Advocating for Change in Medical Legislation

Abstract

Advocacy is becoming an increasingly important role for physicians, and there is extraordinary value to becoming effective advocates on behalf of our patients. Until recently, advocacy was not a formal part of medical school or residency curricula. The American Academy of Pediatrics (AAP) has published an extensive overview of advocacy for the pediatrician.1 This online guide breaks down legislative reform efforts into individual, community, state, and federal levels. We focus here on state and federal legislative advocacy, the practice of taking a position, and initiating actions in a legislative arena so as to deliberately influence policy choices.2 Health law can have a profound impact on a physician’s practice of medicine, and there is a general call for physicians to become advocates for changes in public policy.3 However, there is little in standard medical journals outlining how medical personnel may specifically advocate for changes in laws that affect our daily professional lives. We describe here a recent effort to change the law in Rhode Island regarding HIV testing in pregnancy and use that effort as a launching pad for broader discussions of how involvement in legislative change can be an important and rewarding process for hospitalists. In 2006, a 4-week-old term infant presented to our hospital with a chief complaint of fever and rash. On the second hospital day, after an accidental needle stick, the child’s HIV status was reported as positive. The child made a prolonged and gradual recovery.4 Two salient facts emerged from this case. First, the mother had been offered HIV testing while she was pregnant but had refused. Second, had she accepted testing, there is a strong likelihood that her infant would not have acquired the disease. Limitations in current state law allowed the infection to progress and motivated us to try change …