Why physician advocacy is so important [PODCAST]

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“We need to stay healthy for our patients, but also for ourselves and our families. We need to mobilize the faction not just with regard to this pandemic, but by anticipating the arrival of others. So how do we advocate for ourselves? A great way to start is continuing our conversations amongst our colleagues and sharing experiences, looking to local businesses in our communities who are helping us procure masks and other supplies (several salons have already started contributing their supplies to local hospitals), and demanding more from our government going forward. Our government is prepared to increase spending when it comes to the military (in 2019, Congress authorized 716 billion in military spending), but health care workers are now in the midst of a devastating war, and all we are offered are substandard responses, ‘there aren’t enough tests,’ ‘do what you can with what you have,’ ‘wear bandanas’ etc. Remember these moments going forward. Remember the failure of the system to support us. Remember the fear, the anxiety, the guilt for not being able to do more. Take these wartime memories and harness them into political power because we are far more powerful as a unit than we are as lone warriors.”

Jessica Kiarashi is a neurologist and can be reached on Twitter @jkiarashimd.

She shares her story and discusses her KevinMD articles, “Physician advocacy in the age of COVID-19” and “Why doctors should get political.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Jessica Kiarashi. She’s a neurologist, and she wrote a pair of related KevinMD articles, “Why doctors should get political” and “Physician advocacy in the age of COVID-19.” Jessica, welcome to the show.

Jessica Kiarashi: Thanks so much. It’s great to be here with you.

Kevin Pho: So we’ll get into your articles in a little bit, but first off, can you share your story and your journey to where you are today?

Jessica Kiarashi: Sure. I was born and raised in New York. I always knew I wanted to be involved in medicine, and I’ve been really lucky to work with a lot of different patient populations throughout my life. I attended undergraduate in Boston, and I later went to medical school in Chicago. Then I returned to New York and worked in the Bronx, where I did my neurology residency, and then I did one year of headache medicine fellowship and moved to Dallas, where I now practice at an academic center, specializing in headache disorders.

I’ve always been really fascinated by the brain. I think it’s the most interesting part of the body, which is what drew me to neurology. Headache medicine specifically was something that was really fascinating for me, because it’s a field that is relatively new, but there have been so many new advancements over the last few years, and you really have a chance to change patients’ lives and change the course of their headache disorder. So that’s what I’ve been doing now.

Kevin Pho: Well, as a primary care doctor, I have to say thank you, because sometimes I see patients with unclear etiologies of headaches, and having a headache specialist to refer to is definitely very helpful. How has the pandemic affected you and your practice?

Jessica Kiarashi: In Texas, we actually shut down pretty early, back in March, once things were getting a little bit out of control. We were seeing what was happening in New York, so our hospital went straight to virtual the first week in March. We actually stopped seeing patients in person at all back in March, and we’ve been doing solely virtual visits since then, as well as Botox and nerve block treatments.

Those things actually shut down for a few months in the beginning, because they had a rule in Texas where the governor said we couldn’t do elective procedures, and it’s kind of a gray area whether Botox or nerve blocks are elective or medically necessary. But we had to stop doing those for a few months as well. Then we picked back up on those, and we’re doing about half a day a week of procedures, but still doing everything else virtually.

Kevin Pho: Sure. So now I want to talk about your pair of KevinMD articles, and I think they’re somewhat related. The first is “Why doctors should get political,” and the second, “Physician advocacy in the age of COVID-19.” Now, for the audience members who may not be familiar with those articles, can you walk them through them and share the stories of why you decided to write them?

Jessica Kiarashi: Sure. I’ve always been really passionate about advocacy for both patients and physicians, and I’ve often expressed my frustration through writing. Throughout college, I worked with children with developmental disabilities, and then I went on to work in autism research, and it was clear that there are so many disparities with regard to socioeconomic status, race, and access to interventions within that world of developmental disabilities. I had a mentor in Boston who was in the advocacy world for these children as well and had been able to be successful in getting a lot of these required therapies covered for them by insurance in the state. So it was a nice example of how advocating for something you’re passionate about can produce desired change.

I wrote these articles at a time when I was frustrated and disappointed with just how the health care system is going in America. I feel that the health care system is denying equitable care to certain patient populations, and there’s this big issue of access as well. Originally, “Why doctors should get political” is really about how doctors have a role in sharing their expertise with their patients and fighting for things that they think are important for their patients. So, trying to get insurance companies to cover medications, which we already do on a daily basis, but also, the important thing is to engage the patient as well in their own care. It’s really a lot of burden on a doctor to be advocating for patients if patients are not going to advocate for themselves as well.

So originally, I wrote that so that patients can get involved: They vote for people in office who represent their views and are going to help with their medical issues, they develop advocacy groups around these medical issues, and they just get more involved. I’ve been really lucky because I’ve been able to work with different types of patient populations in Chicago, Boston, New York, and Dallas, but really, the one thing that seems to be similar across the board is that there are these huge health care disparities. Even with regard to headache medicine, if you look at a map, Texas, New York, and California have a high number of headache doctors, but they’re all concentrated within really urban areas, and then there are these rural areas that don’t really have access, and we have a lot of patients who travel far to see us. So there are just so many issues that we really need to be more vocal about.

And then of course, the other article I wrote, about physicians advocating for themselves in the age of the COVID pandemic, also stemmed from frustration about this feeling. Back in March, when things were getting started, we had all these doctors, nurses, and other health care professionals on the front lines putting their lives at risk every day, putting their families at risk, and not having the proper resources, not having the proper PPE to be doing their job, going to work every day worrying about themselves and worrying about their patients. So that article is more of a call for physicians to be more outspoken about what they need to properly do their job and really fight for themselves as well.

