Dr. Sandroni finds argument to be otiose in the face of a reality that demands action; poverty and misery in our surroundings cry out for the proper response from physicians. In his view, we who confront that reality are either with him and the forces of good or against him and them. If we are with him, we will be engaged in political advocacy on behalf of the poor and miserable; if we are not so engaged, we fall short of meeting our professional responsibilities.
Dr. Sandroni's willingness to condemn physician stances toward advocacy other than his own should, I think, give us pause. A take-no-prisoners approach to the politics of social welfare has, of course, plenty of precedent in our political tradition. Its appeal is likely to be a matter of temperament as much as of political conviction. While many things might be said in response to Dr. Sandroni, the most salient might be that however much he wishes all of us to join in a political crusade on behalf of the poor and miserable, it is not going to happen. Too many of us have no interest in politics, or no confidence in the efficacy of political action (or, at least, of the kinds of political action Dr. Sandroni would likely favor) for relieving poverty; some of us, doubtless, care less about poverty and misery than we should. Dr. Sandroni may succeed in inspiring some of those around him to follow in his activist footsteps through his own dedication to advocacy. But he is not going to convert all of us in the medical profession to political activism by presuming our moral inadequacy or by attempting to redefine medical professionalism to fit his own political preferences. Nor should he, or others who favor mandatory physician advocacy, try to do so.
He is, in any event, correct to suggest that what is at stake here has implications going far beyond academic debates. He and I could doubtless have an interesting discussion (or, failing that, perhaps, a debate) about policies likely to diminish poverty, our duties to the poor and miserable, or our civic responsibilities. And, at present, we could afterwards proceed to the wards or the clinic and conduct our professional practice in good fellowship, united in our professional commitments if not in our political views. However, if the movement for mandatory physician advocacy had its way, such unity amid diversity would no longer be possible, as physicians who made the political choice of noninvolvement in advocacy (or, perhaps, involvement in the wrong kind of advocacy) would be censured and ejected from the profession. Whether we choose to maintain our present catholicism of political outlook in a unity defined by our professional work—or insist that a given political stance is required for professional orthodoxy—is about as momentous a decision as our profession can possibly make.
Thomas S. Huddle, MD, PhD
Professor of medicine, Division of General Internal
Medicine, Department of Medicine, University of
Alabama Birmingham School of Medicine and
Birmingham VA Medical Center, Birmingham,