicines and perform our procedures, but also work toward improving our entire health care system. Our professional governing body makes no distinction between helping patients through syringes, scalpels or statutes.
As German physician Rudolph Virchow noted in 1848: “Medicine is a social science, and politics is nothing else but medicine on a large scale.”
Importantly, as physicians, we advocate for our patients all the time. We feel completely at ease when we do this on the day-to-day level. If one of our patients cannot get an appropriate follow-up appointment with a specialist or their insurance company denies them a specific medication, for example, we eagerly take up arms. We fight a million reams of red tape on a daily basis to get that one patient what she needs.
We must now embrace this same ethos on a macro level by lobbying our representatives, joining activist groups and even running for office ourselves. The only difference is the outsize impact these efforts could have: working through a single ream of red tape in the form of legislation could positively affect the lives of millions of patients.
Laws affecting human lives should not be drawn along partisan lines, but by evidence-based policy that’s best for constituents. As Washington fails this litmus test, citizens must step up. As health care providers, advocating for our patients is both an ethical imperative and a professional requirement. Our patients depend on us for their care – we must help them get it, whether that comes in the form of pill or policy.
Farzon A. Nahvi is an emergency physician. This article originally appeared in the Guardian.
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