Kevin Pho: So when it comes to sharing our views and sharing our opinions, physicians don’t get a lot of training on this in medical school and residency. So if we have a particularly strong opinion, and if we want to share our voice and make our voices heard, what are some ways physicians can do that?

Jessica Kiarashi: For me personally, I’ve gotten involved in certain groups through the American Headache Society, for example. I’m chair of the underserved population and headache medicine committee, where we work to come up with strategies for how to combat health care disparities. I’m also involved in Miles for Migraine, which is an advocacy group for patients who live with migraine. I think it’s about getting involved in those types of endeavors, parts of societies, groups, or advocacy groups, where you can have your voice heard and you can come up with projects.

I always think it’s important to have strength in numbers. It’s nice for one physician to write an article, or give a talk or interview expressing his or her views, but it’s always nice to have a group of people who are like-minded and have a common goal. They’re always stronger that way.

Kevin Pho: So you mentioned writing is one way that we could share our voice. Now, what are some other specific ways? I think you mentioned a few, whether it’s going on television or being interviewed. What are some other ways physicians can make their voices heard aside from writing? Because I know some physicians may not be comfortable writing.

Jessica Kiarashi: Yeah, definitely. Even just doing this, going on a podcast, is a great way to get your voice heard. But even starting a committee at your own institution. We now have a diversity and inclusion committee where I work, and people can get involved in that, and we hold meetings and have agendas about the types of things that we want to change with regard to diversity and inclusion within our hospital system. So I think that you can really do it anywhere. You can start a committee, you can join an advocacy group, or you can start an advocacy group on your own, and those are just great ways to get associated with people who think like you and have a common goal.

Kevin Pho: Sure. Now, regarding the article “Why doctors should get political,” there are some who say that doctors should not get political and that we should stick to medicine and, proverbially, stay in our lane. What do you say to people who think that doctors should not be involved with politics?

Jessica Kiarashi: I don’t think that’s right, because throughout my career, people have also said to me, “Maybe doctors should stay out of the politics and not express their views.” But I really think that we are in a privileged position, because as health care professionals, we have this clinical expertise. There are so many researchers who work day and night coming up with these evidence-based treatments, and it’s really our role to share this with the world.

Even if you look now, it’s really disheartening, because we’re going through the COVID pandemic, and there seems to be this anti-science rhetoric, or people who don’t want to wear masks. It’s offensive in a way, because doctors and researchers have worked really hard to come up with treatment strategies and to come up with ways to contain the pandemic, and then there are people who have political agendas who overshadow science. So I think at these times specifically, it’s really important to have our voices be heard.

I even commented on this in my article with regard to things like vaccines. We know vaccines work. We’ve done the research. This is the evidence, and it’s our role to keep pushing that. So no matter what, if there are politicians who are trying to quiet us and use their own political agenda to gain ground, we need to be the ones who are outspoken and say, “No, we’ve done the research. We know it works.” Part of our job is to speak to what’s going to improve the health of Americans on an everyday basis. So I really think it’s important for us to be more political.

Kevin Pho: We’re talking to Jessica Kiarashi. She’s a neurologist, and she wrote a pair of KevinMD articles, “Physician advocacy in the age of COVID-19” and “Why doctors should get political.” Jessica, you mentioned a few topics that doctors should advocate on behalf of themselves. Now, what are some other issues that doctors should care about going forward?

Jessica Kiarashi: I think there’s a lot that doctors deal with on a daily basis. So of course, there’s advocating for their patients and advocating for themselves, for their own safety. And one other important thing is their mental and emotional well-being. Through the COVID pandemic, there are a lot of health care professionals who are suffering emotionally because of the things that they’re seeing on a daily basis. They’re seeing sick patients, they’re seeing patients who are dying, they’re doing their best with limited resources, and really, it’s taking a toll on their emotional state and mental state and affecting their families. So I think something they need to advocate for is better mental health services for health care professionals and patients.

I think physician burnout is a huge, huge topic that I know has been really important in the last few years as well. We know that there’s a higher rate of doctor suicide these days. So it’s things like addressing physician burnout: How can we, as a society, improve physicians’ well-being and allow them to continue to work and take care of their patients?

Kevin Pho: Now, you clearly have a lot of experience with advocacy over the years. From that experience, are there any lessons that you could share with my audience, who may be thinking about advocating for a particular cause?

Jessica Kiarashi: Well, I think it’s important to be outspoken. I know, like you said before, doctors shy away from being too political or too opinionated, but the one thing that I think is really important is just to let your voice be heard. Be outspoken about what you’re passionate about, whether it’s having a conversation with other doctors that you work with or even talking to some of your patients about it. I sometimes have patients ask me, “What do you think is going on with COVID?” or “What are the facts?” They actually ask me for my opinion, and I feel like those are opportunities to let your voice be heard. So the most important thing is just don’t be afraid to say what you think, and from there, that’ll open a lot of windows and a lot of different opportunities for you.

Kevin Pho: And my final question: Do you have a take-home message that you want to share with the KevinMD audience?

Jessica Kiarashi: I think my take-home message overall is probably just what I’ve been talking about all along, which is just don’t be afraid to let your voice be heard. Like I said, as health care professionals, we have a lot of influence. We may think that we don’t, but our patients really do listen to us. They listen to us when it comes to their treatment and the management of their care, so I really think they would listen to us when it came to other topics as well. And our colleagues listen to us. Our colleagues respect us, and we just need to make sure that our voices are heard and that we’re not allowing others to overshadow what we know is true.

It’s really hard in this age of politics overshadowing science, as I was saying before. So really, in this moment, it’s more important than ever for us to be loud, and the louder we are and the more voices we have, the more change we can bring about together.

Kevin Pho: Wonderful. Thank you so much for sharing your time and insight, and thanks again for being on the show.

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