A pediatrician husband recently wrote here in KevinMD about the stark differences in assumptions about work-life balance for men and women, in “What does your husband think of you being a surgeon?” Then I came across another article on Medscape by a male cardiologist, whose wife is also a physician, entitled, “The gender gap in cardiology is embarrassing.” Both men’s wives delayed their medical training, and these husbands bore witness to our culture’s implicit gender bias against their life partners. I strongly encourage you to read both pieces; they are short and poignant.
Now, consider how much more weight and influence these pieces carry, simply because they are written by men. If you find this difficult, imagine your internal response if they had been written from the women’s perspectives. Which position is more likely to evoke, “Hmm, interesting,” as opposed to, “What are these women whining about?”
When we consider advocacy, it’s fair to think of it as those with more power and influence using these advantages to champion those who have less. Sure, the less powerful and influential can and do advocate for themselves, but without allies among the advantaged, the message and movement stall and stutter. Consider slavery and the Civil Rights Movement. If it were only ever black people advocating for themselves, what would the American racial landscape would look like today? Think about women’s rights. There is a reason the United Nations launched the HeforShe campaign. Self-advocacy is required, but sorely inadequate, to lift people out of oppression. And let’s be clear: Oppression takes many forms, which we often fail recognize or acknowledge.
I have a fantasy about patients advocating for physicians.
I imagine Sally and John (names changed), two friends communing at their favorite coffee shop, one of their regular meetings of mind and soul. The conversation veers toward health care, and Sally starts ranting about how physicians don’t care about patients anymore. They’re only in it for the money, having sold out to pharma and industry, and they think of themselves as second only to God him(her)self, exercising control over patients’ lives with little regard or actual caring. In this coffee shop scenario, I as a physician have no power or influence. If I sat there with them, trying to explain how ‘the system’ drives wedges between us doctors and our patients, about how on average doctors spend twice as much time on administrative activities as patient care activities, how 50 percent of us report burnout, and how our suicide rate is up to 4 times that of the general public, I estimate that I’d likely be seen as whining and making excuses. In this scenario, facing a (rightfully) prejudiced audience, my voice counts for very little.
Although physicians still enjoy a fair amount of respect and deference in society, our struggles, personal and professional, are still poorly understood by the general public. I think people are even less cognizant of the insidious and profound detriment that physician burnout and depression have on patient care and the economy at large. But when doctors describe our adversities to patients, I think we still come across as whining. Knowing that I write this as a physician, what is your reaction? Is it closer to, “You live at the top of the food chain, what are you complaining about?” Or rather, “Wow, what’s going on that so many doctors feel so badly, and how could we all help one another?”
Lucky for doctors everywhere, John is my patient, and we have a longstanding, collaborative relationship. He empathizes with Sally’s perspective, as he knows what she has been through medically. He has also inquired about my work, and understands the systemic frustrations that physicians face in all fields. Because they are such good friends, John feels comfortable challenging Sally’s skewed assertions. He describes what he has learned from me, and explains earnestly that all doctors are not, in fact, swine. Because he is her trusted confidant, she believes him. Her attitude opens ever so slightly, and she is more likely to acknowledge how physicians and patients alike suffer from our overall health care structure. John is, in this case, the strongest advocate for me and my ilk.
Whenever one of us stands up as a member of a group, and speaks up to our peers on behalf of another group — white people for black people, men for women, Christians, Jews, and Muslims for Muslims, Christians, and Jews, liberals for conservatives, physicians for patients, and vice versa in each case — we are all elevated. Our mutual compassion and humanity are called forth to heal our divisions. This is how personal advocacy, how everyday power and influence, works.
As a patient, you have more power than you may realize. I bet most people don’t necessarily feel adversarial toward doctors. But they probably don’t necessarily feel allied, either. What can you, as a patient, do to bridge this gap? How else could we all, physicians and patients alike, create that essentially healing inter-tribal connection?
Catherine Cheng is an internal medicine physician who blogs at Healing Through Connection.
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