Role of the Physician- Bystander vs. Upstander
“As I have been looking around lately at what has been happening in the world (local, national, world), the question that keeps coming back to me is how much of bystander vs. upstander can I be and should I be as a citizen and as a physician?
From Executive orders bringing ICE agents into health centers and cities such as Minneapolis (and Cincinnati), to the Senate Bill 1 eliminating DEI departments, trainings and scholarships at Ohio Colleges and Universities, there is a lot for us to react to, turn away from, but also respond to.“
For this Reflection, please review the materials linked below and respond to the prompt in the discussion board. Please also post at least one response to one of your peers’ posts.
Is there a role for us as physicians to be upstanders- at the patient/individual level? At the community level?
If so, what might that look like for you?
Is there a specific population or issue that you are passionate about / concerns you?
Yes, I think there is a role for physicians to be upstanders, both at the bedside and in the community. At the individual level, this often looks less like grand gestures and more like refusing to let fear, bias, or policy erase a patient’s dignity. When immigration enforcement expands into or near health care settings, the downstream effect is often immediate. Patients delay care, miss prenatal visits, or avoid emergency evaluation because they fear exposure to authorities. These consequences are not abstract policy effects but direct determinants of whether people seek care at all. In those moments, being an upstander may mean creating safety within the clinical encounter: protecting confidentiality, communicating transparently, and recognizing how structural forces shape a patient’s health decisions. It also requires acknowledging that health disparities are not accidental but rooted in historical policies and systemic inequities that medicine must actively address (Wang and Chi, 2025). Even small actions, such as advocating for language access, connecting patients with community resources, or speaking up when bias influences care decisions, can help ensure that the clinical space remains one where patients feel seen and protected.
At the community level, being an upstander requires recognizing that professional neutrality cannot mean silence when policies threaten equitable care. Ohio Senate Bill 1, for example, would prohibit DEI offices, training programs, and certain scholarships at public universities while imposing compliance requirements tied to institutional funding. Policies like these raise important questions about how institutions will continue addressing well documented disparities in health and education. For physicians and trainees, responding as upstanders may involve supporting evidence based equity initiatives, participating in community partnerships, and advocating for policies that improve access to care rather than restrict it. For me, the population I feel most concerned about is children and families navigating complex medical conditions while also facing social barriers such as language differences, disability, immigration concerns, or economic instability. In pediatrics and child neurology especially, the effects of structural inequities appear early and shape the trajectory of a child’s life. When families struggle to access therapies, transportation, stable housing, or specialized care, those barriers quickly translate into developmental and health disparities.
Because of that, I increasingly see advocacy as inseparable from clinical care. Physicians may not be able to solve every structural problem, but we are often uniquely positioned to witness the consequences of policy decisions long before they appear in data or headlines. Being an upstander, for me, would mean using that perspective responsibly. That might include supporting community health initiatives, speaking about health disparities in professional settings, or helping shape institutional policies that protect vulnerable patients. It also means cultivating the humility to listen to communities who have long understood these inequities. Ultimately, the responsibility of physicians extends beyond diagnosing disease. It includes recognizing when systems are contributing to harm and being willing, when appropriate, to stand with patients whose voices are often the easiest for society to overlook.
Adam, I like how you state “advocacy is inseparable from clinical care”. In those small moments with the patient in front of you to make sure they get their prescription to the larger moments to lending your voice to an issue, your actions to advocate are available each day.
I agree with Dr. Kiesler as well. It’s almost we assume this position as we rise to the occasion as new physicians. Small to large, our job serves people in extreme vulnerability.
Yes physicians have a very unique role and responsibility to be upstanders. We are firsthand responders to many barriers of healthcare, such as insurance, language barriers, health literacy, patch and spot medicine that leaves patients segmented and often broken. Although we often focus on the practice of medicine, we have a unique perspective on easing people’s transition back to a world that’s not as controlled and certain as a hospital. It’s a huge responsibility to carry that load, but who better than someone who’s navigated the system and can advocate. As an AI on internal medicine this month, I find myself attempting to take the extra time to engage in more than just a “snapshot” of the patient. It doesn’t even take that much time to ask a few extra questions about the patient’s support system and ability to take the medicines or engage in lifestyle changes we both know are beneficial for them. I think outpatient providers have a unique role in ensuring this follow-up as well, but they are undervalued and overworked. Why can’t I start that conversation when I perform their history and physical? I think my most treasured resource in the hospital thus far has been social work and care managers. Their ability to craft clear discharge plans, smooth follow-ups into appointments and navigate the often dreaded but necessary conversations amazes me. There is one on our floor that keeps me in the loop, weaving medical advice into their narrative. Roughness and rawness that is perceived in the room upon entry exits with understanding, ease and gratefulness.
