Reflections on the Physician as Advocate
Author: Teva Brender
Keywords: advocacy, professional societies, legislative process, structural determinants of health
His handcuffs were heavier than I thought they would be. And colder too. In that moment I realized that I had never felt a real pair of handcuffs before; I certainly didn’t expect the first time to be in a hospital room. After checking Mr. B’s pulse I knelt down and asked how I could help make him more comfortable. As I stepped past the correctional officer in the hallway I paused, collecting my emotions – shock, anger, sadness – before continuing on to the nutrition room to grab him some ice water.
Biking home that night I thought about Mr. B and the trauma he must be experiencing. As the medicine team we could treat his sickle cell crisis, offering empathy and compassion; but benevolence alone could not palliate the indignity of being shackled to one’s hospital bed.
Responsible for the full spectrum of disease and witness to the countless social determinants of health, internists are privileged with the perspective and platform to promote policies that will benefit the public. For far too long physicians, organized medicine, and the healthcare industry have not done enough to challenge a status quo that perpetuates health disparities across race, class, wealth, and gender. Yet times are changing. From gun violence to police brutality, structural racism, and disinformation about vaccines and COVID-19, physicians have started to find their civic voice – a legacy that I hope to inherit and continue.
But advocacy is not a solo endeavor; an effective advocate needs allies. So, days later, and unable to stop thinking about Mr. B, I connected with several colleagues active in the Oregon Chapter of the American College of Physicians (ACP). I had no way of knowing it at the time, but those initial conversations would eventually culminate in us writing a resolution on the healthcare rights and humane treatment of incarcerated persons that was adopted as policy by the ACP and the American Medical Association.
I am under no illusions. I first met Mr. B on my internal medicine clerkship when I was an MS3. I am currently an MS4, and just the other day I took care of a patient who was shackled to his gurney. Our resolution changed no laws; nor did it even change official policy at my institution. But, to paraphrase the great Dr. Martin Luther King Jr. who himself was drawing inspiration from the 17th century abolitionist Theodore Parker, though the moral arc of the universe bends slowly, it bends towards justice. Allow me to explain.
For the last several months I have had the privilege of co-chairing the Oregon ACP’s Advocacy Day subcommittee on Policy, Research, and Education, now leading the same group that, just a year before, had been my introduction to policy and advocacy work. Like the old medical pedagogy – see one, do one, teach one! In this capacity I advised a group of students who were interested in writing their own policy resolution on the reproductive healthcare rights of incarcerated females. What’s more, we were able to connect them with pediatrician and state Representative Lisa Reynolds, MD, who is the chief sponsor of HB 4146, a bill to designate a gender-responsive coordinator for Oregon’s correctional facilities. HB 4146 is currently being considered in the House Ways and Means Committee so perhaps when you read this essay it will have passed and become law.
This is the work of the physician advocate. To listen to our patients, both to the words that they say and the words that they don’t say. To stand with our peers in order to lean on those seemingly immovable systems and structures at the root of health disparities. And to bend those institutions, ever so slightly, ever so imperceptibly, towards equity and justice.
About the Author: Teva Brender is a fourth-year medical student at Oregon Health & Science University planning on pursuing a career in internal medicine. His other interests include health policy, physician advocacy, and narrative medicine. He is a proud member of the Oregon Chapter of the American College of Physicians serving on the Advocacy Day Planning and Health and Public Policy Committees. He is also the co-chair of the Policy, Research, and Education sub-committee. He has published original research on advocacy curriculum in undergraduate medical education and has written policy resolutions on healthcare for incarcerated persons for the ACP and American Medical Association.