To the Editor:
As a group of resident and faculty scholars in advocacy, we appreciate Dr. Huddle's thoughtful reflections on advocacy and advocacy education.1 However, we have several serious concerns with his stance. His argument that political advocacy is a civic virtue and not a professional one does not take into account the significant influence of the U.S. government on the current practice of medicine. While we agree that education in advocacy should not dictate particular political views, this position does not negate the need to train medical scholars in advocacy and promote political involvement for the sake of patients.
It is impractical to believe that a physician can competently perform clinical work in the U.S. system without political advocacy. Particularly as emergency physicians, daily we are faced with patients' most desperate health needs and barriers to health care. While Dr. Huddle points out that physicians may advocate and effect change for individual patients, this approach is not economically sustainable to meet the needs of every patient with barriers to care. All physicians should use research and contacts with patients to identify community-wide challenges in health care and advocate well-considered, systems-based change. Only through this approach can physicians accomplish their most fundamental duty demanded by medical ethics, thus benefiting entire communities rather than just individual patients.
While Dr. Huddle expressed his concern that advocacy education would displace clinical work and the basic duties of physicians, this is simply not true. Time and effort allotted to political advocacy may be the only way to protect the doctor–patient relationship. In the current medical climate, we physicians are often bound by preexisting mandates and laws set by individuals unfamiliar with our work. We desire to give the best care to each of our patients, but the environment in which we practice limits our ability to do so. This is why advocacy must be a part of university and medical school education. Without it, as Dr. Huddle says, advocacy “would thrust academicians into activities for which their careers have offered no preparation.”
We do not argue for advocacy forced on the uninterested; however, we do propose that advocacy is necessary to facilitate the care our patients need. There has been a paucity of advocacy education historically, but our current system requires more active participation than the “occasional and optional avocation” Dr. Huddle suggests. Through scholarly advocacy, based on objectivity and truth, we are able to provide better care to our patients. Recognizing societal challenges and advocating a system that removes barriers to health care for our patients is our responsibility as medical professionals.
Melissa Halliday, DO and the members of the Indiana University Emergency Medicine Scholars in Advocacy Track
Emergency medicine resident, Indiana University School of Medicine, Indianapolis, Indiana; [email protected].
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 June 13, 2011.