For me, upstanding medical care screens for barriers, connects patients to resources and builds trust. Taking the time to listen to patient concerns, their unique experience and how I can be a part is something I treasure everyday. People are so sick, and I have the ability to carefully present their narrative to a team with combined decades of experience at a University Hospital. Personally, I try to bring this experience to my free clinic and through other volunteer experiences. I try to focus on pillars such as strengthening healthcare infrastructure, engaging community partners and improving continuity of care for patients.
I have a passion for underserved care, and yes I mean those who have nothing but on the flipside those who have everything but no one to effectively assemble the complex puzzle we call healthcare. Even as a budding surgeon, I still have the responsibility to engage patients in primary care access, referral systems, after hospital follow-ups and mending community partnerships that keep patients valued and connected. I know of a few surgeons who have started medical missions domestically and abroad, touching upon the very idea that we took an Oath to serve others, first before our own. Dr. Wang so eloquently says regarding selfish means to care for patients, “the consequences can be measured in missed and late diagnoses, inadequate treatment, and lives damaged by structural failures.” I argue the next time you meet a patient, ask them about their care thus far, what they hope to achieve, their worry, concern, obstacle, you’ll learn a lot more than you would think. It might even change your medicine.
Thanks, Quinn. I like your perspective that an upstander screens for barriers, connects to resources and builds trust. I feel that is what you and your colleagues have done through developing the CAIN Clinic. The most important was building trust- through showing up, week after week, and building relationships with those at the pantry and eventually the clinic. Being there for your patients and being there for your community.
Hi Quinn,
I really liked your perspective that underserved doesn’t always have to fit the mold of those with multiple social determinants of health. Underserved care could be those that have resources but have difficulty navigating our complex healthcare space. This is a perspective that can apply to any clinician regardless of the population we serve. I think the aspect of taking a step-back and asking a patient about their care requires a lot of humility, and they’re conversations we don’t often have with patients. I think taking this perspective into your future career in ortho will take you very far, especially given the fast pace of clinic.
posted this in the wrong section 🙂
Quinn, reading this reminded me of a cardiothoracic surgeon I worked with on my surgery clerkship. He talked to every patient about smoking cessation after lobectomies. He said that we all have a responsibility to talk about smoking cessation with patients – and what better time than after getting a portion of cancerous lung removed? He discharged several patients home with chantix and the motivation to quit. I appreciate that you, too, recognize that supporting patients takes a village. All portions of the healthcare team can take part in encouraging patients to become the best version of themselves. I know your future patients will feel lucky to have you on their team.
Yes, I do believe that physicians have the responsibility to act as upstanders at both the individual level and community level. At the individual level, the result isn’t as obvious as standing up for a coworker/classmate when discrimination is recognized. Obviously, when these situations arise it is important for the physician who is in a position of leadership/authority to step in and support the marginalized. In the day-to-day clinic life, being an upstander first means being informed. It’s important that physicians stay up-to-date on what’s happening at both the local and national level. There is no opportunity for intervention with blind ignorance. The second and arguably more important step is equipping ourselves with resources within the community that combat discrimination and inequity. When we see a patient that can benefit from one of these organizations, it is our duty to know about these organizations and to refer them for assistance. This aspect of patient care is what has really resonated with me in physician and society and now with my 4th year service and advocacy elective. I’ve hear from so many people what great work my community partner does and how they wish they knew about them earlier. In my future career in primary care, I want to be the connection point between patients and resources in the community.
At the community level, the first step is to get out and vote to make your voice heard. There won’t be genuine change until those with a passion for equity are within positions of power. While we can’t change the results of elections, we do have a responsibility to make our voice heard. Along the lines of making our voice heard, physicians should feel empowered to write their local congressman/political leaders and express their views. This becomes much more important as attendings where we’ll be in positions with more power. Lastly, physicians should feel called to devote their time and talents to organizations in the community that are making a difference.
