I got myself into a bit of tussle on Twitter today.
In a provocative piece on the newsletter Persuasion, Dr. Sally Satel argued for caution in the matter of doctors becoming political activists.
I retweeted it below:
Most of the replies express extreme disagreement. One question stood out as worthy of a longer reply than Twitter allows.
And then this:
Thank you CC for the calm inquiry. My answer goes something like this:
Dr. Satel and I are both against racism.
But let’s say we objected to being forced to do implicit bias training or white fragility corporate modules. Then let’s say we argued publicly against these policy interventions.
We would likely be fired, or castigated on #medtwitter, or both. Read the timeline for evidence.
This is where my June 7th post comes in: Namely that I am concerned that legitimate debate is increasingly impossible in today’s culture.
Here are a couple more vignettes highlighting the challenges of doctor-activism.
As a cardiologist I see minority patients whose social situations surely play a role in their heart disease. I treat these patients as best I can, taking into account their specific challenges. I practice minimally disruptive medicine.
Like anyone I want the disadvantaged to have better lives. But…how exactly is my medical degree supposed to guide me in crafting solutions to improve the situation of poor people? Is it Bernie Sanders’ approach? Or Elizabeth Warren’s? Or, god forbid, a free-market approach?
I’ve visited a certain eastern European country a couple of times. There I noticed very little homelessness. My hosts added that there was almost no issues with drug abuse. Why, I asked? Their answer was that in their country family structure and religion were very important. My hosts felt that these factors played a central role in limiting societal inequities.
Imagine expressing that view on #medtwitter now. Boom. You’d be gone! So I won’t.
Another example: Dr. Satel cites a Dr. Donald Berwick essay in which one of his calls to action is for doctors to oppose the electoral college. That’s a long way from electrophysiology.
I took some history in college, and I have been an American for a good while, but how is my medical degree relevant to arguing for or against the constitution of the US?
Yes, we can have a discussion about the electoral college, but why would Dr. Berwick think a large swath of the medical profession should advocate on one side of a debatable issue? in the matter of governance, doctors in smaller rural states might feel differently than those on the coasts.
The pandemic has given us another terrific example in the challenges of political activism. The American Academy of Pediatrics initially advocated for getting kids back in school. Others said this was foolish.
Let’s say you are a pediatrician and parent and your spouse is a teacher who happens to have chronic lung disease. Your professional society is advocating for re-opening schools. Your position is different.
Yet the school debate gets even more complex. Keeping kids out of school arguably hurts disadvantaged kids more than rich kids. Thus, on these grounds, could one go so far as to call such a policy, racist? I would not. But perhaps the nuance of advocating for solutions to societal problems comes out?
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Doctoring is a great job. I love it. But cardiologists have no special expertise in fixing the societal forces that contribute to the higher rates of heart disease in disadvantaged groups.
I’ve written before that we should strive for more diversity in medicine. We should have more women and minority representation. I have no special expertise on how to achieve that. There is likely more than one way.
Trauma surgeons and emergency medicine doctors treat patients with gunshot wounds, but do they have any special insight into the best gun control policy? Yes, you could be for banning guns, but surely there are surgeons and EM docs who would disagree.
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Doctors like anyone can and should participate in debates over policy solutions.
But, as a group, we have no special wisdom over any other citizen.
To act as if we do shows our hubris.
And hubris is a doctor’s greatest foe.
JMM
8 replies on “Doctoring and Activism”
I’ve been following you and your blog for years. You have also given input on a couple of questions I have had over that time period. In that time I have never given thought to your political leanings. Your a EP/Cyclist. And I’m a Cyclist with long standing issues with arrhythmias. We have common ground.
I also follow you and a few other EP’s on Twitter. Only one of them besides you I have never met personally.
I’m pretty sure I can 100% guess the other EP that I follow, and don’t know political leanings based solely on some of his posts. However, the majority of his posts I find interesting and informative wether in the EP realm or otherwise. I also would not off hand discount someone’s professional input based solely on their political leanings.
My PC Doctor is a 2A fan. We often talk about days at the range and of how many Coyotes he’s snuffed out since my last visit with his AR-15. My guess is that he doesn’t have those conversations with all his patients as there would surely be fallout.
I would leave a comment on this subject but contrary to the wisdom of Christopher Hitchens , I am quite confident it would be a waste of time.
I have learned from experience that giving unsolicited advice offered absent a personal request is a waste of time.
Whenever I read as essay that starts with ‘As a doctor, I know’, I realize (a) someone who is going to expound on a topic that is outside of their expertise and (b) this person thinks the reader won’t recognize a flimsy appeal to authority.
It’s the rhetorical equivalent of screaming ‘DON’T YOU KNOW WHO I AM?’
Solid arguments stand on their own merit, not on the letters behind the name of the person stating the case.
Wow – I read through the twitter comments and am astounded by the dominant attitude.
Twitter docs – We have standing and indeed a responsibility to speak for our patients about almost any injustice they face.
Also Twitter docs – You want to know how much my bill will be from this visit? uh…umm…I just don’t have any real way of knowing. I’m just a cog in the wheel. Sorry. It’s out of my hands…..
I don’t know any of these patients who are begging their docs to speak up for them about social issues. Most of us would just love to see the same doctor twice in a row and get an accurate bill.
And THIS helps to explain why I would never ask my GP for parenting advice either…
Or nutrition advice, for that matter (at least until the dueling keto vs vegan cardiologists come to some agreement).
Thanks Dr. John….
Nice essay and I agree. I wonder if we could go so far to say that aggressively pushing social issues diminishes our effectiveness as physicians. I have plenty of far left and far right patients and try to stay pretty even-keeled with both, ie respect their views but don’t push back much either way. My job is to practice medicine.
in this very polarized time, I (patient) admit that if one of my doctors supported Trump (on Twitter, with a sign in the office, with a comment), I would walk away. So I guess that’s another factor to consider.
Nice and thoughtful, JM!
When I get a chance (read, “make the time”) I enjoy your PoV.
Now that I am retired and having been awarded an MBA, I am teaching medical students – One course I am giving is on Public Policy in Medicine, to pre med students. It is fun, and interesting. With all the polarization over the past 8 years, not much has been done (through legislation) on medical policy. Actually not many Executive Actions in health policy.
Lots of tweets – which is why I’m not on twitter – meaning that I agree with you – don’t offer off the cuff tweets, or retweets.