• In The Trenches

    End the Silence -- Make Every Voice Count

    "What we've done, love can still undo."
    -- Dave Barnes

    Last week, the AAFP launched its first-ever virtual Week of Action. Given the necessary cancellation of the annual Family Medicine Advocacy Summit, we offered our members a variety of steps they could take to communicate the need to protect our country's primary care infrastructure. We created videos, backgrounders and other support materials to help members get engaged with their members of Congress.

    While those preparations were underway, the killing of George Floyd brought the country to a standstill and uncovered the gaping wounds that racism has caused. A collective helplessness emerged, and we all felt powerless.

    We received heartbreaking stories from members who lost their ability to see patients in the aftermath of protests but who still, in the face of that, fully understood the simmering rage and frustration that had boiled over. We heard from a member who had finally gotten an entire family -- including their son who has autism -- into the practice after months of pandemic-related delays, only to immediately have to lock down due to protests. The helplessness many of us have felt has been palpable. How do we help patients? How do we help neighbors? How do we help ourselves?

    I am proud that the Academy quickly rejected the status quo, its defenders and the blatant abuse of power that has led to too many unnecessary deaths.

    The struggle now becomes deciding where we go from here. Do the statements issued by powerful people and organizations simply fade away, or can we truly begin to do the work of change?

    It is extremely easy to call out the failings of others who led us to where we are today; it is much harder to identify our own shortcomings. How have we, as a society, contributed? As individuals?

    Racism is a moral failing in our cultural contract -- a particular failing for some of those who have a responsibility to protect and serve all members of society. Many have fought for years for the right to participate in society as equals, and it is disheartening to see that more than 50 years after passage of the Civil Rights Act, we have yet to attain that goal. My grandfather was a Tuskegee Airman and spent the first part of his career facing these injustices head-on, watching as prisoners of war had more freedom to move around his base than he did as a pilot fighting for his country. Those wounds and humiliations stayed with him. Although he turned the experience into positivity by educating others, it left an indelible stain on him. I know he'd be disappointed, as I am, to see where we are today.

    The markings of racism are not just mental -- they are physical, as well. Countless studies have suggested correlation of racism and physiological health. One study, even after controlling for a variety of factors, found that youth exposed to high levels of racism had higher circulating cytokine levels three years later. These inflammatory indicators have been shown to be reliable predictors of chronic diseases such as stroke and coronary disease. In addition, experiencing racism contributes to high-risk, unhealthy behaviors such as smoking and substance use. It also leads to delays in receiving recommended preventive services such as mammograms and cholesterol testing. These delays are widely accepted as contributing to worse health outcomes and accelerating untimely deaths. Racism is literally killing people faster.

    The good news is that there are things we can do now. The AAFP's implicit bias resources can make an immediate difference in day-to-day practice by prompting an internal gut check against our own reactions that are often habit-driven and immediate. There are also excellent resources for educating ourselves about the plight of people of color in this country.  

    Family physicians often engage many of their five senses when treating patients. It is time that as a profession, and as a country, we prioritize one sense above all. It is time to listen.

    Family physicians are uniquely positioned to be leaders in national healing -- in their communities and in the house of medicine. Who better to carry the message than the physicians who care for patients throughout their lives? In this pivotal moment in U.S. history, it is important for the Academy to lead with the compassion and strength that led you down a career path dedicated to caring for others.

    This will take courage, persistence and thoughtful engagement with those in a position to influence change. It is incumbent on all of us to be the change that we seek and to ask the same of those who represent us. Advocating for your needs and the needs of your patients with lawmakers has never been more consequential. It is so important to remember that every voice counts -- and equally important to remember that silence speaks, too.

    I am personally humbled to represent such an engaged and thoughtful membership, and I look forward to working together to bring about change in our communities.

    Stephanie Quinn is senior vice president of advocacy, practice advancement and policy.


    The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.