Medscape article by Shelly Reese
Some doctors are born activists. It’s in their DNA to stand up, speak out, and get involved.
Others evolve. Ordinary physicians ensconced in busy lives—work, family, community—they’re too busy doing the proverbial laundry of being a doctor to find time to stand on a soapbox. But then something throws the switch. It may be a cataclysmic event, or the proverbial final straw. Something compels them to step forward—frustration, grief, conviction—and there they are: accidental activists.
Activists are as varied as the causes they advocate, but they often share some underlying similarities, says Lauren Duncan, PhD, professor and chair of the psychology department at Smith College in Northampton, Massachusetts. They have a desire to help the community and to make the world a better place. They also believe strongly that they can make a difference.
This may help explain why some physicians are drawn to activism. “Doctors are very efficacious,” she notes. They treat patients; patients get better. “Doctors know from experience that what they do can make a difference.”
We talked to five physicians about the evolution of their activism and the causes that drive them. Here are their stories.
Fighting for Family and Community
Although we often associate activism with college students, Dr Duncan says many people become more socially active around midlife. As people mature, their “spheres of caring” expand, she says. They want to act for the betterment not only of themselves and their immediate families, but on behalf of the community as a whole.
Drs Shaila Serpas and Michelle Davis, both family physicians, live on opposite sides of the country, but Dr Duncan’s depiction of an activist describes them both.
For Dr Serpas, assistant program director for the Scripps Family Medicine Residency Program in Chula Vista, California, fighting childhood obesity became a personal and a professional imperative more than a decade ago. As with many parents, her initial foray into activism began at her children’s elementary school.
Frustrated, Dr Serpas approached the principal. “This was over a decade ago, when wellness wasn’t on the school platform the way it is now. The feedback I got was, ‘The cookies were donated, so that’s the reward we offer,’ or ‘We can’t do anything about a teacher handing out licorice in the classroom because there isn’t a policy against it.’ I just wasn’t getting any traction.””I wanted to raise my children with healthy eating habits, and I wasn’t feeling supported by the school environment,” she recalls. “Bad habits were so pervasive. They (the kids) were counting M&Ms to learn math skills. If they had a walk-to-school event, they celebrated with cookies and sweet drinks afterward. If they won Student of the Month, they got a gift certificate to a fast-food restaurant.”
So Dr Serpas joined the Chula Vista district’s wellness committee. By 2010, the committee had created a policy that eliminated food-oriented birthday parties, removed flavored milks in the cafeteria, and improved the elementary schools’ lunch menus.
But school wasn’t the only place Dr Serpas was hitting a wall. While caring for overweight patients battling a litany of chronic conditions, she realized “there was too little time in the office with patients to really have an impact. I started to see how hard it was for them to make healthy choices because of problems in the broader environment. I realized I had to get outside the clinic to effect change, and I knew I could alter the trajectory if I got involved with kids.”
Dr Serpas’ activism gained momentum. She partnered with community organizations throughout the area, joined the wellness committee in the adjacent Sweetwater Union High School District, and began training residents to become community health activists. “We’ve had our residents testify at city council meetings and advocate for health policy changes, such as bike lanes and rezoning, so we can get toxic businesses out of residential areas,” says Dr Serpas, who now serves as cochair of the San Diego County Childhood Obesity Initiative’s Leadership Council.
When Personal and Professional Concerns Coincide
Dr Michelle Davis, who practices family medicine in Kentwood, Michigan, likewise traces her activism to the overlap of personal and professional concerns. In 2014, she was seeing a lot of patients with whooping cough and reading headlines about a measles outbreak traced to Disneyland. Concerned about declining herd immunity, she went online to check the vaccination rate at her grandchildren’s future school. “The compliance rate was disgusting,” she says.
“I really thought if people were educated about how at risk they were because of unvaccinated kids, they’d do something,” she says. “Michigan has the fourth highest rate of waivers in the nation. Some of our counties have compliance rates that are lower than those in Third World countries. Until people speak up and pay attention to this issue when they vote, the law will not change. This isn’t a personal choice issue any longer. This is a public health issue.”Appalled, she launched a campaign to change a state law that allows parents of school-age children to obtain vaccination waivers for religious or philosophical reasons. In August, Dr Davis launched a Facebook page and a website, mivaccinations.org, where visitors can read through vaccination facts and email their concerns to state lawmakers. More than 2500 people have visited the site.
Dr Davis doesn’t know whether she’ll be able to effect legislative change in the state, but for now, she says, she’s doing what she can—beyond the walls of the exam room—to educate the public and appeal to their sense of civic responsibility. “I think most people want to do what’s right for the community.”
The Moment That Changes Everything
Activism doesn’t always feel like a conscious decision. For some individuals faced with a cataclysmic event, it may feel less like a choice than a necessity, Dr Duncan says.
That’s how it was for William Begg, MD, who was working in the emergency department (ED) at Danbury Hospital on December 14, 2012, when a gunman killed 20 elementary school children and six staff members at Sandy Hook Elementary School in Newtown, