Do Medical Professionalism and Medical Education Involve Commitments to Political Advocacy?

Abstract

To the Editor: We wish to present a different perspective of advocacy education from that in Dr. Huddle's1 article. To medical educators, advocacy is not equal to political action or involvement in politics. Instead, advocacy education seeks to foster an awareness of the world around a patient beyond the four walls of the clinic. At the crux of this debate is the need to recognize the social determinants of health—the economic and social conditions that shape the health of individuals and communities. This means acknowledging the new understanding of health in which environmental, social, behavioral, physical, and economic factors contribute significantly to the health and well-being of patients. Physicians must address the problems facing adults and children in the 21st century by influencing these critical determinants of health and well-being. To do so, physicians must successfully merge their traditional clinical skills with public health, population-based approaches to practice and advocacy. Current trainees are too familiar with scenarios in which a simple prescription is not sufficient to treat a patient's problems. Not only does an obese 12-year-old girl need antihypertensives to treat high blood pressure, but she will also need dietary and lifestyle modifications that could potentially save her life. Therefore, for trainees it is a natural extension of this broader approach to recognize the lack of safe places for children to play and exercise, the lack of quality choices of food in school cafeterias, and the challenges for lower-income children to access quality health care. Thus, it is vital that trainees learn that intervening at the population level to support local initiatives or to advocate the passage of legislative bills to improve these and related conditions is an appropriate function of a physician on behalf of his or her patients. Here at UCLA, we have had a Community Health and Advocacy Training program for over 10 years. Our curriculum includes 12 weeks of specialized rotations, a community-based continuity clinic, longitudinal community projects, and a dinner seminar series featuring guest speakers from the community. We have also participated in a statewide coalition of 13 pediatric residency programs focused on developing and sharing curricula for community pediatrics and child advocacy. Since 2003, we have had a one-month legislative and media advocacy rotation for third-year pediatric and med-peds residents in this program. During this month, residents are empowered to use their roles as physicians in society to improve the social and environmental conditions in which their patients live, with the goal of ultimately improving patient health and quality of life. Not only do these educational experiences fulfill “requirements” by the Accreditation Council for Graduate Medical Education, but we believe that this training also produces better doctors who are able to care for populations of patients and address the health needs of Americans in the 21st century. Alice A. Kuo, MD, PhD Director, Community Health and Advocacy Training (CHAT) Program and Combined Internal Medicine and Pediatrics Residency Program, David Geffen School of Medicine at UCLA, Los Angeles, California; [email protected]. Lisa Arcilla, MD Adrian Castro, MD Leian Chen, MD Bianca Edison, MD John Huang, MD, MPH Kiran Mitha, MD Melissa Orkin, MD Zarin Tejani, MD Diana Tu, MD Joanna Yeh, MD UCLA CHAT, class of 2011 Mridula Watt, MD Lindsay Wells, MD UCLA CHAT, class of 2012 Ryan J. Coller, MD Alma D. Guerrero, MD, MPH Wendy M. Slusser, MD, MS UCLA CHAT faculty