How deeply involved should physicians be in America’s social struggles?
Diversity and inclusion efforts are maturing into ubiquity across U.S. healthcare. Social determinants of health are rising as essential clinical considerations. Given this momentum, should medical doctors go a step further, pushing for change on issues that only indirectly impact people’s health?
A distinguished physician makes a case for standing down in such scenarios.
Stepping into the fray on broad socioeconomic issues “takes physicians into realms where they have no expertise—and thus risks eroding public trust in the medical profession,” Sally Satel, MD, submits for consideration.
A visiting professor of psychiatry at Columbia University’s Vagelos College of Physicians and Surgeons, and a resident scholar at the American Enterprise Institute, Satel presents her argument in a piece published Aug. 23 in the online outlet Persuasion.
“Doctors learn a lot during their training,” she writes. “But they should not spend their time in medical school being told how to re-order, for example, an unfair economic system. Our empathy for victims of unfairness ought to reach that far—but our expertise doesn’t and can’t.”
Satel positions her argument as a counterpoint to calls for maximal involvement emanating from several medical organizations and journals.
“The American Board of Internal Medicine, for example, recently decried ‘structural, systemic and cultural racism,’” she notes. “Meanwhile, the American Academy of Pediatrics has implored its members to ‘dismantle racism at every level’ of society.”
Satel also references the medical student organization White Coats for Black Lives, which maintains that “policing is incompatible with health,” as well as former CMS head Donald Berwick, MD, whose “agenda for action,” published in JAMA, “includes doctor-led support for ratification of human rights treaties and opposition to the electoral college.”
Physicians who want to take a stand on any socioeconomic or political issue “should of course feel empowered to do so as private citizens,” Satel maintains. “But, just as importantly, they should not feel pressured to become active in politics or to adopt specific views on the nature of race relations.”
“Racism is indeed a poison,” she concludes. “But physicians are not trained to extract it from the body politic. And if doctors stretch their authority too far, it will break.”
In the article’s combox conversation, more than one reader takes Satel to task for failing to mention shortcomings in healthcare coverage and access for vulnerable subpopulations.
“Yes, it makes perfect sense that MDs would have an important say in access to care via coverage,” Satel responds. “The main points I tried to make were that the more distant from our mission of health provision and the less we know about a policy … the more questionable our involvement becomes.”
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.