Dr. Anthony Fauci, National Institute of Health Director of Allergy and Infectious Disease and White House Coronavirus Task Force member, recently underwent surgery to remove a vocal cord polyp. This is not surprising given that a major risk factor for developing vocal cord polyps is overuse of the voice, something Fauci has likely experienced during the COVID19 pandemic as he has been called upon to speak so often.
Like Fauci, many physicians have found their voices as a result of both the pandemic and George Floyd’s murder and spoken out against longstanding health care, economic, and social inequities, as well as the nation’s deeply-rooted racism. To be most effective, doctors should be formally trained in social justice and advocacy skills to uproot and address the health inequities and the root causes of a broken health care system. Traditional medical school curriculum should include social justice training and advocacy skills.
As a doctor, I have always found social causes to be intimately connected to practicing medicine. My late grandmother, Hazel Monteith, a social worker and social justice leader in Jamaica was a strong role model for me. Early in her career, she coordinated social welfare projects for the Jamaica Federation of Women and served as a Senator for a short time. But she was best known for her regular morning radio programing on Radio Jamaica, where she answered calls about a wide spectrum of social and economic issues. While visiting my grandmother in a developing nation, it was clear to me that social determinants greatly influenced quality of life and can result in human suffering. Gross health inequities are not limited to third world countries; they are happening here in the United States and costly to all.
Social justice in medicine has always mattered, but the COVID-19 pandemic has been one of the most vivid recent examples of structural racism due to the disproportionate number of cases and deaths for people of color. Before the pandemic, for example, persistent health inequities and structural racism contributed to higher rates of strokes in Blacks, beyond traditional risk factors such as diabetes and hypertension. Historical housing discrimination may impact mental health disorders, result in overexposure to environmental toxins, and food deserts, which may contribute to food insecurity. When treatment protocols stop working, at some point, we must not only ask why but also speak out.
Several barriers may prevent doctors from becoming advocates for social justice. For one, the inclusion of social justice in medical school curriculum remains controversial. For example, Stanley Goldfarb, former dean of curriculum at the University of Pennsylvania Perelman School of Medicine, stated that “at ‘woke’ medical schools, curricula are increasingly focused on social justice rather than treating illness.” But, illness is more than a biological phenomenon, and the impact of many issues of social justice, such as access to health care, homelessness, racism, unemployment, and firearms directly impact patient outcomes. Moreover, the accreditation body of medical schools explicitly states that curriculum should also “include the medical consequences of common societal problems.”
Many think that medicine is an apolitical institution, yet so many policies impact the health of our nation and how doctors practice medicine every day. Advocacy itself can be time-consuming, and physicians may already feel too burned out to take on additional activities. Moreover, some doctors, including Fauci, have been targeted for speaking out, especially in regard to conspiracy theories around vaccines and face masks. However, programs that train physicians to have a public voice to disseminate evidence-based information and to inform on policies that promote health equity could be ultimately rewarding.
We are living in a time of multiple crises. More than ever, physicians need to use their public voices for public health education, health care reform, and social justice. Advocacy is a critical skill inherent to practicing medicine. Medical school curriculum should not only incorporate advocacy skills for social justice, but health systems and academic societies should provide more opportunities for professional development in leadership. While Dr. Fauci takes a much-needed rest to recover his voice, I hope many other physicians will gain the courage to find theirs.
Teshamae Monteith is a neurologist.
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