On a day that marked the start of a new academic year for hospitals around the country, an editorial1 published by a fellow physician sparked a lively public debate. Titled “Doctors Need to Shut Up More,” the article was received by some as sage advice for both newly minted interns and their veteran mentors. However, its thesis, that doctors should limit their scope of practice to the biology and physiology of the human body, was met by many of our colleagues with vocal opposition.
The author’s proposition, a version of the popular “stay in your lane” reproach, was that physicians and medical organizations should not comment on contemporary, hot-button issues such as immigration or nuclear disarmament, because these are outside of their fields of expertise and may harm their institutional credibility. However, what the author neglected to consider is that physicians are bound by an oath2 to protect the health of all humans, not just those in the examination room. It is our adherence to this pledge that opens the door for a broader recognition of the human experience and thus an extension of our “lane”:
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
These words remind us to not just provide patients with the immediate services they need but to address the root causes of the problems they face. As such, we reject the author’s premise that physicians ought to remain sidelined from political and social discourse. To the contrary, we believe that doctors need to speak up more.
Physician advocacy is not a new phenomenon, especially in pediatrics. Being on the front lines of patient care, we are routinely exposed to the faces affected by modern ills, such as unemployment, food insecurity, drug addiction, gun violence, and racism; understanding and addressing these social determinants of health are also fundamental components of our vocation.3 Therefore, doctors must continue to shape legislation at both local and national levels by sharing their experiences to influence a conversation that is so often divorced from the realities our patients face. It is in this relationship between a physician and a patient where public health policy and individual well-being intersect.
In the late 1970s, for example, after examining a 3-year-old girl who was nearly comatose in his office, Needleman and colleagues4 made the connection between her illness and toxic levels of lead in her blood. By speaking up and suggesting that even small amounts of the heavy metal could result in chronic learning disabilities, they brought global awareness to a previously unrecognized problem. Their advocacy was instrumental in ushering in a federal ban on lead-based products, and since it was passed, lead levels in children have decreased by >90%.
A decade later, during the height of the Cold War, the physician-led organization International Physicians for the Prevention of Nuclear War5 shared the Nobel Peace Prize for “creating an awareness of the catastrophic consequences of atomic warfare.” None of its members were physicists, but these doctors focused the world’s attention on the pathologic manifestations of nuclear proliferation and played a meaningful role in the denuclearization talks that followed.
Since then, hundreds of editorials have appeared in our medical journals penned by physicians on a range of issues that were previously viewed as taboo. Sakran, a trauma surgeon and gunshot victim, and colleagues6 have frequently advocated for the reform of our nation’s firearm laws. Danaher,7 a pediatrician who is familiar with the physical and psychological effects of toxic stress, has publicly condemned the current administration’s systematic separation of migrant children from their parents. This journal has been no exception, elevating the voices of those in the pediatric community who wish to speak up on behalf of society’s most vulnerable. Sharing these personal, human stories, grounded in scientific truths, helps to shape public policy in a way that only those with our experience can.
Moreover, speaking up may be good for our psyches, too. As Eisenstein8 recently suggested, advocacy for our patients can help to reduce the moral distress that contributes to physician burnout. Although the collective action of campaigning can provide a valuable service to society at large, it may also serve as an important act of self-care. The longer we are able to stay motivated and engaged in this important work, the more society serves to reap the benefits of our labor.
This is not to say that we should speak up reflexively or without thought. However, as a diverse group of individuals with numerous physical, spiritual, economic, social, and cultural backgrounds, we should feel comfortable using these perspectives to improve the lives of our patients and their families given that the societal impact we make when we lend our voices is well documented. If we stay silent in this suggested “lane,” we may miss important opportunities for intervention and in doing so may betray the commitments we made when we chose to enter the profession.
Moving forward, we should not censor each other but rather take positions that empower one another to speak up outside of the examination room. We have learned over the years that the doctor-patient relationship extends far beyond the chief complaint, and that what we do not say may be deafening.
Drs McLaren and Masiakos drafted, reviewed, and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
FUNDING: No external funding.
We thank Dr Jennifer Brokaw for her review of the article.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.