Refracting the concept of physician advocacy using the prism of professional resistance

Abstract

Background Advocacy is a well-established term in the context of medicine and medical education. However, what constitutes advocacy is unclear and at times contested as it can range from relatively anodyne acts of facilitating patient journeys to more substantial acts of non-compliance. As a result, guiding medical learners in establishing advocacy as part of their future practice is a somewhat subjective and variant undertaking. Analyzing advocacy using the emerging concept of professional resistance as an analytic prism can afford better understanding of what advocacy means in a health professions context. Methods The authors employed a concept analysis methodology to explore discourses of advocacy using the concept of ‘resistance’ as a prism. The findings of the study are presented as a series of dyadic tensions that elicit different meanings of advocacy, including the rhetorical uses of the term ‘advocacy’ and ‘resistance’. Results Physician advocacy can be defined in terms of six dyads: scope and scale, goals and intentions, effort and risk, disobedience and confrontation, responsibility and commitment, and consequences and outcomes. Moreover, describing acts or positions as ‘advocacy’ confers legitimacy and authority, whereas describing acts or positions as ‘resistance’ confers doubt as to their ethical and professional credibility even when they refer to the same things. Conclusions By utilizing resistance as an analytic prism to deconstruct advocacy in health professions education, the authors seek to resolve some of the tensions and areas of uncertainty associated with the use of the term ‘advocacy’ in medical education, and to advance new ways of thinking about these two concepts. This is achieved through developing an understanding of advocacy and resistance, not as discrete categories, but as discursive positions, such that there are factors common to both that need to be interrogated to properly understand the advocacy-resistance landscape in medical education.