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Wednesday Dec 12, 2018

No Need to Yield: Advocacy Is Our Lane

Members of the medical profession have long advocated for patients, whether it be in the form of addressing hand hygiene in the operating room, promoting childhood vaccinations, educating the public about the need for bicycle helmets and car seat belts, or demanding smoke-free environments in public spaces or lead-free drinking water in our communities.

[Tochi Iroku-Malize, M.D. and others]

Here I am (third from left) with other members of the New York State AFP and a congressional staffer after a meeting at the office of Rep. Joseph Crowley, D-N.Y.

The common theme is that we are promoting and protecting the best interests of our patients.

Despite the need for, and the many successes of, physician advocacy, medical education is often limited to clinical teaching. Today, learners at various stages of their careers -- medical students, residents, faculty or community physicians -- find themselves in a world in which physician advocacy is expected. And so medical schools, academic medical centers and specialty societies may need to reassess whether and how they provide resources to enable our colleagues to advocate, as well as how they train them to do so.

There are those who say that policy-making and advocacy should be left in the hands of politicians and lobbyists. However, such arguments miss an important, basic understanding: that many laws and policies that might not seem directly related to health care -- think seat belts -- do, in fact, directly affect our patients' health.

During the AAFP Congress of Delegates in October, family physicians debated more than 70 resolutions. And although many of these covered exactly the kinds of issues you would expect at a physician meeting -- payment, administrative burden, the nation's opioid crisis, etc. -- our members also discussed public health issues that affect our patients beyond hospital and clinic walls, such as school nutrition, climate change, family leave, immigration and gun violence.

Our organization is not alone in this perspective. In an Oct. 30 news release,(www.acponline.org) the American College of Physicians called for "a public health approach to firearms-related violence and the prevention of firearm injuries and deaths," publishing an updated position paper(annals.org) to that effect in the Annals of Internal Medicine. The National Rifle Association responded Nov. 7 -- the same day 12 people were killed by a gunman in a California bar(www.nytimes.com) -- with a tweet(twitter.com) that said, "self-important anti-gun doctors" should "stay in their lane." Less than two weeks later, another shooter killed a pharmacist, a police officer and a physician(time.com) at a Chicago hospital.

The "Stay in your lane" message was not well received by physicians,(www.chicagotribune.com) given that the phrase essentially means "Mind your own business." When patients are poisoned by lead in their drinking water or shot with lead bullets, that becomes our business.

Clearly, it is important that everyone understand that advocacy is one of the major roles of a physician.(journals.lww.com) And whether advocating for better housing, cost-effective treatments or better payment, one needs the skills to do an effective job of protecting and promoting important issues. To be effective, one must consider the issue at hand, its health-related impact, potential solutions, stakeholders (including decision-makers) and the message intended to bring about change.

The unique role of family physicians -- caring for the entire individual (physical and psychosocial) and entire families -- lends even more weight to the need to embrace these skills. Many of us advocate for patients daily, on a smaller scale, for things such as prior authorizations. We need to develop the capacity to step outside our comfort zone onto a larger stage.

If we do not deliver important health messages on behalf of ourselves, our patients and our community, we will have failed to fulfill our mission as family physicians. Fortunately, our Academy has ample resources to help family physicians stay informed, as well as specific advocacy events and leadership opportunities in which students, residents and physicians may participate.

The key is to recognize the myriad opportunities to learn about and get involved in advocacy so that we may seize those opportunities and continue to make a difference.

Tochi Iroku-Malize, M.D., M.P.H., M.B.A., is a member of the AAFP Board of Directors.

Posted at 02:20PM Dec 12, 2018 by Tochi Iroku-Malize, M.D., M.P.H., M.B.A.

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