When I made the choice to be a doctor at a medical school I wasn’t sure exactly what ramifications (beside teaching the next generations of doctors) my job would have.

It became clear to me after a year that being an academic afforded me many privileges: of course, mentoring and teaching relationships, but also the security of letting a big institution worry about the business aspects of my practice (marketing, billing, and even malpractice insurance). Most prized of all was the ephemeral “academic” time, amount varying by year and commitments, that affords me the time to be creative (research, course design, teaching) or simply to catch up on amassed work. Something clicked and made me realize that this was a luxury that academics have that private practice doctors don’t necessarily get; and thus I reached a personal conclusion that we have an obligation to go beyond our mere doctoring (not taking that for granted) to work on some of the societal problems that underpin poor health.

I shared this opinion in a newsletter for the Society of General Internal Medicine, an academic society of doctors doing research, teaching and advocacy at our nation’s medical schools.

One doctor felt compelled to write a rebuttal, telling me, in essence, that physicians (academic or otherwise) have no special role in society beyond taking care of patients; that my idealistic notions of physician advocacy were overblown.

Read the essay below and let me know what you think:

*                         *                         *                         *

What are the societal obligations of a doctor?

Academic physicians have the privileges of caring for patients, training future doctors, and engaging in research.  But what is our obligation with regard to advocacy?  Are we required to become advocates, or can we declare, on the basis of our other missions, that we “give at the office?”  Since our academic homes are by and large non-profit institutions that provide under-reimbursed and uncompensated care, is it legitimate to claim that we contribute just by showing up?

To a large extent, advocacy is a natural outgrowth of our daily work, whether on behalf of a patient, a resident, a student, or for the benefit of our own research and careers.  Many of us become advocates through what amounts to happenstance—we are presented with a situation that seems obviously wrong—and we become engaged in finding solutions.  Others of us enter medicine with advocacy passions, though given the long training process, it can take us time to find our “faculty” voice.  A few of us, I suspect, having achieved faculty status, don’t want to rock the boat too much and risk jeopardizing what we have achieved.

Continue reading