Learning objectives
1. Describe the four levels of health advocacy as a physician – interpersonal, organizational, health system and policy
2. Identify the six keys for effective advocacy
3. Identify effective ways to incorporate the community into your advocacy
4. Identify key points to effectively advocate in writing through letters to the editor
5. Reflect upon your personal goals for advocacy as a future physician
Please read / view the above readings and then respond to one or both prompts below. As a group, use the page to respond to each other’s posts (at least one response to another student).
-I think that advocacy as a physician is absolution an obligation- at least in most patient facing fields. When I think about my future role as an ER doc, I think it is absolutely vital to be able to advocate for my patients with admitting teams, consultants, team members, and community resources. At the end of the day, people show up to the ER universally in a vulnerable state. No one comes to the ER because they can figure it out at home, so it is (or will be) my responsibility to make sure that their best interests are protected, that they are safe, and that they get the best care possible in a system and an world of science that they may not understand.
-I think patient vs. system advocacy is such a hard question. If the system is broken, often times patient/individual advocacy can’t work. I think without question both are required to function and function well. Ultimately, the doc who can advocate beyond the limits of the system takes care of their patient, but risks burn out for themselves. The doc who can fix the system but doesn’t fight for the individuals who are a part of it misses the point. When it comes down to it, I see myself fighting for the individual, and I think that can often feel more noble than fixing the system, but I hope to be involved in both and provide expertise and honesty where I need to in order to change the system for the better.
I like your point about how advocacy in an increasingly difficult system can perpetuate burnout among docs. A burnt out doc is a doc who cannot fully show up for patients. This is a difficult line to draw, where we advocate for patients as individuals vs advocacy at the systems level. I like how you talk about your role in the ED as being an advocate at the level of the patient, and think that is how we all can do right by our patients.
I agree with you Laura. When the system is broken, it makes patient advocacy much more difficult. But at the end of the day, you need to ensure you are first advocating for your patients, and ensure their care is appropriately being addressed. When patterns emerge in barriers, it is important to investigate and potentially ask colleagues if they have found ways to address these barriers. If they have not, it creates the opportunity to collaborate more to advocate on a system level.
There is no question that advocacy is paramount to the role of a physician. In terms of how to be most effective as a physician advocate, I believe that a greater impact can actually be had initially at the individual patient level. Healthcare systems across the United States have grown increasingly contrived in the last few decades. The rise of red tape billing practices, private equity ownership, etc. makes navigation of the system significantly more challenging for the average layperson. As doctors who know more about how these systems operate, albeit marginally more, we have a responsibility to help patents navigate that system to achieve health goals. If we can’t take the time to push for a consultation, push for a needed procedure, call that insurance company, using the force of our credentials, patients will ultimately lose out. Part of the job of being a doctor is going to bat for those under your care; this is the bedrock of our service-oriented profession.
I will admit that in the last several years, as I have read more about how power works and is distributed in the United States, I have become less and less hopeful that meaningful change can be achieved by a single physician alone, and working together in numbers is considerable straining. Health systems are simply too large and too powerful today. With the already limited time we have outside of clinic, I think it is most worthwhile for doctors to focus on advocating for patients as individuals. Outside of this, it is important to remember that we are still voters. We have a choice in the people that we elect as our leaders. It is important for us to be well read and up to speed on latest policy issues, and to understand the positions of our elected official and how those positions encourage our contradict community health.
I have two thoughts. I largely agree with you.
1.The question of systems-level or individual-patient-level advocacy is a challenging one. Our first job as physicians is to take care of the patient in front of us. If we see the patient in front of us, but we are thinking about the 10,000 patients we aren’t currently able to help because we are only one person, we are doing a severe disservice to the person in front of us.
2.We need more physicians represented in elected office who can advocate for thousands or millions of patients by passing legislation or removing burdensome regulations on healthcare providers. However, for the not politically-minded physicians, prioritizing what you have immediate control over is much more effective in the long run as opposed to ruminating on all the ways the system is bad.
Michael, I agree that it has become more difficult, as individual physicians, to make a systemic impact. Especially when addressing the looming and expanding influence of things like insurance companies or private equity, there is little to do in one’s practice. On the other hand, I think that there is still power in organizations and communities led by physicians. For example, many professional physician groups have been counteracting the negative impact of vaccination recommendation changes enacted at the federal level. Also, social media has given the platform for physicians and organizations to speak out against private equity encroaching upon hospitals and physician groups. While I see some more optimism in the systems-level approach, I also believe individual advocacy can extend our practices farther than we think. By engaging a patient and improving their access to a health screening or by offering a transportation method to a specific treatment, your patients will benefit greatly.
