“When you see something that is not right, you must say something. You must do something.”
-Rep John Lewis
“When a pandemic response has become so politicized, when leadership is so absent, when health messaging is so muddled, when science is so marginalized, it’s easier to understand how the best-prepared country in the world for a pandemic could have lost 190,000 citizens to the virus.”
“The rescue of a society and the restoration of a political ethos that remembers to heal have become the physician’s jobs, too. Professional silence in the face of social injustice is wrong.”
-Donald M. Berwick, MD MPP
I used to segregate politics from my professional work. It seemed like a dangerous mix. I wanted patients to see me solely as a healer: non-intimidating, non-judgmental, and, therefore, non-partisan. I wanted them to trust me and confide in me, and I didn’t want politics to undermine that mission.
As an educator, I had similar concerns. How would residents feel if I expressed my beliefs? Would they worry about biased assessments? Would they feel comfortable speaking up and engaging in honest debate? As a program director, I know the power of my position. Would my politics destroy our learning climate?
Most of you probably know I shed those worries long ago. They’re overblown. More importantly, I’ve come to realize we can’t hide our beliefs, especially now. None of us can, because politics and healthcare are wholly intertwined. Consider a partial list of the issues we face this year: a devastating pandemic, gun violence, global warming, diminishing air quality, systemic racism, hunger and homelessness, falling life expectancy, insufficient funding for science, millions without health insurance, an opioid epidemic, and exorbitant drug prices. If we truly have a duty to protect patients, how can we stay silent?
The core tenets of our profession must shape our politics. Just as we speak honestly to our patients, even when the news is bad, we must demand the same of our political leaders. Just as we believe that science should inform clinical practice, we should demand that it inform policy as well. Just as we place concern for others over the temptations of selfishness, we should demand the same of our nation. Just as we fight to defend the vulnerable, we should demand that all members of society have access to safe housing, clean air, nutritious food, and effective education. And if we truly believe the world’s richest country should not have 30 million people without health insurance, we must demand that political leaders address this abomination and recognize healthcare as a human right.
I know I’m a physician and not a politician. I can’t write laws, let alone understand the intricacies of legislation, budgets, or competing proposals. But I do know the difference between politicians who want to expand healthcare and those who want to take it away. I do know how politicizing science undermines our ability to fight COVID-19, how racism devastates the health of my patients, and how disregard for the environment subjects populations to tornadoes, hurricanes, floods, crop failures, wildfires, homelessness, toxic air, and preventable disease. As a physician, I do know patients need a government that’s dedicated to serving all people, regardless of race, citizenship, or party affiliation.
As physicians, we must use our expertise. Patients trust us and so does most of society. With that trust comes a duty—a professional responsibility—that extends beyond our daily work. We must speak up for science, rigorous thinking, honesty, and compassion. We must speak up for laws, policies, and political leadership that work for the health and wellbeing of our patients. And we must speak up with the same attention and diligence we bring to the care of our sickest patients. As Donald Berwick, co-founder of the Institute for Healthcare Improvement, has said, “To try to avoid the political fray through silence is impossible, because silence is now political. Either engage, or assist the harm. There is no third choice.”
So, please speak up. Share your expertise. Use your power wisely and responsibly. The time has come to diagnose, heal, and mend our ailing nation.
Have a good Sunday, everyone,
PS., For further reading:
Tom Friedman: Who Can Win America’s Politics of Humiliation?
Arthur M. Feldman: What can Osler teach us about the covid-19 pandemic?
John Lewis: Together, You Can Redeem the Soul of Our Nation
Donald M. Berwick: The Moral Determinants of Health
Donald M. Berwick: Moral Choices for Today’s Physician
Nicholas Kristof: How Did the ‘Best-Prepared Country’ Become a Horror Story?