When physicians are complicit

The other day I asked myself why do I focus my attention on immigrants when there are plenty of other underserved and neglected populations.  When an opioid crisis surrounds me, why do I speak of a crisis at the border?  When structural and overt racism contributes to an infant mortality rate of 10.97 for black women’s babies, twice the rate for the nation as a whole.  When only 18 states have banned “conversion therapy” for minors who question their heterosexuality or binary genders.

After a lot of thought, I decided that working at the border was a response to a blatant injustice conducted by my country. The changing rules for entry, the biased system, inhumane conditions.  We are not treating people from other countries fairly.  As a citizen of the United States, I am complicit with these actions.  Injustice – not treating people equally.  I feel responsible for our wrong approach in dealing with persons fleeing conditions in their homelands.  And, I am affiliated with this group called the US by geography, heritage, and history.  Factors with which I had little choice in deciding.

So, why don’t I feel this same affiliation with the group defined as physicians?  A group I did choose, in a way.  Though race, wealth, exposure, location, and history contributed to my becoming a doctor in no less a random manner than my being born a citizen of the US.

Why not the same sense of responsibility for injustices perpetrated by my own profession?  I have not tirelessly responded to correct the damage caused by prescribing opioids as I have to immigration.  Instead, I stand to the side.  Silently arguing that my prescribing practices were without fault.  I am not to blame. Mildly irritated at new urine drug screen requirements.  Cringing at the thought of becoming an addiction medicine specialist.

What else am I complicit with as a practicing physician? What problem, what health hazards do I ignore?  Yesterday, I renewed someone’s proton pump inhibitor knowing that he shouldn’t be on it for so long.  Another patient was using a non-steroidal anti-inflammatory nearly every day.  My spoken advice was to stop or cut back, try an alternative, but in the end, I excused my inability to change those patient’s behaviors by attributing it to “individual choice.”  As many people say,” he drank, smoked, ate himself to death.”  But, as doctors, do we give up too easily?  Shouldn’t I take responsibility for that?

It is an injustice. Because some people are treated differently than others.  Even as physicians, we treat ourselves (intentionally or not ) better than our patients.  About a decade ago, I purchased long term care insurance.  The salesman had a special extremely low premium for doctors.  He said actuarially, we are healthier and live longer.  Access to care, high medical literacy, and better socio-economic factors certainly contribute to these outcomes.  But why am I not rallying against that discrepancy?

I feel more responsibility for the remote actions of a group I am only randomly affiliated with. And less culpability for those I could really be held accountable for.  Similarly, my degree of affiliation is indirectly proportional to my actual contribution to an injustice. Something to think about.

Ann Colbert is a family physician.

Image credit: Shutterstock.com

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