To the Editor:
With great interest, we read Dr. Huddle's1 perspective on the exclusion of advocacy as a professional responsibility, but we must respectfully disagree with his dissection of this valuable aspect of a physician's identity. While we agree that partisan politics in medical education may not be appropriate, Huddle's discussion blurs the line between partisanship and advocacy. Conceptualizing the role of the physician to assess, treat, and even be an advocate for individual patients without acknowledging the role physicians inevitably play to improve the systems in which they work too narrowly restricts professional responsibility. Dr. Huddle seems to suggest that a physician could be obligated to engage in advocacy on behalf of individual patients, but dismisses working toward systemic remedies. By this logic, a physician may be compelled to fight for coverage of a study for an individual patient, but is powerless to advocate systems-level redress.
Few professionals are poised to make such an impact on both individuals and society as are physicians. Medical education must embrace the full value and power of the tools at physicians' disposal to ensure improved health and social welfare. From the development of Medicare to the Patient Protection and Affordable Care Act, physicians have played a vital role in telling their patients' stories and advocating a more just and inclusive system. While the debate about these landmark pieces of legislation may have been politicized, the role of the physician should not be likened to that of a politician. Thus, the teaching and practice of advocacy need not be partisan.
We believe all physicians should have at least some competence in advocacy. There is a spectrum of physician advocacy activities that most, if not all, physicians engage in every day.2 Given the current dysfunctional state of the U.S. health care system, it would be a tremendous disservice not to ensure that we, the next generation of physicians, are prepared to advocate in every sense of the word. Few can speak to and influence the processes that govern the factors and systems that affect individuals' and populations' health as well as physicians.
Matthew J. Stull, MD
Education and research fellow, American Medical Student Association, Reston, Virginia; firstname.lastname@example.org.
Elizabeth A. Wiley, JD, MPH
Legislative director, American Medical Student Association, Reston, Virginia, and third-year medical student, George Washington University School of Medicine, Washington, DC.
John A. Brockman
National president, American Medical Student Association, Reston, Virginia, and fourth-year medical student, Case Western Reserve University School of Medicine, Cleveland, Ohio.