People in positions of power, clinical or otherwise, have voices that others hear and listen to; as such, they should embrace a broader advocacy role working toward not just the wellbeing of their patients but also justice for the disempowered. Jean Fagan muses on the responsibilities of clinicians in our society.
In the past week I have been coincidentally linked to two key note addresses given to medical students by two health leaders who could not be further removed from one another, but whose messages are both so strikingly similar that they caused me to reflect on my personal responsibility.Both leaders happen to be in HGI’s contact network i.e. they are personally known to one or more HGI consultant. One was addressing graduating medical students at Harvard University 2012 Class Day; the other, delivering a key note presentation to medical students from the University of Tasmania. One is a paediatrician and appointed by President Obama to lead the Centres for Medicare and Medicaid Services from July 2010 to December 2011; the other, a Fellow of the Chapter of Addiction Medicine ( FAChAM) and the clinical head of Addiction Services in Tasmania. I guess it’s a little clearer why I would suggest that at face value, at least, they are worlds apart!
Both leaders spoke from the heart and from a conviction that many in positions of power, influence and leadership have either lost or never had their compass bearings focused on responsibility to help the vulnerable in society, are prepared to distort the facts for their own purpose and are moved by fear of “authentic” questions and media headlines. Both professionals work at the top levels in their respective professions, close to the politics of health and government. They shared these common themes:
- The day a medical student graduates he / she gets a compass to navigate a pathway which should, firstly, always be the oath to care for all patients. However, they talked about a second compass bearing that might not be favourable to some; nevertheless, just as there is a duty to heal the sick, there is a second duty, which is to cure injustice.
- Graduating as a doctor gives you entry to a career of privilege, rights and licence. It gives you a voice in public debate and the oath you take bestows on you the responsibility to use that voice – “to be ashamed of miseries you didn’t cause” (Berwick), to be a voice in a compassionate society and to understand that a physician is a “healer, who is not a leader who permits pragmatics to quench purpose” (Berwick).
- Both quoted compelling data and statistics that evidenced their concern for the health and well-being of many in our society and the choice being made by many individuals in power not to speak for the disempowered or against injustices or to support a common humanity. Serious and disturbing data such as: 20 million people live in extreme poverty in the United States, which means that they live on less than US$11,000 per year as a family of four. And: alcohol, tobacco and other drugs are responsible for 12% of Australia’s burden of disease and injury (Beg et al, 2008). The estimated proportion of ED injuries attributable to any level of drinking in the 6 hours prior to injury was 28% (Australia-wide; Chikritzhs et al 2011).
- Healthcare and health are a human right, and health is a “critical resource for life, a resource that provides opportunity for maximising one’s capacity to flourish in life” (Ottawa Charter, 1986; Culyer and Wagstaff, 1993).
- There is, because of the duty bestowed on you by the oath you took as a graduating medical student, a responsibility “to apply your minds to evidence-based public policy and to the range of commercial and social counter-drivers of health” and “to drive appropriate and necessary policy change” ( Dr Adrian Reynolds, AMSA / UTAS FutureMed, 2012).
- Dr Berwick noted the quote on a plaque in the foyer of the Hubert Humphrey Building, headquarters of Health and Human Services: “The moral test of government is how it treats people in the dawn of life, in the twilight of life and in the shadows of life, the sick, the needy and the handicapped”. He reflected that as a physician, you must not forget your purpose as a healer to the people in the dawn, the twilight and the shadows of their lives. “Those that suffer need you to be something more than a doctor; they need you to be a healer. To become a healer you must do something even more difficult than putting your white coat on. You must take your white coat off. You must embrace and treasure the memory of your shared, frail humanity – of the dignity of each and every human being”.
As citizens of the world, we all have a responsibility to contribute to a shared humanity and to navigate with a moral compass that gives us our bearings to contribute to a compassionate society.
Lastly, I want to share a quote sent to me by one of my sons yesterday. It struck a chord with me, because without health, this fundamental human characteristic can’t be realised – “A decent society should maximise the possibilities for this fundamental human characteristic (the need for creative work, for creative enquiry) to be realised.” – Noam Chomsky