ChesterCountyMedicineSpring2019 - 7

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Herein lies the reason why doctors are such limited advocates.
We tend to limit ourselves to core patient care, we want to be
caring and loving healers maintaining neutrality in all other
aspects. Doctors are taught to keep personal preferences out
of the clinical realm and avoid political and social intercourse.
Moreover, finding time out of one's busy schedule can be difficult
and sometimes impossible.
Physicians are also not prepared well by medical schools and
residencies, advocacy not being a priority in their curriculum.
Most doctors don't even know what advocacy is. Dr. Rudolph
Virchow said "physicians are natural attorneys of the poor"
which is so true. In 2002 the American Board of Internal
Medicine in its charter on medical professionalism called
advocacy "commitment to the promotion of public health and
preventive medicine, as well as public advocacy on the part of
each physician." I think the American Medical Association has
a better definition "advocate for social, economic, educational
and political changes that ameliorate suffering and contribute to
human wellbeing."
To me advocacy comes in two parts:
1. Advocacy for our patients, which we are eminently qualified
to do and less reluctant to participate in. It is the most important
part of what we should be involved in and teach medical students
and residents as part of their core curriculum. Unfortunately, with
the change in insurance and employment patterns, advocating for
one's patients is becoming more and more difficult. Legislatures
should be our natural partners, unfortunately they have voters,
contributors, and other groups to deal with so it leaves us to do
the right thing and advocate for the sick because we have taken
the oath.
2. Advocacy for physicians, we are eminently poor at this, we
feel selfish and unscrupulous, unfortunately this has led to
diminished power to do the other positive things we can do.
While lawyers, engineers, and even blue collar workers have
unions and look after each other, we lag behind. Power that
doctors wielded not too long ago is replaced by how to survive,
when your own life is not settled how will one take care of those
under our watch. We must get involved in our own welfare, along
with our patients. Doctors have one of the highest burnout and
suicide rate of all professions. Forget about advocacy, most of us
are not even members of AMA, latest data showed only 25% of
physicians are members compared to 75% in 1950.
There is a much quoted saying, "if you are not sitting at the
table you could be the food." Advocacy is hard demanding work
and has no personal rewards; at times it feels prohibitive but it is
for the good of our patients and our colleagues and it is the right
thing to do.

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