In my future career, one population that I’m very interested in serving is the geriatric population. I feel like the older generation has a much more difficult time navigating referrals, polypharmacy, and multi-morbid conditions. Their voice also often gets silenced during medical visits by healthcare professionals blaming acute problems on the consequences of aging. I can’t wait to become an attending and serve this population by equipping myself with organizations that can step in and address health disparities.
I love your navigation comments. I totally agree this will be a crucial part of an upstanding practice!
I also really appreciate how you acknowledged the geriatric population because my brain totally went to recent news stories and charged social media content on immigration, war, women’s health, etc… The geriatric population seems like a wonderful example of where your voice and knowledge will be so helpful in advocating for your patient’s health and independence. You really made me think about this, so thank you!
When I first read this prompt, my brain auto-corrected “upstander” to “advocate”, and it was interesting to reflect on what the difference between those two words was for me in my professional identity. I decided that being an advocate doesn’t seem so different to me than being an upstander, and I think that is a core part of what it means to be a physician. Reading my classmates’ responses, it seems like that’s a pretty shared conviction too. And I know we’ve written a lot of responses on what it looks like to be a physician advocate & the responsibility that we have to do so.
We take an oath to do no harm, yet there is so much literature showing how social determinants of health and systemic racism profoundly worsen outcomes across nearly every measure. Even in just two years of clinical rotations, I have watched the system work against my patients in real time. That has shaped how I think about my role: I want to work from the inside out and learn my section of the system well enough to help patients navigate it. I hope to eventually chip away and, at the very least, make positive changes in my future clinic. I’ll be honest, I still see myself operating at the individual level right now, but I’m actively trying to find role models and ways to show up at the community level too.
One of the reasons I do see myself operating at the individual level in my next years of training has a lot to do with recent legislation. The rollback of DEI initiatives under Senate Bill 1 genuinely frightens me. So much hard-won progress feels suddenly fragile, and the broader political climate, one that is actively punishing change-makers, makes me worry about feeling stuck as an individual patient upstander out of fear of retribution towards myself or in some way outing my patients when I try to speak up for them. That’s something I’m still sitting with, and makes me uncomfortable and angry.
The area where I feel most called to be an upstander is women’s health. Access to reproductive care is narrowing in many parts of the country while stigma and charged rhetoric keep rising. What concerns me just as much as the policy changes is the chilling effect they create — women who are too scared to ask for help in the first place. It’s hard/impossible to advocate for someone who feels they can’t speak up. I’m seeing this firsthand on my current lactation rotation. The team has noticed that women, especially Spanish-speaking patients, have become noticeably more reluctant to engage or ask for help with their breastfeeding. It feels like too significant a shift to be coincidental, and I think it reflects the very real fear that a lot of immigrant families are living with right now due to the horrors of ICE.
One other note that I thought of with this prompt is how hard it can be to be an upstander as a student. I recently had a patient seeking a gender-affirming hysterectomy, and during the visit some comments from my preceptor outside of the patient room made me uncomfortable. My preceptor was very kind and accepting to the patient, but his outside-the-room comments did not feel good to me. I felt very caught between not wanting to overstep and not wanting to stay silent. In this moment, I chose to be an upstander for my patient by making sure his pronouns & name were accurate in the chart and taking a very thorough (and as inclusive as I could) history. I stayed silent to my preceptor though, and I am challenged by that action as I write this reflection. This was definitely not the ideal way to handle this situation per everything I just wrote above.
Being an upstander will take practice, and I hope as my responsibility and title continues to grow, I can be a positive influence on how I speak about my patients to providers around me. All in all, I feel like being an upstander is & will continue to be a challenge, but one that is so important for our patients in the current political climate and healthcare system that we have.
Caroline, you have always had such insightful comments throughout this course. I think that the difference between an advocate and an upstander is the situation. An advocate can push for the rights of others at any time. An upstander sees a person in a crucial moment of conflict, and has the bravery to speak up then and there. The situation with your preceptor is challenging, and something I wrote about in my response (rant) a bit too. How can we balance a situation where we have a lot on the line ourselves? I imagine that in the grand scheme of things, we’ll all be looking back at the times that we were silent because someone had power over us and wish that we had challenged that power.
