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Advocacy, Out Loud

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Recently my Department Chair shared an email with our section listserv: it was an opportunity to sign a letter to Governor Kemp (of Georgia), reviewing the increasing rates of Covid-19 and asking for, among other things, better policy around masks and large gatherings. I signed my name. I had a moment of pause first, though, because I have always been taught to separate politics from work – but then I realized, Covid-19 is matter of medicine and health, not politics. This new virus challenged all of us initially, but we have learned more about its transmission, and we can speak now to an appropriate response.

The further along I go in my career, the more concerned I am about physicians’ collective voice in medicine. One reason to speak up right now is the anti-science bias we are currently seeing in some parts of the country. I am sure it’s the worst offenders who make it to the news and social media – still, the degree to which people confuse facts with opinions is alarming, and in the absence of a rebuttal, these viewpoints propagate. That is why it is so important for us as physicians, with our knowledge base and expertise, to speak out against misinformation.

Personal experience and conversations with friends have shown me the biggest barriers for women in medicine to speak up are time and confidence. I cannot solve work-life balance with a blog post, but I can say with respect to confidence that we should take ownership of what we know instead of deferring to other experts. There are plenty of women physicians who do use their voices; I am speaking to those of us who have traditionally shied away from the spotlight, who find rule-following easier than rule-bending. Questioning norms doesn’t come easily to me, either, but I am learning that sometimes it’s the only option.

We can also look to social media for some great examples of advocacy in action. In late July, in response to an article with ill-advised definitions of professionalism, #medbikini demonstrated that wearing a bathing suit on vacation is absolutely fine. This week, in response to a prejudicial opinion piece on diversity, #medTwitter clarified that such viewpoints are unacceptable. I don’t think the take-home is “Those authors are bad;” I believe it is “How do we fix our system to do better?” Even if we disagree there, though, these waves of unified support reveal the original papers’ fallacies and offer constructive solutions. For me, they have been wonderful, reassuring examples of what we can accomplish when we combine our voices.

My sister engages in climate health, exploring the impact of the climate crisis on the human condition. In proofreading her op-eds, and seeing her passion for this topic, I have learned how important it is to speak up when we know the answer to a problem because of scientific principles. If non-scientists are the only ones talking, the narrative becomes not only skewed, but false. We have to talk about what we know, and we have to do it loudly enough to become mainstream. Perhaps women have not traditionally held the power to direct these conversations, but it feels like a genuine shift is happening presently. We can look beyond science to the #MeToo and #BlackLivesMatter movements as illustrations of our capacity to bring about real, quantifiable change – though much more work remains.

Advocacy impacts every part of the care we give to our patients. I have spent the past year learning obesity medicine, in an effort to better serve my clinic panel. Although I certainly recall lectures from medical school about food deserts and cultural perceptions of “fatness,” re-engaging with the societal contributors to our obesity epidemic made me realize how important my voice is outside the office, too. Of course I should be advocating for reducing sugar-sweetened beverages and normalizing portion sizes in our society. Of course I could work with my local government to identify safe outdoor spaces for exercise, important for both physical and mental health. As physicians, public health is a part of our job description.

To some degree, we intrinsically do this for the diseases we routinely treat. I don’t know a transplant physician who can’t offer some solution to the shortage of organ donors, or an infectious diseases physician not well versed in PrEP. What I am challenging myself, and those of us like me, to do, is to find topics we know and care about, and to move that conversation beyond our home/office/friend group. I just listened to Priya Parker on a podcast, and she asked the question, “What is the biggest need in the world that you might have the passion and capacity to address?” What an inspiring question.

We can advocate for everything that impacts us, from our insurance reimbursements and medical licenses, to our neighborhood schools and grocery stores. From a work perspective, most of our professional societies already do this; we just have to join in. I also believe that representation is a key part of advocacy. Congress currently has seventeen physicians serving, and only one is a woman. The American College of Cardiology Board of Trustees has fourteen members, and four are women physicians; the Board of Directors for my hospital has sixteen members, and two are women physicians. I look at these numbers, and I wonder, what does the world look like when the number of women physicians in leadership goes up? How can we move that needle? Our willingness to participate is certainly not the only barrier, but it is one of them. After all, how many of us have actively sought professional committee or board positions, or ever considered running for public office?

Our voice matters, and we have helpful things to say. I serve on the board of a nonprofit organization that works to end domestic violence in the Asian/Pacific Islander community, and even in this non-medical space, my background as a physician has been useful several times. Health is such an integral part of our lives, there is not a single area I can think of where a physician’s perspective would not be helpful – so let’s find, and raise, our voices together.

Author: Lakshmi S. Tummala, MD, FACC

Lakshmi S. Tummala, MD, FACC

Dr. Tummala is a cardiologist at Grady Memorial Hospital and an Assistant Professor of Medicine at Emory University School of Medicine. She was previously a cardiologist at the DC VA Medical Center, and an Assistant Professor of Medicine at Georgetown and George Washington Universities. Any views or opinions expressed in this blog are hers alone, and sharing resources does not equal endorsement.


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