Do politics have a place in medicine? [PODCAST]

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“In addition to being a pediatrician, I am Jewish and the granddaughter of a sole Holocaust survivor. My grandfather’s family perished in Auschwitz, a concentration camp in Poland. My grandfather alone escaped, skiing through the night, to his safety and ultimate survival.

The request from my hospital, the presidential debate, and the seeming dismissal of parentless children reminds me of a quote from Elie Wiesel, a Nobel Prize-winning writer, and Holocaust survivor.

“What hurts the victim most is not the cruelty of the oppressor, but the silence of the bystander.”

I will not tone it down.

I will not be silent.

I believe a medical institution that is dedicated to the well-being of all people would not ask me to do otherwise.”

Ariana Witkin is a pediatrician.

She shares her story and discusses her KevinMD article, “Why politics has a place in medicine.”

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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, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Ariana Witkin. She is a pediatrician, and she wrote the KevinMD article “Why politics has a place in medicine.” Ariana, welcome to the show.

Ariana Witkin: Thanks so much. I’m so happy to be here.

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

Ariana Witkin: Yeah, absolutely. So I’m Ariana Witkin, as you said. I’m a board-certified pediatrician and a postpartum coach. I currently work clinically as a newborn hospitalist, and I’m also the founder of Ariana Witkin Postpartum Coaching and Consulting. I work with women through pregnancy and postpartum, equipping and empowering them for the biggest transition of their life, which is having a baby.

My career trajectory and path to medicine was by no means linear, and still very much ongoing. So a little bit about that: I was not pre-med. I went to Brown University in Rhode Island for college, and I studied anthropology there, which I loved at the time. I was also working for a nonprofit, and that work took me to Ethiopia, and it was really there, working in public health, that I decided I wanted to go into medicine.

So from there, I attended Mount Sinai’s Humanities and Medicine program, which unfortunately no longer exists but did at the time, and really was made for people like me who didn’t have a background in the hard sciences but more in the humanities. During my time at Mount Sinai, I spent time pursuing other interests as well. I went to Oxford and did a medical ethics fellowship there, and I really spent a lot of my time doing kind of nonclinical activities. I was really more interested still in public health, just like I am today.

So after medical school, I headed to the beautiful Pacific Northwest. I went out to Seattle, to the University of Washington and Seattle Children’s Hospital, for my residency, and I continued to focus on working with global communities. I spent time working in Kenya. I also worked locally with immigrant families in Seattle. And from there, while I was in Seattle, actually, I got married, and my husband had been previously based in Boston, so we headed back to the East Coast, where I live today with him and my two-year-old daughter.

Kevin Pho: Wonderful. And tell me about your background in humanities. How does that inform and influence your medical career now?

Ariana Witkin: Yeah, totally. I think it is one of my greatest strengths. I feel like, for me, the most important thing has always been about learning about other societies, global communities, other cultures, and really looking at health and medicine from that lens. As you know, medicine is not kind of a one-size-fits-all approach, and I think it’s so, so important to look at the patient, the people that we’re working with, within the context of their environment. My anthropology, my humanities background, really informs how I do that.

Kevin Pho: So let’s transition into your KevinMD article. You wrote it back in October. It’s titled “Why politics has a place in medicine.” Now, for those who didn’t read that article, can you just walk my audience through it and share the story of why you decided to write it?

Ariana Witkin: Yeah, absolutely. So to be honest, the article just kind of poured out of me. I was sitting one night on my couch alone. I was watching the final presidential debate of 2020. I was watching the debate, which was hard for me to watch. It was controversial, and the topic of families being separated at the border came up, and I just started crying, sitting there.

As I said, I have a young child myself. As a pediatrician and a postpartum coach, I work with families. I work with mothers and newborns, and the idea of separating innocent, helpless children from their desperate, asylum-seeking parents is and was heartbreaking. I just felt like I had to do something about it. I had to channel that energy somewhere.

In the article, I mentioned that I was also watching on the heels of having had a conversation with colleagues at work, at my hospital, about a new policy that asked us not to talk about politics at work, or talk about the upcoming election or any policies that were in place, including this family separation policy. These things in combination, this policy at work and watching the debate, just really got me thinking about our responsibility as pediatricians, and as physicians, as health care providers in general.

I think we have not only a responsibility to care for patients and do no harm but also to protect and advocate for them, to really stand up for those who can’t. So in addition to doing the work day in and day out, caring for patients and their families, for me, that means shedding light on the criminal activity, really, that is separating children from their parents at the border. That is really what prompted me to write this article.

Kevin Pho: So after you wrote this article, what was some of the response from some of the readers or your colleagues?

Ariana Witkin: Yeah, so I would say I got kind of a mixed response. Some people were very supportive and agreed that advocacy and politics definitely had a place in medicine, particularly when it came to the rights of vulnerable children. And there definitely were people that disagreed, and that was a conversation that I was open to, who felt like, “Nope, it’s our job as physicians to kind of not have any politics at play and solely just kind of treat the medical issues at hand.”

Kevin Pho: So at your workplace, when that edict said not to talk about politics, was politics a common topic of conversation among your colleagues before then?

Ariana Witkin: So yeah, I think just leading up to the election, it was the thing on people’s minds, right? It was all over the news. There was lots happening. Seemingly every day, there was some kind of new issue or surprise that we were being confronted with in terms of the election or the former president. And so yeah, it was the topic on people’s minds, so it was a common discussion in our break rooms, over lunch, in the nursery when there were no parents around and we were just hanging out with the babies. So yeah, it was definitely a popular topic.

Kevin Pho: So after the institution said not to talk about politics, what was your response? How did you feel about it, and what happened next?