Caroline, I really appreciated your first paragraph (and the rest) of your reflection. Your comment about auto-correcting “upstander” to “advocate” stuck out to me because I kind of had a similar knee-jerk reaction to the prompt. In our medical education, we were often taught to advocate for the unique needs and goals of our patients. I associate “upstander” with being an “upstanding citizen,” so I guess the term also works because upstanding citizens also advocate for causes on individual, local, state, national, and world levels. I hope that our peers also are leaving medical school feeling empowered and educated enough to advocate for our patients and communities. As we get further in our careers, I also hope that our advocacy doesn’t peeter out and we don’t lose our empathy as people say we will. Life is hard, and life is busy, but I hope that we all work towards a better world for all.
There 100% is a role for physicians at every level to move from bystanders to upstanders. We occupy a very privileged place in our social structures, where people are quick to assume that we are experts simply by the title we carry.
To start, at the patient level, as a medical student, when I have seen patients get treated incorrectly by those with more authority than me, most of the time, I have taken the role of bystander. I have
doubted my own intelligence, and convinced myself that whoever has more authority and more years of experience than me probably knows more than I know by virtue of their position. This makes it easy to wash my hands of any responsibility. As I shift from medical student to resident, and I am no longer paying for the privilege to be a learner, but am instead the person delivering care, I need to develop the confidence in my own clinical skills to become an upstander for my patients. At the same time, this applies to the treatment of medical students by residents, attendings, and other educators. As I work my way up that pyramid there is inherently more ability and confidence to take the role of upstander. After reading the bystander intervention tip sheet though, I am wondering how I can reframe that confidence? How can I make it a natural part of my experience? It’s hard to think about what I might be risking or missing out on if I speak up to someone who has authority over me.
And then at the community level, I think that the same principle applies. We have to encourage more confidence, and firmer beliefs about the dignity of every individual and how we should all defend these. Yet the trend towards silencing dissent is apparent. The article describing the ban on DEI in
universities shows that the bill also including a ban on strikes, which are one of the most powerful tools that workers have as a collective to make change. And to be quite frank, these aren’t high-paying jobs. Academics are amazing and I am grateful to those who have played a role in our education, but this is such a ridiculous field to stifle. The “Answering the Call,” article offered another saddening perspective on silencing academics, with the late cancellation of a research study that so much work had gone into planning. Sorry for ranting here. In summary, I do believe that our position as physicians positions us uniquely. We already have the respect of many due to our title, and we have an obligation to put that to use for the betterment of our neighborhoods. This may seem like an idealistic value, but it is what we swore an oath to when we started at this institution.
Megan, I agree that we have a unique role in having the respect that we do within our community as physicians. I think even in my own writing, I struggled with balancing the idea of paternalism vs patient empowerment in advocacy. I like how you explained here that it is a privilege that is bestowed to us by the community to be an advocate, not something innate in us, but something that we have to earn, learn, and seek to become. And I 100% agree that while we have been taught repeatedly how to be an advocate step-by-step, the confidence to challenge long reigning, monstrous policies and preconceived notions of our older, “wiser” colleagues is something that I still have to grow.
Because physicians are proponents of whole body, mind, and systems health, we absolutely have a role in being upstanders at the patient and community level. Throughout our entire training in medical school, we have been taught the biases in healthcare. What is heard by us is lived by our patients. We have been taught how to advocate, where the inequalities are rooted, and what standards of health are supposed to be. And because we have this privilege to understand the knowledge and intricacies of medicine as a textbook subject and a complex bureaucracy, we have a responsibility to advocate for those who do not. Even more so, health is so much more than the body and thus for our treatments to be sustainable, just, and accurate, we have to treat the system as well. This is especially important in this climate as DEI policies are threatened. I believe the article on “Answering the Call” underlines the importance of the impact of DEI negation: “the costs of regression are not theoretical: they are lived” – “Patients from marginalized communities bear the brunt of regressive policies in medicine, and they will continue to face unchecked biases,
widening disparities, underrepresentation, and eroded trust in systems that are meant to serve
them”. This is so much more than politics but threatened progress.
For me, being an upstander in the loss of DEI-related research and initiatives lie in the patient level in the way I address my own and my colleague’s implicit biases in the clinic, advocate for marginalized patients by helping them with insurance coverage, transportation, medication access, and use culturally responsive, individual-based care. At the personal community level, my ideas for being an upstander involves challenging stigmatizing language and behaviors in my healthcare team, supporting colleagues from underrepresented backgrounds, and encouraging inclusive teaching for my learners. Finally, at the wider community level, I hope to educate communities about preventative care and healthcare resources, volunteer and connect with community health care initiatives, and help steer policies that bridge disparities in healthcare.