I believe that advocacy is deeply intertwined into the role of a physician, and is an obligation to the profession. Even if a physician doesn’t deliberately choose to engage in advocacy on a larger scale, each patient encounter is an opportunity to build trust, provide health education, and ensure care for this individual – advocacy on an interpersonal level. It’s also important to note, that a seemingly brief single encounter with a patient can make incredible impact on individual patients who then return to their communities with those experiences. Negative encounters can create decreased trust for the entire healthcare system on an individual and community level – but thankfully the opposite is true as well. This is reflected in Dr. Ravenell’s Men’s Health Initiative where they found that non-medical community members more effectively engaged other community members to receive colorectal cancer screenings than even physicians. It is amazing that dedicated advocacy on an individual patient level has the power to make changes in an entire community.
I completely agree with you Megan. It’s helpful to remember just how impactful a single encounter may be on both an individual and a community level. In considering advocacy, I think it can feel overwhelming because what immediately comes to mind is public advocacy relating to large health systems and policy. While those things are certainly needed and important, realizing that we have such a large potential to make a difference even on an individual patient level is a more attainable first step for many.
Advocacy is an obligation for physicians insofar as one’s moral compass demands or professional standards designate. When we say “obligation”, that sounds to me like a legal standard or mandate, that if not followed, a legal consequence will ensue. In certain instances, this might be the case. For example, if an ER doctor doesn’t perform a medical screeing evaluation or adequately attempt to stabilize a patient who comes in but cannot pay for the service, that doctor would be in violation of EMTALA. Outside of this, any two physicians might differ in what they deem to be “advocacy” and in the capacity they have to offer this advocacy. So the question of obligation then becomes about should versus must.
Yes, I believe physicians should advocate for their patients in the privacy of the exam room, in public settings, and in matters of policy. But if one physician feels more comfortable only advocating directly to patients from the privacy of the exam room, I don’t feel it’s my duty to tell him or her how to practice or that he or she is advocating improperly. Physicians are certainly important members of the healthcare community, but we cannot be everything to everyone. We have to know when we are being stretched too thin and when we need to rely on other members of the system to help us be most effective in our advocacy and delivery of care – examples of other members might include community health workers, nurse navigators, social workers, care coordinators, etc.
I think this is a super fair point, Hawk. Medicine is a team sport, and the patient in front of us deserves attention as much as the patients who might be served better by systemic changes. I like the distinction between “should” and “must”– I do wonder if at the end of the day both still remain true, though. Yes, we should want to help our patients and advocate for them in our scope, but while practice patterns might be different, I think we must do right by our patient, and if that means advocacy in some way or another, including looping people with different expertise, then advocacy becomes an obligation. I don’t think we all need to be knocking down DC doors in order to make a change, but I do think advocacy is vital in our roles, especially given the complexity of power dynamics between patient and provider in medicine. When it comes to advocacy, I think maybe should becomes must when patients don’t have the ability/expertise to be a part of conversations being had about them, especially when we can be the bridge for them.
As the political landscape continues to change rapidly, I find myself thinking more about what my role will be in advocacy as a future physician. Coming into medical school, I believed physician advocacy to be pursued intentionally by a select population of physicians rather than something required or expected of all. However, my perspective of this has shifted through these years in medical school. Interacting with patients on a day-to-day basis who are deeply impacted by policies and barriers on so many different levels made it clear just how much our patients need us as advocates. Physicians are in a unique position with patients in their most vulnerable moments and see just how much these barriers affect the care they can receive as well as their health outcomes. I think the bigger question is not whether advocacy is an obligation in the profession, but rather to what extent we are obligated to do so.
Physician advocacy on the individual level with patients is, in my opinion, an absolute obligation. Patients are relying on us to provide compassionate care that is in their best interest and to advocate for them to receive the medications, procedures, and support that they need whether that involves referring to/consulting other providers or calls with insurance companies. I think that as we go up the levels of our spheres of influence into communities, health systems, and national policy that the obligation becomes less strict. Advocating on higher levels involves an increased amount of time, work, and knowledge of the system that may not be feasible for all physicians and although I think we should all strive to be active advocates for our patients on every level, it simply may not be possible for all. I believe that the most important priority should be to ensure that we are doing everything for our patients on an individual level each and every day, and to advocate on levels beyond that if it is possible for us.
