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Medical Schools Need to Produce More Clinician-Activists to Help Drive Social Change

Discussion in 'Medical Students Cafe' started by Hadeel Abdelkariem, Sep 30, 2019.

  1. Hadeel Abdelkariem

    Hadeel Abdelkariem Golden Member

    Apr 1, 2018
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    For hundreds of years, health care providers have been on the front lines of social change. Think Margaret Sanger, a nurse who championed women’s rights and started the organization that later became Planned Parenthood, or Max Recamier, one of the physician founders of Doctors Without Borders, who openly worked against governments fomenting violence.


    As we lose more and more clinicians to burnout, our nation is losing some of its most effective agents for social change. And if medical schools choose to heed Dr. Stanley Goldfarb’s recent call to shun “social justice” in medical education (the quotes are Goldfarb’s), then we could very well lose a whole generation of them.

    Goldfarb goes on to chide medical curricula’s “increasing focus on climate change, social inequities, gun violence, bias, and other progressive causes only tangentially related to treating illness.”

    I disagree.

    Not only are those factors inextricably tied to health, but they are also social determinants of health on which clinicians are uniquely positioned to act.

    In “The Doctor-Activist,” Dr. Ellen Bassuk shares the stories of dozens of clinicians who pioneered the most vital social advances of the last century. From workplace safety to civil rights, doctors have played significant roles in just about every social movement in U.S. history.

    The pursuit of women’s rights, for example, was bound to the autonomy of women’s bodies. As advances in medicine provided birth control and abortion access, women’s choices expanded — along with their sense of agency and control. We can thank Sanger for that effort.

    Early in the fight for gay rights, as LGBTQ communities were battling the diseases of discrimination and AIDS, it was a doctor — Anthony Fauci — who laid hands on the bodies of dying patients and humanized a population.

    In the rural South, clinicians like Dr. Daniel Blumenthal, one of the first VISTA volunteers in Jim Crow-dominated Arkansas, worked in black communities to desegregate clinics, form integrated community advisory boards for health clinics, and advance issues like educational justice and access to housing in historically underserved communities.

    The list of clinicians as agents of social change is exhaustive. From Flint, Mich., to the U.S.-Mexico border, health care providers are today working to improve the lives of their patients by improving (or dismantling) the structures that contribute to poor health. These days it’s hard to be a doctor without being an advocate.

    And yet here we are with an influential physician like Goldfarb, a former associate dean of curriculum at the University of Pennsylvania’s Perelman School of Medicine, saying that “medical schools are not the right place to produce [activists].”

    Actually, medical schools need to produce more clinician-activists to help drive social change, for at least two reasons.

    One is because clinicians have a unique vantage point: They are privy to social trends long before those trends become epidemics in our communities. When they observe patient after patient with the same diagnosis, they’re the first to see the patterns. That perspective is critical. As Dr. Rudolf Virchow, the father of modern pathology, rightly noted, “Medicine, as a social science … has the obligation to point out problems … physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.”

    Another is because Americans have thrust the work of social healing on doctors — abdicating responsibility to clinicians to treat what we cannot see, refuse to acknowledge, or lack the political will to confront. We won’t address gun access, so doctors dress gunshots. We won’t prevent hunger or homelessness, so doctors prescribe food and shelter. Our communities are fractured, so doctors are left treating anxiety and depression. If we lose our doctors, who will take on what the rest of us have neglected?

    It’s time to widen the pipeline of socially active doctors, not narrow it.

    We can do that by incorporating — not eliminating — advocacy training in the education of health professionals. Health systems can designate the spaces and time for providers to gather in support of one another and advance specific measures to alleviate the social determinants of health that bring patients to their clinics every day.

    And the public can partner with clinicians to tackle the chronic conditions we’ve shamefully abandoned to them. We need to engage health care professionals in meaningful social change. It’s good for them, and even better for us.

    Health care professionals are our canaries in the coal mines of society. Let’s use that insight, the data that follow from it, and our conviction to make the kinds of change we simply can’t do on our own.

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