Clinicians should expand their definition of professionalism to include working for societal change to improve the health of all.
Passion in the Medical Profession | December 28, 2020 | 6 min read
By David Kopacz, MD, University of Washington
How we define ourselves determines our responsibilities—are we technicians following orders or are we true professionals working for the health of not just one patient in an exam room, but for the public health of all?
The idea of medical activism has been criticized lately, from both inside and outside of medicine. How we define ourselves determines our responsibilities. If we define ourselves as technicians with a narrow scope of being protocol managers, then we will just do as we are told, “stay in our lane,” follow orders, and place institutional priorities over our patients’ and our own well-being. Instead, if we define ourselves as professionals, we still must be good technicians, but that isn’t the whole of our identity. As professionals we have a higher responsibility and calling—medical activism.
What does it mean to be a professional?
To be a professional means that one is constantly professing—similarly if one is a profess-or. The roots of the word “professional” are related to “profess” and “prophet,” and have to do with taking vows, declaring openly, and making public statements. Our job as professionals it to profess, to declare openly, to speak, tell, say, to be prophets of health (which is different than being the profits of the healthcare industry). The industry, organization, and institution aren’t inherently moral creations. The institution is more like a machine than a holder of morality, and it’s the jobs of professionals to be moral agents and to provide moral leadership.
The witnessing professional
Dr. Robert Jay Lifton has studied how de-professionalization and emotional numbing happens—for instance, how U.S. soldiers could participate in war atrocities and how German doctors participated in the Holocaust. He’s studied totalitarian regimes and the process of mass psychology gradually shifting from normality to malignant normality, in which atrocities no longer seem morally abhorrent.
As citizens, and especially as professionals, we need to bear witness to malignant normality and expose it. We then become what I call “witnessing professionals,” who draw upon their knowledge and experience to reveal the danger of that malignant normality and actively oppose it. That inevitably includes entering into social and political struggles against expressions of malignant normality.
The new professional
Author and educator Dr. Parker Palmer speaks of the new professional, “a person who not only is competent in his or her discipline but also has the skill and the will to resist and help transform the institutional pathologies that threaten the profession’s highest standards.”
Palmer states that “the very institutions in which we practice our crafts pose some of the gravest threats to professional standards and personal integrity. Yet higher education does little if anything, to prepare students to confront, challenge, and help change the institutional conditions under which they will soon be working.”
“The very institutions in which we practice our crafts pose some of the gravest threats to professional standards and personal integrity. Yet higher education does little if anything, to prepare students to confront, challenge, and help change the institutional conditions under which they will soon be working.”
“The notion of a ‘new professional’ revives the root meaning of the word. This person can say, ‘In the midst of the powerful force-field of institutional life, where so much conspires to compromise the core values of my work, I have found firm ground on which to stand―the ground of personal and professional identity and integrity—and from which I can call myself, my colleagues, and my profession back to our true mission.’” -Dr. Parker Palmer
The moral determinants of health and becoming a medical activist
Dr. Donald Berwick’s recent article, “The Moral Determinants of Health,” argues for an expansion of the role of professionals to include societal reform. “Healers are called to heal. When the fabric of communities upon which health depends is torn, then healers are called to mend it. The moral law within insists so.” Morality is what separates the technician from the professional. Medical activism is born, again and again, when circumstances demand, from the identity of the physician/clinician as a professional and a moral agent in society whose “lane” is to treat disease, alleviate suffering, and promote population health and well-being at individual, local, national, and global levels. Nourishing medical activism keeps the focus on care and compassion in healthcare and society. We must all adopt identities of what Parker Palmer calls the new professional and Robert Jay Lifton calls the witnessing professional in which we become moral agents within our world, tearing ourselves away from the endless demands of the Electronic Medical Records system, raising our gaze from the computer screen to the world we all live in.
17 topics in medical activism:
1. Gun violence as a public health issue
2. Racism and health
3. Toxins in the environment, for example lead in the water in Flint, Michigan
4. Social determinants of health
5. Moral determinants of health
6. Physicians for a National Health Plan
7. Shifting the focus from the individual (burnout) to the institution (moral injury)
8. Human rights medicine, for example international trauma work
9. LGBTQ+ rights
10. Women’s rights
11. Religious tolerance
12. Immigration policy and public health
13. Working for the health of health professionals
14. Sexism and health
15. International Physicians for the Prevention of Nuclear War
16.Climate change and public health
17. World Mental Health Coalition—authoritarianism, fascism, and public health
Becoming a medical activist
Dr. Samuel Shem wrote of the “doctor’s disease,” and how to resist the “inhumanities of medicine:”
1. “Learn our trade, in the world,” and be aware that “Medicine is part of life, not vice versa.”
2. “Beware of isolation. Isolation is deadly; connection heals.”
3. “Speak up . . . speaking up is essential for our survival as human beings.”
4. “Resist self-centeredness . . . learn empathy.”
Becoming a new professional
Dr. Palmer describes five “immodest proposals” for educating the new professional:
1. We must help our students debunk the myth that institutions possess autonomous, even ultimate, power over our lives.
2. We must validate the importance of our students’ emotions as well as their intellect.
3. We must teach our students how to “mine” their emotions for knowledge.
4. We must teach them how to cultivate community for the sake of both knowing and doing.
5. We must teach and model for our students what it means to be on the journey toward “an undivided life.”
Drs. Shem and Palmer give us a good start on ideas for becoming a medical activist and witnessing professional. To their lists we can add:
1. Engage in self-care.
2. Join the compassion revolution.
3. Reconnect to your moral purpose and calling.
4. Find heart and soul projects that have meaning to you.
5. Read about social change and medical activism (recommended reading below).
“If you stand up for caring, compassion and the humble service of patients and communities, you are a threat to established and powerful interests.” -Dr. Robin Youngson, “Time to Care: How to Love Your Patients and Your Job”
1. “The Doctor-Activist: Physicians Fighting for Social Change.” by Ellen Bassuk and Rebecca Carman
2. “Re-humanizing Medicine: A Framework for Transforming Your Self, Your Practice, and the Culture of Medicine,” by David Kopacz
3. “Hope in the Dark: Untold Histories, Wild Possibilities,” by Rebecca Solnit
4. “The Power of the Powerless,” by Vaclav Havel
5. “Disturbing the Peace,” by Vaclav Havel
6. “Moral Resilience: Transforming Moral Suffering in Healthcare,” by Cynda Rushton
7. “Radical Transformational Leadership: Strategic Action for Change Agents,” by Monica Sharma
8. “An Autobiography: The Story of My Experiments with Truth,” by Gandhi