Hey Jaden, I think you raise a very pertinent issue regarding the interplay of healthcare and socio-political factors and how it impacts the role of physician advocacy. While advocating for patients at an individual level is a bare minimum necessity, the landscape recently has shifted to the extent that advocacy at a systems level can have drastic effects to the personal, professional, and social life of physicians inside and outside the hospital. While essential for a systems-level reform, I think categorizing it as a professional obligation for physicians might be a stretch and are more of an individual choice that we make.
I believe advocacy is an integral part of the physician’s profession. The extent and form of that responsibility may vary depending on a physician’s role within the broader healthcare system, but at a minimum, every healthcare provider has a duty to advocate for their patients. Beyond individual patient care, physicians should also work to address barriers affecting the communities they serve and, ideally, contribute to systemic reform that improves healthcare delivery at scale. Physician involvement in administration, public health, and policy helps bring individuals with direct patient care experience into conversations about healthcare reform, creating the potential for more effective and patient-centered systems.
Patient advocacy is the foundation of medical professionalism, and its importance cannot be overstated. At the same time, systems-level advocacy is critical for creating lasting change. In the healthcare infrastructure we practice within today, physicians can often address immediate patient needs, but many barriers to health outcomes stem from larger structural issues that extend beyond the bedside. While individual advocacy efforts may achieve important short-term improvements in patient care, broader efforts aimed at systemic reform are necessary to produce substantial and sustainable improvements in healthcare access, delivery, and population health outcomes.
Hello Ameya, appreciate your response about system/infrastructural advocacy. This makes me consider how many administrative efforts/changes are a result of interprofessional advocacy throughout rungs of leadership. With this in mind, it does feel like some level of dedication or commitment to advocacy is required of most if not all members of a medical team. I think a barrier to achieving this is the realistic ability of the individual, as they cannot advocate for every action item at the same time.
I really appreciated your note on the importance of systemic reform. Small scale advocacy efforts are imperative as a combination of small efforts does lead to change. However, large scale activism allows for systemic issues to be addressed head on. There is an essential need to re-allocate how our systems manage health related issues, and specifically how it trickles down into the community. Through recognizing patterns, identifying gaps, and having honest conversations with patients, it allows for physicians to visualize barriers from a bird’s eye view and work towards implementing change. Thank you for sharing your thoughts!
I believe advocacy in some sphere is an obligation of the profession, but that we should also broaden our understanding of what advocacy looks like. In most regards, we think of advocacy as a tool to implement institutional change. With this in mind, I think a fair amount of the other work physicians do outside of patient care (such as research and QI, etc) are also advocating for the wellbeing of patients and improvement of those involved in the healthcare structure. Something interesting brought up in the Spheres of Medicine article is how the ethical decisions/non-decisions physicians can take are also patient advocacy, such as not engaging with harmful lobbies or acknowledging harmful practices.
If someone had to choose between patient or system advocacy, then patient advocacy is the first (and, in my opinion, non-negotiable) responsibility of a physician. But going back to my earlier point, I think ultimately systemic advocacy is in support of patient, maybe not at the individual level but always on a larger scale for patients as a whole. If a physician were to encounter a dilemma where patient advocacy and system advocacy were at odds, I believe a physician is more obligated to advocate for their patient, but also work through why the incompatibility exists.
Soumya, this is a good point that I hadn’t thought of. Advocacy can be done a variety of ways, and it’s important to consider the work outside of patient care that can be done to still advocate for patients. I have the same thoughts as you on patient vs system advocacy. I always think of patient advocacy being more approachable and something that should be done regardless. Something I also considered was that you can advocate for your individual patients but not necessary the system, but when you advocate for the system you are ultimately advocating for your patients as well. It’s a complicated topic, however I think we all agree that patient advocacy is 1. more feasible day to day and 2. something that should be a non-negotiable and ingrained in practice.
