Physicians and Advocacy: A Prescription for Change

Dr. Charles van der Horst during his arrest after protesting for Medicaid Expansion at the North Carolina General Assembly.Photo courtesy of Dr. Charles van der Horst

Dr. Charles van der Horst during his arrest after protesting for Medicaid Expansion at the North Carolina General Assembly.
Photo courtesy of Dr. Charles van der Horst

A doctor getting dragged away in handcuffs might be something we see in a movie, but we rarely think of it as a real-life occurrence. Dr. Charles van der Horst proves that assumption wrong.

Last May, Dr. van der Horst, Professor of Medicine and Infectious Diseases at UNC-Chapel Hill, was arrested at the North Carolina General Assembly protesting issues including the state’s decision not to expand Medicaid. The risk of such a decision was something Dr. van der Horst said he felt compelled to stand up against. “The laws were going to lead to the deaths of about 2,000 people each year,” van der Horst said. “We [doctors] need to take care of our patients. Not just their organs, but the patients out in the community.”

Physicians have a unique role to play in regard to advocacy and activism surrounding medical issues, and recent debates over the Affordable Care Act and Medicaid expansion have prompted doctors to step away from the office and make their voices heard in their communities. “We are intimately involved,” Dr. van der Horst said of physicians. “We don’t just measure patients’ blood pressure and prescribe a pill. We know that they don’t have health insurance to afford the pill, or they’re working two jobs and eating poorly because they don’t have enough money, or they’re homeless out on the streets. Once you have that information, it’s our responsibility as a physician to do something about it.”

Dr. Heidi Miller, an internal medicine physician for Family Care Health Centers in St. Louis, echoed the idea that doctors play an integral role in effecting change. Dr. Miller said she spends half her time practicing medicine at a health center that serves patients who do not have the ability to pay for their services. She spends the other half on local projects and advocacy at the state level to provide an equitable distribution of health care. Among other movements, Dr. Miller has been involved in the call for Missouri to expand Medicaid, just as Dr. van der Horst does in North Carolina. Part of her work included testifying multiple times at special state-level hearings about Medicaid expansion. Dr. Miller used these opportunities to represent her patients and tell their stories, an ability that Dr. Miller said she does not take lightly.

Dr. Heidi Miller leading former Missouri Governor Matt Blunt on a tour of a Family Care Health Center clinic, which provides medical care to patients regardless of insurance status. Photo courtesy of Dr. Heidi Miller.

Dr. Heidi Miller with former Missouri Governor Matt Blunt. Dr. Miller works at a Family Care Health Center clinic in St. Louis, providing medical care to patients regardless of their insurance status.
Photo courtesy of Dr. Heidi Miller.

As an example of this privilege, she cited the chance to address the misconception that patients who could benefit from Medicaid expansion do not work. “They work minimum wage, they can’t afford health insurance, and the jobs that they work are often really physically demanding,” Dr. Miller said. “I have several patients who wash cars all day. They’re bending, crouching. I have several waiters who are carrying 30-pound trays. I have patients who are house cleaners who work their bodies extremely hard. To tell decision makers that if you want these patients to continue to clean your houses and drive your taxis and tow your car, then they need to be healthy, and they need health coverage.”

Not only do they have the unique ability to bring their patients’ voice to the forefront of social change, but physicians also hold a position of power. The white coat represents education, dedication, and a life of service for others, but it also serves to amplify doctors’ voices. Even when unsolicited, the white coat commands respect, and doctors should take advantage of this opportunity to demand justice for their patients. Doctors must recognize the invaluable role they have in the movement towards equitable healthcare access. “It’s an integral part of being a doctor to recognize that your purpose is not just to treat the patient that’s in the exam room with you but to have a broader purpose to ensure that the people in our community have equitable access to care,” Dr. Miller said. “If someone spends years learning how to become a superb physician, and they learn really advanced techniques in treating disease, I’m not sure how that physician can deliver care without working to make it accessible to anybody who needs it.”

Dr. van der Horst also cited the image of the white coat as a useful tool in working towards health equity and said doctors must make use of that. But Chris Chen, a fourth-year medical student at Washington University School of Medicine who has been involved with Doctors for America, said medical students and undergraduates invested in equitable healthcare play a role too.

Chen emphasized that students are the future of the health and medical field, and that they should exercise that power. Chen cited an example of a letter to the editor he and a friend were able to publish in the New York Times. The letter surrounded issues regarding the primary care workforce, and Chen said they framed it in the perspective of medical students interested in primary care. “We were able to articulate it in an interesting way that caught people’s attention,” Chen said. “I don’t know that if you were just another doctor, even if you made the same point, it would have gotten in. You use the hook you can.”

Dr. Miller also highlighted the importance of the student voice. She recalled bringing a medical student with her to a rally, and the legislators of the Medicaid Transformation Committee were keen on hearing his views.

“They were so interested in hearing about his perspective and his future plans, and his career,” Dr. Miller said. “The legislators are really interested in what shapes the future workforce and what drivers are there. The legislators should learn how students’ ambitions reflect the current level of resources and challenges in providing medical care.”

While it may seem obvious that doctors have great insight when it comes to achieving equitable access to healthcare, legislators and policymakers often do not recognize this until physicians fight to make their voices heard. Similarly, students and patients must push for change by taking advantage of the unique niche they occupy in this movement. Whether a physician, medical student, undergraduate, or patient, each individual has a voice in the fight for equitable access to healthcare. Now, it’s up to you to use it.

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