Advocacy as a core aspect of patient care

Advocacy has always been at the forefront of all that we do as physicians. From the moment we first engage with a patient and establish that sacred patient-physician relationship, we become the champion and advocate for that person, ensuring that every decision we make is to advance their health and well-being as we practice our art and craft.

The physician is, therefore, a natural advocate for fixing the broken health care system. More specifically, the internal medicine specialist is the best trained and equipped to fully embrace this important and necessary obligation for the good of patients and society as a whole. A physician has a comprehensive view of patient care, embraces the longitudinal approach, and can navigate the nuances of how decisions made by outside forces such as insurance companies, government entities, and legislative bodies positively and negatively impact an individual's health and longevity.

Advocacy is not a spectator sport. If we are not at the table, we are most certainly on the menu. Having worked in advocacy for most of my medical career, it has become clear that lawmakers have little to no understanding of a physician's experience unless physicians explain it to them.

Legislators are constantly lobbied by a multitude of interest groups that are not always aligned with our concerns, and if we do not make them aware of what we perceive to be wrong, then their understanding of the issues will be very narrow. It is incumbent upon physicians to make sure those decision makers are fully informed. While we may be fortunate to engage with those who agree with us, we must also engage with those who fundamentally disagree with us.

As it has been said, there are no permanent friends, no permanent enemies, only permanent issues. Politics truly does make strange bedfellows, and a legislator may be our biggest supporter on one issue but our greatest opponent on another. We cannot allow ourselves to be drawn into petty bipartisan bickering but must remain true to our mission and keep patients as our North Star. Regardless of who is in power at the time, as the pendulum will always swing the other way, we must remain steadfast and nonpartisan as we advance the issues important to us.

While it is tempting to easily resort to tribalism and label one party or another as good or bad, it does not serve us or our patients in a meaningful way to do so. We must look for common ground and expand on the issues we can agree on while navigating the issues that we disagree on. I do honestly believe there is more that unites us than divides us, and I will always look for key concerns that will advance the profession and the welfare of our patients.

There are so many levels of advocacy that any one of us can be involved. ACP's Leadership Day lets physicians from all over the country travel to Washington, D.C., to speak to members of Congress and advance our issues. Hundreds of physicians giving up time from the busy practice of medicine to come to the nation's capital is an effective message that is not lost on legislators, who truly value our input and perspective. That is but one way to become involved and I encourage anyone who has not participated to consider joining ACP on Leadership Day. The camaraderie of reconnecting with your colleagues across the country for this noble cause is a fulfilling and enriching experience.

Advocacy, however, is not a one-time event. It must be constantly nurtured and developed. The key to everything we do is relationship building, and that is true for our patients, our practice, and our advocacy. Lawmakers want to hear from us, not just in the few minutes they have in a congressional office but also in their home district, when issues become apparent to constituents. We need to be recognized as the first and most valuable resource for members of Congress, as well as the first call for any issues that affect medicine. Becoming the primary key contact is not done by chance, but by the deliberative effort of each of us to engage with our elected officials, to develop relationships, and to open lines of communication and maintain those connections throughout the course of a term. As internal medicine specialists we are so well versed in critical follow-up and ongoing engagement, skills that can be applied to advocacy efforts and reward us by truly impacting the course of health care.

While many have great concerns about the function and influence of political action committees (PAC), it cannot be understated that their existence and influence are both realities and necessities. We may agree or disagree with their viewpoints, but we must acknowledge the role they play in our current political climate so we can be effective at all levels for our patients and our profession. PACs can be another tool to improve the health care system by helping medicine-friendly candidates who understand the issues get elected to office. Ignoring this integral fact is a disservice to our advocacy efforts and the patients we serve.

As a lifelong advocate, and proponent of causing what the late congressman John Lewis referred to as “good trouble,” I hope that I have encouraged many of you to look not only at why internal medicine physicians are best positioned to be advocates but also why this is an obligation of our profession. It is not enough to merely voice concerns; we must actively participate in the process. The work is never done, and the finish line is always being pushed forward. What is guaranteed is that if we don't participate, the outcomes will be much worse. Only through a collective effort can we hope to accomplish our shared goals. I look forward to continuing this journey as we all work together for the practice of medicine and the patients we serve.