Advocating for advocacy

I'm coming down off the high afforded by the Society for General Internal Medicine's 2011 annual meeting - collaborative and inspiring. I was surprised by my own reactions to two plenary addresses.

One was by Holly Atkinson, former head of Physicians for Human Rights, on the topic of advocacy and professionalism: "Should Medical Professionalism Include Advocacy?"

Not surprisingly, given Dr. Atkinson's history, her answer was Yes. The most interesting moment of her talk came with a question from the audience. The gist of the question was that requiring advocacy for professionalism implies that those of us who don't participate in advocacy aren't good doctors. In response, Atkinson proferred a definition of advocacy that was disappointingly weak. Everything is advocacy - an individual doctor who goes to bat for their patient is an advocate too! But if that's advocacy, the word loses useful meaning. I wanted Atkinson to bite the bullet and say - that's true! Doctors that don't advocate are lesser professionals. I wouldn't have agreed with her (I think every doctor has their own interests and talents, and politics - which is what Atkinson really meant - needn't always be among them), but I would have had more respect for her advocacy of "advocacy."

The second plenary was by Michael Marmot - Sir Michael Marmot to you. He was deliberately provocative, acid-tongued, and wholly self-possessed: an example of what an entertaining medical speaker should be. Again, though, I was not wholly satisfied. Marmot's research is unimpeachable - he is the giant whose Whitehall studies established the importance of the social gradient to health. His findings lead to some striking observations: the life expectancy in some neighborhoods of Glasgow is lower than in some poor countries, even though Scotland provides basic services that are often lacking in, say, Africa (drinking water, basic food and shelter, etc.). That's because the poor of Glasgow are sicker and dying sooner than the rich.

Marmot too is an advocate. But, like Atkinson's, his passionate call didn't echo with me - not because I'm cynical, but because (looking at the two speakers' biographies) they themselves, at the beginning of their careers (where I am now, more or less - not that I'm going to be an Atkinson or a Marmot) did not work as advocates. Marmot did research. Atkinson trained in global health and health juournalism, founding and editing what eventually became Journal Watch.

I agree wih their call to justice in health, but I think advocacy comes with knowledge. Rather than marching out to demosntrate, I need to gather facts first - in my own way. Then with time, perhaps, I will be able to advocate from my own heart what I have established in my own little corner of research.

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