Che Guevara, whose politics some readers will disagree with, clearly described why doctors should be advocates and activists. The correct response to the political injustices of the world with their direct and indirect impacts on health, according to Guevara, is for doctors to become activists.
Activism has its attractions. It’s hard, for example, not to be drawn to climate activism when our species is hellbent on planetary destruction. Activism leads us to educate ourselves and others. It allows us to show leadership, such as by measuring our carbon footprint and implementing plans to reduce it. 1
Where activism falls down, however, is when it doesn’t persuade. As doctor activists we might advocate for a particular health policy or clinical practice but that advocacy must be in line with what we understand of the evidence. Doctors who advocate for a particular therapeutic intervention or against vaccination may do more harm than good when their arguments aren’t supported by the best available evidence.
The right to activism or advocacy, whether on an individual basis or when representing an organisation, comes with responsibility. 2 Patients and institutions trust doctors, and therefore doctors can be powerful advocates for good or accelerators of harm. It’s also important to remember that not everybody will agree with you however convincing you believe your arguments to be.
Perhaps the most effective activism is that which is done without it being overt. It’s the activism that drives researchers to study the impact of multiple long term conditions on underserved populations. 3 It’s James Lind’s advocacy for more objective evaluation of therapies. 4 It’s in the unsung heroes, all NHS staff according to Rob Atenstaedt, who do their duty in an overstretched health service – each and every one deserving of a long service award. 5
Activism generally conjures up revolutionary sentiments but it is also much more prosaic – the powerfully ordinary activism of day to day clinical practice.
References
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