This is why we became doctors right? We all dreamt of changing the world. It was a clear cut path on how to make lives better. Now, we navigate practicing medicine, often by swimming against added tides. Forces outside of our clinical space clearly impact our care. Slowly, to me almost a decade after becoming a doctor, it’s become evident that we can’t practice in a vacuum from these tides. A pandemic swept in and our ICUs were filled with victims of misinformation. Healthcare delivery and regulation is now constantly decided by politics and too often with minimal input from medical experts. Most recently, women’s reproductive healthcare has been revoked as the basic medical right it had been for over 50 years. Politics have encroached the sacred place between us and our patients. We, their physicians, have a duty to rise and influence the systems hindering our medical care. And really, there’s no one better to make these waves. Why?

 

First: You bear witness to injustice.

No one sees what happens to your patients like you do. Physicians occupy a unique space that primes them both for opportunity and success at advocacy. First, and foremost, we are the primary witnesses for the difficulties, the injustice, and the healthcare barriers our patients suffer and how this translates to both individual and community hardships. While folks can study and put data to back these truths, only we see our patients miss appointments when they don’t have transportation. Only we see them confused by misinformation that leads to declining care. Only we see their family’s faces in agony in the ICU. No one sees what happens to your patients like you do.

 

Second: Your Voice has Power. You have Privilege

Historically, physicians were integrally involved in leadership and power in their communities. More than 1 in 10 signers in the Declaration of Independence were physicians. Robert Virchow led the progressive party in Germany and is responsible for establishing its water and sewer systems. Since then, even though physicians have retreated to the exam room, and distanced themselves from civic engagement, they still have higher access to both financial and institutional resources, legislators and community leadership.  When speaking from a place of expertise, public trust is greater when physician voices endorse a need for systematic change. When the general public is polled, physicians are still a neutral, unpoliticized and trusted voice for both truth and well-meaning intention. This is evidenced repeatedly when physicians speak out for or against health policy in the legislature. What will you do with this power and this privilege?

 

Third: You are an Expert.

At the very minimum, you are one of the most trained individuals in some part of human physiology and pathology. In this era of expertise, the vast majority of lawmakers, who vote for such policies, do not have your understanding of how specific legislation might affect your patients. They may never dream that an abortion ban might affect access to methotrexate for an ILD patient. They have not seen the complexities, the grey zones of medicine that you have. Because of this expertise, compounded by the trust and the power of your voice, healthcare professionals are greatly positioned to whisper in ears and influence those decisions. Because this expertise is missing from both politics and mainstream media, it is up to our voices to educate our communities and be the messengers for health issues and the policies that surround them.

 

Lastly: You CAN do it!

Sure. You’ve trained for a decade. You know those inhalers, that bronchoscope, that ventilator like the back of your hand. You may not know how to establish a non-profit, how to interpret polling results and how to create politically strategic messaging. That’s ok! This is a pursuit that is outside of our clinical abilities. While we aim to improve the health of our communities through our voice, we don’t have to do it alone. There are tons of expert advice out there. Lean on longstanding advocacy organizations, medical societies and institutions. Start small, voice your opinions to your colleagues, to your patients; then write about it and talk about it. Recruit. Find like-minded folks, harness their energy and seek that expert advice on how to move forward. Keep moving and keep making waves. Rally. Write. Speak. March. Publish. And if you ever need a listening ear or a megaphone, you can find me at [email protected]

 

Marcela Azevedo, MD is a Staff Interventional Pulmonologist at the Cleveland Clinic and Assistant Professor of Medicine at Northeast Ohio Medical University. On her personal time, she leads a statewide advocacy organization with over 4,000 physician members. This organization led the effort to amend a state constitution to secure patients’ access to healthcare. She is a mom, wife, advocate, doctor.