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Academic Medicine:
doi: 10.1097/ACM.0b013e318226752f
Letters to the Editor

Do Medical Professionalism and Medical Education Involve Commitments to Political Advocacy?

Schickedanz, Adam MD; Neuhausen, Katherine MD; Bennett, Heather MD; Huang, David MD

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Resident, Department of Pediatrics, University of California, San Francisco, School of Medicine, San Francisco, California; adam.schickedanz@ucsf.edu. (Schickedanz)

Resident, Department of Family and Community Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. (Neuhausen, Bennett)

Resident, Department of Internal Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. (Huang)

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To the Editor:

As young physicians, we read Dr. Huddle's1 article with disappointment. He not only fails to recognize public advocacy for patients as a vital professional responsibility of physicians but also ignores the achievements of generations of physician–advocates, whose voices we need now more than ever.

Advocacy is an essential physician skill, as it has been for ages. In 1849, Rudolf Virchow, a physician and the father of modern cell theory, wrote, “If medicine is to really accomplish its great task, it must intervene in political and social life.”2(p323) He would later become an advocate for better sewer systems and standardized food safety and inspection to protect his fellow citizens. More recently, physicians have led the fight to control tobacco and make motor vehicles and highways safer through seatbelt, airbag, and drunk driving laws. These achievements through advocacy complement our clinical efforts and have spared countless lives.

Becoming advocates may not interest all physicians, but those who wish to be advocates for population health should have ample opportunity. Just as all trainees are introduced to the principles of medical ethics or biostatistics to enrich their clinical careers, early medical training should cultivate advocacy skills as well. We should not fear that giving medical trainees the skills to advocate will turn them into politicians or lobbyists.

We can all agree we do not want the medical profession to be politicized. But like it or not, health care has already become entangled with politics, as recent election cycles have clearly shown. This existing politicization of medicine demands more effective physician advocates, not fewer. The solution: Train young physicians to represent the higher purposes of the profession in public discourse and to educate political decision makers with the best evidence. In this way advocacy provides a remedy to overpoliticization of the profession, not the slippery slope toward it.

We and many other physicians will continue to engage in public advocacy on behalf of the patients and communities we serve, without fear that this will somehow harm our professional virtue. Indeed, we harm our virtue and our patients so much more by refusing to stand up for them on public matters of health.

Adam Schickedanz, MD

Resident, Department of Pediatrics, University of California, San Francisco, School of Medicine, San Francisco, California; adam.schickedanz@ucsf.edu.

Katherine Neuhausen, MD

Resident, Department of Family and Community Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.

Heather Bennett, MD

Resident, Department of Family and Community Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.

David Huang, MD

Resident, Department of Internal Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.

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References

1 Huddle TS. Perspective: Medical professionalism and medical education should not involve commitments to political advocacy. Acad Med. 2011;86:378–383. http://journals.lww.com/academicmedicine/Fulltext/2011/03000/Perspective__Medical_Professionalism_and_Medical.29.aspx. Accessed April 25, 2011.

2 Farmer P, Sen AK. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Los Angeles, Calif: University of California Press; 2005.

© 2011 Association of American Medical Colleges

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