Physician Advocacy: The Role of Doctors in Driving Change

00:01 Hello and thank you for joining me today.

00:04 I'm Megha Garg and today we'll talk about physician advocacy.

00:09 What is it? How do we do it? What is your role in advocacy? So first, I'll start with a definition proposed by Earnest and colleagues.

00:21 Physician advocacy is action by a physician to promote those social, economic, educational, and political changes that ameliorate the suffering and threats to human health and well-being that he or she identifies through their professional professional work and expertise.

00:40 Physician advocacy is increasingly recognized as a core component of medical professionalism by medical organizations.

00:49 They have had long standing statements about the role of physicians as advocates in such organizations as the American Medical Association, the Royal College of Physicians and Surgeons of Canada, and the Accreditation Council of Graduate Medical Education in the United States, and as such, physician advocacy skills are increasingly included as a component of medical training. Now, I will mention that there is not consensus on the role of physician advocacy in medical education.

01:23 A study by Griffiths and colleagues showed that first-year medical students share the consensus on the value of individual advocacy for patients, but vary on their views of broader advocacy on a societal level and whether it should be a formalized, core competency of medical school training.

01:42 We know there are values that physicians can bring as advocates.

01:48 Physicians are uniquely positioned in society to be public advocates for health.

01:54 We understand medical issues in society.

01:57 Social determinants of health and public trust of doctors is high.

02:02 We have credibility as a profession in our society, and we're very privileged to have that trust and credibility of society.

02:12 And with that privilege comes a responsibility to act.

02:17 And we know there are challenges to engaging in advocacy.

02:21 And there are just a few that I'll talk about here.

02:24 First, we don't all have the skills and comfort and knowledge to be advocates.

02:32 Physicians have a lot of responsibilities on their plate, and time for advocacy may be difficult to find and to build into a career.

02:44 Advocacy can contribute to physician burnout as an added responsibility, and in some ways goes against one of the core ideas of medical training that teaches doctors to be objective and to weigh the evidence, and to not necessarily have personal opinions about everything that you are engaging in with the conversations with your patients.

03:09 And some feel that public advocacy may interfere with patient relationships if you are expressing opinions that may not align with the patients who are coming into your clinical spaces. And yet we recognize there is a role and that physicians must choose where they are on that spectrum of advocacy.

03:31 And so I'll share a model of how we can think about advocacy, um, on, um, different domains and across different levels of influence.

03:43 So first, if we think about this graphic here, we've got some lug nuts and we've got a wrench and we've got some adjacent circles.

03:52 So the domains of influence here are these these screws here on the graphic.

03:57 We can think of our domains as the practice level.

04:00 So this is the individual providers work environment my clinic or my individual encounter with the patient.

04:09 The community level which are the people institutions, non-governmental organizations that surround the practice such as the schools, faith groups, businesses and community groups that influence both the practice and the patient who is coming to you.

04:26 And finally, the government level.

04:27 This can be government on any level, the local, state or national level.

04:35 Then we think about the skills that we need to implement our advocacy goals.

04:42 So these are policy goals, for example, formal or informal policy goals to be able to identify decision makers, have conversations with people that are intended to change the status quo.

04:55 Communication skills. How do I translate medical jargon into a clear and compelling message for different audiences that may be non-medical and through various formats? And relationships. Partnering with stakeholders to achieve the desired changes.

05:15 And there are different levels of advocacy.

05:17 The individual level that we've discussed for your patient's unmet need, it's often a part and built into your daily clinical work.

05:25 Adjacent activating those around you to act on behalf of a patient group and without necessarily thinking about policy change.

05:35 And then finally, structural changes.

05:37 This is the policy change.

05:39 Thinking about affecting the rules and the resources that we have in a more permanent way.