Plainly speaking, advocacy is an “option” of the profession, however in my eyes it is absolutely an obligation that physicians accept (and should embrace) when pursuing this field. Physicians are in a very unique position that I feel can be easily lost as training and work in the field continues, and I personally believe it’s important to ground ourselves along the way to remind us why we started and how much power we hold in terms of simply caring for patients properly. I would guess that a lot of physicians go into the field to help others, and it would be a disservice to not advocate for them. If I’m speaking from moral standpoint, I view it as an obligation, however Hawk made a good point that when they think about obligation they think about something that must occur, and physicians advocate for their patients to varying degrees. Right now, I think advocacy in the field as a whole is an option or “should”, but I’d love to get to a point where it is a concrete obligation or “must”.
On initial thoughts, patient advocacy seems more doable and something that can actively be done every day with every patient you see. System advocacy can be a bit more challenging to approach and as well as more time-intensive. If physicians were to take time away to focus on system advocacy, they would have less time to spend with patients. The less time spent with patients means less time advocating for them at the individual level. However, focusing on system advocacy may mean you can advocate for more than one patient at a time. It’s a challenging question, however I would say patient advocacy is more important as it’s something we can do every day.
I think you make a really interesting point about there being a tradeoff between patient and system advocacy! It is easy to talk about these things in the abstract, but it is important to remember that they have real life, practical implications. So while it seems like it would be a great thing if all physicians got super involved with policy-level advocacy, it might actually be detrimental to patient care. As you say, it is definitely a challenge and I imagine many physicians struggle to find the balance.
I believe physician advocacy begins as an option for the profession. A significant portion of medicine has occurred in reaction to maladies as they impact patients. Whether through delivering a symptom-reducing drug or a targeted surgery, medicine has acted as a response to negative health outcomes. Also, physicians can easily settle into the pattern of acting only through their office, prescriptions, and recommendations. There is no requirement to step beyond this, as it takes time and effort while not commanding immediate return or profit. While the option of advocacy exists, it can also easily become an obligation. As physicians ask further of their patients and investigate beyond the walls of the hospital or office, the need for advocacy emerges. To meaningfully address the root causes of diseases being treated medically, advocacy must be engaged. Whether through social determinants of health or other systemic structures that impact disease states, there are additional methods that physicians can complete their goal of improving the health of their surrounding communities. Physicians may find that advocacy is the only way to follow through on their mission. In this way, advocacy becomes an obligation for those who seek it.
As a physician, I believe both patient and system advocacy are equally important. Personally, your patients and their access to health services are of the highest priority. You have promised to serve your patients and should work to ensure they individually have the ability to achieve the highest quality of care. On the other hand, you will have a wider yet lesser magnitude impact by changing the system so that all people within a community avoid negative health outcomes. Both must be optimized for your community and your patients to be uplifted.
Brandon, you bring up a good point: medicine currently responds only after a disease has already occurred. As we move toward emphasizing preventive medicine, I can envision that the physician’s role in advocacy would become essential in making this transition happen. From encouraging patients to follow new screening practices to joining large-scale organizations to advocate for additional guidelines, we can help advance the field and encourage patient wellness at both the individual and system levels. This future will continue to establish physician advocacy as an obligation rather than an option.
I agree that the interpersonal level comes first. When people hear advocacy, they may go straight to thinking about policy and big state/national efforts. Just through interpersonal efforts, we can affect a lot more people than we think. Listening and advocating for one patient can encourage more patients to trust the healthcare system when they share their experience to others. I also agree that not everyone has to be or feel obligated to interact in policy efforts, etc. It is great when physicians are involved in policy because they are experts; however, it should not be an obligation.
Hey Megha! I really like the points you made in your discussion. I agree with you that physicians are in a unique role where their knowledge of the human body and bridging it to the real world through interpersonal relationships. There should definitely be more of them in positions to enact positive change but it is certainly a challenge. Although I personally saw system advocacy as more important for its wider impact the efficacy of patient advocacy on an individual scale cannot be denied!
I definitely agree that physicians, and other healthcare workers, are representatives of the field of medicine. Patients rely on their providers, not only for treatment, but for accurate information regarding their healthcare. This in itself is a form of advocacy. And a big part of encouraging further advocacy is accessibility. Focusing on small changes, on the impact one can have on a single patient, is still making a positive change that can ideally transform into wider systemic shifts.
I believe that advocacy as a physician is required and is not an option. We are in this field to serve and have our patients’ best interests regarding their health. Health encompasses not only biological processes but also social elements that play a big role.