The populations I am most passionate about are immigrants as I am one. And immigrants are a huge population that have been threatened by this administration in the ICE upheavals and DEI policy removals. I understand firsthand how mistrust, lack of access to resources, and cultural barriers/language can create a complex and difficult pathway to health.
Trong, your reflection really resonated with me and I especially held onto that line about regression not being theoretical but lived! I think it can be very easy and tempting even to think about many of the downstream effects of the change in many policies surrounding DEI in medicine as hypothetical and less devastating than they are. I. believe that part of the reason why includes a lack of lived experience and the deceptively brief snapshot of a patient’s life circumstances a clinic visit or hospital admission may provide. Many of the barriers and mindsets for underserved communities when it comes to the health care system have been developed over decades and generations. As long as it took to get to a place of great inequity is as long is it will take to overcome it, and it almost certainly will take longer. I think the examples of the ways that you could be an upstander are great and I see myself doing many of these things as well.
Yes, there is a role for physicians to be upstanders – and being one at both the individual and community levels is synergistic.
The issue that most concerns me currently is the state of our education. I was raised in small town Indiana with – in many cases – small town ideas of the world. It was through courses such as Gender Studies, Philosophy, and Social Determinants of Health that I expanded my thoughts in a safe classroom environment that I would argue upheld intellectual diversity while maintaining diversity, equity, and inclusion. While I do feel impassioned about a lot of politicized issues that impact the patients in our clinics and those who avoid clinics altogether, I feel most concerned about the generation that grows up going to college with significantly less diversity (of thought, of environment, of people) as a result of Ohio Senate Bill 1. We now rely on professors who are increasingly constrained in what they can say and teach. I worry for future physicians who don’t learn about DEI in their training because they don’t go to a university with alumni funds large enough to overcome the fear of doing so. I worry for those who would make the best physicians but don’t because of a lack of equity initiatives.
My undergraduate university – IU Bloomington – has completely changed. All my professors have left. This is all within a span of 7 years! I worry for the ripple effects of all this, assuming we do establish a more democratic administration at state and federal levels within the next election cycle. Education is the foundation for a healthy society and freedom of choice. I worry, also, for the increasing rates of unwanted but completed pregnancies. More children in the home means more stress on parents – mothers, in particular. More stress in the home increases domestic violence and other adverse childhood experiences. As these increase, so too do rates of mental health conditions, substance use, heart disease, and diabetes. An educated society is the foundation for tackling these problems upstream of their presentation.
With this in mind – what does being an upstander look like when government is attacking education, diversity, and abortion access? For me, it starts at the individual level: by being a family medicine physician who is both competent and safe. Patients have to (1) come to clinic (2) trust their story of illness with their physician and (3) trust in available treatment options in order to get the care they need. I selected a residency program based on its ability to offer resources that get me to competency in reproductive healthcare, gender affirming care, and recognizing my own bias. I know there is privilege in going to a program with enough external funding and state support to fight this fight. Still, I think this is another way we can be upstanders – we can increase the demand for organizations that will fight for patients by being selective about where we train and who we work for.
At a community level, I think of family physicians in states such as Idaho – OBGYN physicians fled for their safety when abortion access was restricted – and now family physicians fill that gap. Family medicine physicians will keep doing what they do best: adapt to fill in gaps of need while maintaining continuity and scope. It starts by advocating for the individual in front of us – but it becomes greater by working in community to move forward change. We will have to rely on grassroots efforts to see the change we want. And we have to be brave and optimistic in that pursuit. In the words of James Baldwin: “I can’t be a pessimist because I am alive. To be a pessimist means that you have agreed that human life is an academic matter. So, I am forced to be an optimist. I am forced to believe that we can survive, whatever we must survive.” It won’t be easy, but we have to believe in our resilience as physicians, and our capacity to bring change to the healthcare systems we work for and the patients we serve.
Yes, there is definitely a role for physicians to be upstanders, both at the individual patient level and at the community level.
