If you wonder how physicians think and feel, about anything and everything related to medicine, healthcare, economics, parenting, relationships, and life in general, check out KevinMD, an expertly curated blog by physicians all around the world. I recently read a heartening and important piece on gender equality in medicine. A pediatrician husband wrote about the stark differences in assumptions about work-life balance for men and women, in “What Does Your Husband Think of You Being a Surgeon?” Then I came across another article by a male cardiologist, whose wife is also a physician, entitled, “The Gender Gap in Cardiology Is Embarrassing.” Both men’s wives delayed their medical training, and these husbands bore witness to our culture’s implicit gender bias against their life partners. I strongly encourage you to read both pieces; they are short and poignant.
—- Please click on the links and at least skim the articles, before continuing here. —-
Now, consider how much more weight and influence these pieces carry, simply because they are written by men. If you find this difficult, imagine your internal response if they had been written from the women’s perspectives. Which position is more likely to evoke, “Hmm, interesting,” as opposed to, “What are these women whining about?”
When we consider advocacy, it’s fair think of it as those with more power and influence using these advantages to champion those who have less. Sure, the less powerful and influential can and do advocate for themselves, but without allies among the advantaged, the message and movement stall and stutter. Consider slavery and the Civil Rights Movement. If it were only ever black people advocating for themselves, what would the American racial landscape would look like today? Think about women’s rights. There is a reason the United Nations launched the HeforShe campaign. Self-advocacy is required, but sorely inadequate, to lift people out of oppression. And let’s be clear: oppression takes many forms, which we often fail recognize or acknowledge.
I have a fantasy about patients advocating for physicians.
I imagine Sally and John*, two friends communing at their favorite coffee shop, one of their regular meetings of mind and soul. The conversation veers toward healthcare, and Sally starts ranting about how physicians don’t care about patients anymore. They’re only in it for the money, having sold out to pharma and industry, and they think of themselves as second only to God him(her)self, exercising control over patients’ lives with little regard or actual caring. In this coffee shop scenario, I as physician have no power or influence. If I sat there with them, trying to explain how ‘the system’ drives wedges between us doctors and our patients, about how on average doctors spend twice as much time on administrative activities as patient care activities, how 50% of us report burnout, and how our suicide rate is up to 4 times that of the general public, I estimate that I’d likely be seen as whining and making excuses. In this scenario, facing a (rightfully) prejudiced audience, my voice counts for very little.
Although physicians still enjoy a fair amount of respect and deference in society, our struggles, personal and professional, are still poorly understood by the general public. I think people are even less cognizant of the insidious and profound detriment that physician burnout and depression have on patient care and the economy at large. But when doctors describe our adversities to patients, I think we still come across as whining. Knowing that I write this as a physician, what is your reaction? Is it closer to, “You live at the top of the food chain, what are you complaining about?” Or rather, “Wow, what’s going on that so many doctors feel so badly, and how could we all help one another?”
Lucky for doctors everywhere, John is my patient and we have a longstanding, collaborative relationship. He empathizes with Sally’s perspective, as he knows what she has been through medically. He has also inquired about my work, and understands the systemic frustrations that physicians face in all fields. Because they are such good friends, John feels comfortable challenging Sally’s skewed assertions. He describes what he has learned from me, and explains earnestly that all doctors are not, in fact, swine. Because he is her trusted confidant, she believes him. Her attitude opens ever so slightly, and she is more likely to acknowledge how physicians and patients alike suffer from our overall healthcare structure. John is, in this case, the strongest advocate for me and my ilk.
Whenever one of us stands up as a member of a group, and speaks up to our peers on behalf of another group—white people for black people, men for women, Christians, Jews, and Muslims for Muslims, Christians, and Jews, liberals for conservatives, physicians for patients, and vice versa in each case—we are all elevated. Our mutual compassion and humanity are called forth to heal our divisions. This is how personal advocacy, how everyday power and influence, works.
As a patient, you have more power than you may realize. I bet most people don’t necessarily feel adversarial toward doctors. But they probably don’t necessarily feel allied, either. What can you, as a patient, do to bridge this gap? How else could we all, physicians and patients alike, create that essentially healing inter-tribal connection?
As always, interesting and thought-provoking, Cathy. I have seen an interesting variation on the “x advocating for y” scenario. For many years, I served as executive director of a nonprofit health-care organization focused on long-term care. When we advocated at the state and national level for additional funding, we consistently heard legislators ask us where the money we were asking for should come from. “Do you want us to take it from acute care, or from education?” they would ask. Our response was always to resist the idea that if someone is going to “win,” someone else would have to “lose.” We even went so far as to sit down with the acute care lobbyists and education advocates and came to agreement that funds expended on any of us served all of us. We agreed that we would not allow legislators to ask us to pit one good cause against another, but instead show them how funding health care or education ultimately saves money in other areas, as well as enriching life in general. Most legislators seem to see money and issues only in silos, but others are coming to see the interconnectedness of all things. It’s the same with human relationships, as you articulate so well.
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Thank you, Donna, and what a great example of allied advocacy you and your colleagues lived!! Those legislators seemed to use splitting as a strategy–divide and conquer–and you all had the wherewithal to resist. Strong work!! I think the next step is to look for candidates who intuitively hold the space for collaboration, negotiation, transparency, and seeking the win-win. And, of course, who are not held hostage by corporate money… 😒 We need all of these aspects in our policy leaders, and we need a tipping point number of them who practice this approach… So we need to keep leading by example the people in immediate spheres of influence, reward these positive behaviors when we see them, and protect our hope and belief that at the core of every person is that deep desire to connect. Gaaaagh, it feels almost too much to even hope for sometimes… 😐 But oh well, onward. 👉🏼
I have great relationships with my doctors. I’m a cancer survivor. When I wrote “Boob Reports” to chronicle my journey (will be published some day) they shared them with other patients. I’ve never given any thought about whether my doctors were men or women, just if they came highly recommended. That said, I’m sure you see all kinds of behavior from the other side.
Thanks for bringing this to the party! Have fun clicking on links and meeting the guests!
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Thanks for stopping by, Susie, and for hosting your blog party. I have read interesting pieces that I would not have otherwise found! Have a great rest of your week! 🙂
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I’m so glad to hear that, Catherine!
This makes me see a whole new side to things- very interesting x
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Thank you, that was the intent. Thank you also for stopping by, please come again! 😊
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