To the Editor:
As pediatric residents, we take issue with Dr. Huddle's argument against training physicians in the techniques of advocacy.1 His thesis is flawed for numerous reasons, three of which we highlight below.
First, Dr. Huddle notes that advocacy should be a civic duty rather than a professional obligation. However, it was not through our civic roles that we learned about the health impacts of childhood obesity. It was not through citizenship that we grasped the difficulties of navigating the health care system for children with disabilities. Rather, it was our profession and our patients that granted us privileged insight into these conditions. Accordingly, it must remain our professional mandate to use advocacy to address these challenging situations.
Second, Dr. Huddle draws arbitrary distinctions between permissible advocacy activities and those he deems more contentious. He notes that “advocacy for individual patients ... is unproblematic” but goes on to state that advocacy for a collective is unacceptable because “it is detached from the doctor–patient relationship.” Such a view is perplexing. Why must we wait for injured infants involved in motor vehicle accidents to enter our emergency rooms before advocacy can begin? Why must we be prohibited from promoting more effective car-seat safety legislation instead? By forbidding us from being advocates for upstream solutions to avoid downstream problems, Dr. Huddle inappropriately eliminates preventive medicine from our scope-of-practice.
Third, Dr. Huddle highlights the fact that physicians currently “engage in community and political activities less often than do [their socioeconomic peers]” as a reason for continuing to refrain from advocacy. Although the reasons behind this less frequent engagement have not been fully elucidated, inadequate training in advocacy skills may certainly be a contributing factor. If anything, abundant physician interest in advocacy, which Huddle openly acknowledges, and a concurrent lack of engagement argue in favor of universal training so that all physicians may become competent in advocacy and feel comfortable initiating and promoting positive community-based changes.
We applaud the efforts of the pediatric residency review committee to incorporate advocacy into our training. Although the thoughts we express here represent our pediatrics perspective, we suspect that doctors caring for other segments of the patient population share similar ideals. As a collective, we physicians are a powerful voice of the disabled and the sick, and as such, it is incumbent upon us to use any available tool to identify and halt all etiologies of disease, be they individual, institutional, or systemic.
Sohil R. Sud, MD, MA
Resident physician, Department of Pediatrics, University of California, San Francisco, School of Medicine, Benioff Children's Hospital, San Francisco, California; firstname.lastname@example.org.
Elizabeth S. Barnert, MD, MS
Resident physician, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, California.
Elizabeth Waters, MD
Resident physician, Department of Pediatrics, University of California, San Diego, School of Medicine, Rady Children's Hospital, San Diego, California.
Peter Simon, MD, MPH
Resident physician, Department of Pediatrics, University of California, San Francisco, School of Medicine, Benioff Children's Hospital, San Francisco, California.