The TED talk mentioned how black men are dying at much higher rates to colon cancer, and this can be partly attributed to socioeconomic factors and/or mistrust in the healthcare system. In order to address these disparities, advocacy is required. If one cares about the health of their patients, they should advocate to close these gaps. For example, the sphere of influence article mentioned how physicians can dig deeper into social determinants of health that patients may face as a form of advocacy. Simply asking about transportation, built environment, groceries, etc. can go a long way. These elements shape our patients’ health greatly, and to better serve them, we should know about these things. Advocacy exists at many levels and does not necessarily have to be at the community or national level to make a meaningful impact, a great impact can be made in a patient’s life with just a conversation.
Physician advocacy is integral to the profession. Physicians hold a unique role within the community of influence. Community members value the service physicians play in society and physicians are widely entrusted with information about the community, which offers the opportunity to integrate and advocate. With that being said, advocacy spans multiple domains which include macro and micro level interventions. Micro interventions including day to day discussions with patients and the team to help with quality care are essential towards patient facing advocacy. This relates to identifying how to make the patient experience better and support patients along their healthcare journeys. On the other hand, macro interventions are those related to systemic based health changes. This includes systems level advocacy through local, state, and national avenues to address large scale barriers. Both count as advocacy, and both are equally essential to building up patient care. Thus, there is no measurement related to this obligation, so long as the obligation is fulfilled. Whether this advocacy is managed through one singular patient, or through a national scaled intervention, advocacy is measured by providing patient centered care that empowers patients in their health journey.
I think physicians should practice advocacy which can take many forms! These can be more systemic such as working with politicians to shape social policy or on an individual level where patients can be open with issues outside of medical problems. At the end of the day, I believe the job of the physician- when done well- inherently improves other’s wellbeing and promotes happiness. If a physician wants to focus on only treating patients, it is certainly and option without shame. However, I think physicians are in a unique position with insight into the human condition where their voice is essential to helping shape policies. However, they make up a minority of government (although I just found out Rand Paul (R-KY) is an ophthalmologist?!) and have been phased out by insurance companies and corporations over the years as healthcare becomes a bigger business.
As far as which avenue to choose, patient and systemic advocacy are closely connected. I also think comes down to philosophy if one wishes to help the maximum number of people possible or focus on one individual at a time. I personally lean more towards a utilitarian mindset where systemic advocacy has a greater impact on patient health. Whether it showing up to vote or attending public forums to help increase education of health issues physicians can find many ways to advocate.
I would classify physician advocacy as an obligation of the profession. A key part of the physician’s role is to use their education and experience to enhance the health of others. I believe many aspects of this job can be classified under the role of advocacy. Sometimes physicians must advocate for the medical knowledge gained from evidence-based research they believe their patient needs to make the best decisions for themselves and their own health. Other times, physicians must advocate for their patients when communicating with insurance companies so that patients not only have the information needed to make a decision, but the capacity to pay for that decision. In terms of system wide versus individual patient advocacy, there is a place for both, and I don’t believe either carries more importance. Big picture wise, system advocacy is how widespread change gets made, but this takes time and can be an extremely daunting task to take on. Patient advocacy may feel smaller, but it is something that is within everyone’s reach and while it may sometimes feel like a minor thing, it definitely makes a big difference to that one patient.
Shivani, your point about physicians advocating for patients by communicating with insurance companies reminded me of the times that I witnessed peer to peer calls during rotations! I think that is a great point and a good reminder that physicians are in a unique position where they understand both the medical care and how that care can be obstructed by health care policies. I also agree that system advocacy can be daunting and perhaps that is part of the reason why some may be more reluctant to do it.
I believe that medicine is a service profession and physician advocacy is an obligation of that profession. On one hand I see it as part of the hippocratic oath that we all take to uphold beneficence and justice. But I also understand the perspective that physicians engaging in advocacy at the level of state or federal government can be viewed as “extra” work, or something that is outside of their purview. Ultimately I fall back on the idea that SDOH, healthcare policy, and the changes in people’s material conditions that result from those policies directly influence patient outcomes. And because of that, physicians do have an obligation to engage in advocacy.
Patient and system advocacy are equally as important. Although I would not call system advocacy more important, I see the value in creating change that can positively affect large populations and address the root cause of problems faced by our patients. I think physicians should speak up about social injustices and share our perspective with our elected government officials. I believe that even if our future work in advocacy focuses in one sphere of influence, it is important that we recognize how each sphere is intertwined and how the direct patient advocacy is inseparable from system advocacy.