Ariana Witkin: Yeah, so as I said, I was kind of upset. I felt like it was not only our right but our responsibility as physicians to shine a light on political issues that were unjust, particularly when they affected our patients. Living in Boston, I serve a diverse patient population: immigrants, children, obviously, and people that often can’t stand up for themselves, don’t speak the language, don’t know what their rights are. So I was pretty upset about it and pretty vocal, as I tend to be, about that. So my colleagues and I kept kind of advocating and talking about what we felt was important, and obviously not letting that get in the way of us caring for patients.

Kevin Pho: So what about in the exam room? If you’re having a family in the exam room that has politics that are opposite of yours, what do you do in that situation?

Ariana Witkin: Yeah, so I definitely think that all people deserve equal treatment and access to care, so I certainly wouldn’t let it consciously affect how I treat them. As I’m sure you know, we all have unconscious biases, and I think in situations like that, I need to check in with myself and make sure that I really am treating everyone as they deserve to be treated. I think if anything came up that I felt was kind of affecting their rights or the rights of other people and was connected to their political beliefs, that would be something that we’d have to address, again, just in the best interest of treating the patient within the context of their environment.

Kevin Pho: So you mentioned family separation being a particularly visceral issue, especially in the area of pediatrics. Now, what are some other political issues that affect the care of the children and families that you see?

Ariana Witkin: So right now, definitely COVID-19, of course, has been a big issue in the past almost year. I can’t even believe it’s been almost a year, but it’s been that long. In our community, I’m now fully vaccinated. Most of my physician colleagues are now fully vaccinated, but seeing how vaccines are going to be rolling out in the community is definitely a hot topic right now.

Children, obviously, are vulnerable and won’t get the vaccine for a while, and there haven’t been any trials. But making sure that their parents, particularly their BIPOC parents, have access to the vaccine in a timely manner, particularly parents who are not in the physician community, and that they will have access to the vaccine so that they can protect their children, is kind of what we’re focused on now.

Kevin Pho: What are some of the strategies that you plan to use on some of the families who are skeptical or even hesitant about taking a vaccine?

Ariana Witkin: Yeah, so that’s a great question. Certainly, vaccine hesitancy is not new to the pediatric community. We face vaccine hesitancy about vaccines that have been well established over time. I think the first thing would be educating people on the mechanism of this vaccine. It’s an mRNA vaccine. There’s no live virus in this vaccine. It cannot give you COVID. It cannot give your children COVID, and it doesn’t get into your DNA. It can’t change your genes. I think just educating people on that is a huge part.

I think being open and honest about our own stories. I was speaking on another podcast recently, actually, about my own experience getting the vaccine. I’m a breastfeeding mother, so talking about my decision to get the vaccine in that context, my fears around possibly affecting my child. So I think just being really transparent about what we know and what we don’t know, because there is a lot still that we don’t know.

Kevin Pho: We’re talking to Ariana Witkin. She is a pediatrician, and she wrote the KevinMD article “Why politics has a place in medicine.” Ariana, have you been placed in a difficult situation professionally from being outspoken when it comes to political issues?

Ariana Witkin: I would say in general, I am outspoken about things that I believe passionately, and not so much. I wouldn’t say I’ve been in a difficult situation in terms of my political beliefs, but definitely in terms of advocating and standing up for patients.

I actually remember, at the beginning of the pandemic, I had a newborn patient (again, I work as a newborn hospitalist) whose mother was positive for COVID-19 and was being discharged from the hospital. The hospital wanted to discharge them and let them find their way home, and the mother was sick, and there wasn’t anyone else to care for the baby. The kind of discharge plan was: Discharge them and let them figure it out. I didn’t really feel like that was acceptable, so I was vocal about that and escalated my way up the administration, and actually ended up working with the Massachusetts Department of Health to come up with a solution that was going to be sustainable for that family.

Kevin Pho: And for those colleagues and other physicians who think that politics has zero place in medicine or in the exam room, what’s your response to them?

Ariana Witkin: Yeah, obviously, everyone is entitled to their own opinion. I think, again, that it is our responsibility as doctors, as people who theoretically went into this field, at the very core, to help people, right? To serve others, to better the world. We have a responsibility to advocate for those who can’t. So I think, not always, but as was the case with this past administration, politics can sometimes influence the rights of human beings, and when we see that rights are being infringed upon, we have a duty to say something about that.

Kevin Pho: And for those physicians who do want to become more outspoken politically in medicine, what are some tips and advice you can give them?

Ariana Witkin: Yeah, so I think joining professional organizations is a great way to do that. If you’re a pediatrician, the American Academy of Pediatrics has a lot of advocacy initiatives, so that would be a great thing to do, as well as your local chapter, like the Massachusetts Academy of Pediatrics, and just getting involved in your local community.

I think the best way to get started is to listen, right? Because you want to know what the problems are in your community, and the best people to tell you that are the people who live there. So going to town halls, going to community meetings, talking to your patients about where they spend their time, what they do, what issues do they face every day, because you might just not know. And really approaching it with that lens of listening and curiosity before making a plan of action.

Kevin Pho: And my final question: What’s your take-home message you want to leave with the KevinMD audience?

Ariana Witkin: Oh, my goodness. I would say the best investment that you can make, whether you’re a clinician, whether you’re a provider, whether you’re a patient listening to this, I think the most important investment you can make is one in yourself. We’ve been talking kind of about the responsibility to care for others, advocate for others. Burnout and kind of moral injury are a big topic in medicine right now as well. I won’t go on my soapbox about that, but I think in order to do kind of all the work that we are talking about doing, you have to take care of yourself.

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

Ariana Witkin: Thanks.

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