At the patient level, I think being an upstander often shows up in quieter, everyday moments. It can look like speaking up when a patient’s concerns are being dismissed, or advocating for additional care or follow-up when it would otherwise be overlooked. It also means setting the tone for how patients are treated, especially those who are labeled as “difficult” or complex, and making sure they are still approached with respect and curiosity rather than frustration. At times, it also involves recognizing when system constraints are limiting care and still pushing, within your role, to make sure the patient is not falling through the cracks. Sometimes it’s less about a single big moment and more about consistently choosing to center the patient, even when it would be easier not to. Throughout medical school, my interest in patient education and access to health care has grown. I see myself modeling what it looks like to not assume reasons for med noncompliance, for example, and prioritizing educating patients on their medications and strategies for consistent adherence to treatment.
At the community level, being an upstander expands into addressing patterns we see repeatedly in clinical care. That can look like engaging in public education, working to improve access to care, or being involved in outreach efforts that meet patients where they are and work to reduce health care inequity. It also means recognizing where gaps exist in the system and being willing to contribute to solutions, whether through advocacy, research, or community partnerships. Even small efforts, when done consistently, can help shift how care is delivered on a broader scale. I see myself prioritizing continued action in the direction of progress, whether it be working to increase representation in drug trials or contributing to pipelines that help increase diversity in the medical field.
For me, this is closely tied to my interest in underserved populations, public education, and access to care. I’m particularly motivated by the gap between what patients experience and what they understand about their health. Being an upstander in that space looks like making sure patients not only have the information they need to participate in their care, but also working to ensure that the workforce and treatment options are developed in a way that is inclusive and offers every patient high quality care.
I really liked Caroline’s comment about her brain auto-correcting “upstander” to “advocate” while reading the prompt. I think that viewing the prompt with an “advocate” lens is easier for me than “upstander” because I have been practicing being an advocate in the healthcare setting for what seems like a long(ish) time. Seeing that I am in this elective, the service and advocacy elective, I think it likely follows that I am at least moderately interested in service and advocacy. As we have discussed previously in this course, integrating service and advocacy into our lives as people and as physicians throughout the next phases of our careers looks different for every individual. We’ve addressed the different levels at which we can advocate, including but not limited to the individual level (patient, family members, friends, community members), local or community level (our offices, our departments, our hospitals, our hobby groups, our places of worship, our teams), city-wide level (public health, local legislation), state level, regional level, national level,, and worldwide. We can choose to work with a variety of organizations, including our own hospitals or clinics, non-profits, local politics, state politics, national politics, varying levels of professional organizations such as the Ohio Academy of Family Physicians, American Academy of Family Physicians, the American Medical Association, and the World Health Organization, and patient-led groups. There seems to exist a neverending list of opportunities for physicians to serve and advocate throughout all stages of our lives and careers. For some, like myself, it is a struggle to find one specific area of advocacy to dedicate the bulk of my advocating time to. Since high school, I have been involved deeply with food pantry/market organizations that address food insecurity. It is easy to see how access to food, knowledge about nutrition, and education about the effects of diet on health are intrinsically intertwined with my profession as a family physician. However, there are times when I feel inspired to work with specific ages – sometimes younger children and other times adolescents, young adults, or older adults – to help patients with the unique challenges of each phase of life. Even still I wish I was a researcher and could research the biochemistry or genetics of mental health conditions and advocate for more support and funding of this research.
Whenever I feel overwhelmed by the things going on in the world, I return to the core of myself: the core that is called to advocate on a daily basis for the patients and families I will see day in and day out for the foreseeable future. To me, medicine has always meant getting to know a patient’s medical and personal case and then using the knowledge I have acquired to walk alongside the patient in their healthcare journey. During my primary care rotations (and honestly during every rotation), I met individuals that I could choose to advocate for or to not advocate for. I never regretted advocating for a patient, whether that meant asking a resident to examine the patient again, calling a family an extra time or two, asking “why,” and making sure my patient had to still be NPO. As an M3, I learned that patient care often meant communicating as clearly as possible about the schedule and trying to make things happen as communicated (although often futile), brainstorming ideas with patients to avoid an enema, removing the NPO order asap so patients eat as soon as they want, ascertaining patients’ goals of care as completely as possible, and collaborating within and between teams to have efficient and evidence-based care delivered with these goals in mind. The medicine matters, but we have to advocate for the whole person, not just the disease. In the end, daily “upstanding” for my patients will likely be my primary mode of advocacy until I get my bearings in residency. As I get to know the area and the patient population, I will find an organization or two to work alongside other advocates. We will see what else residency will bring.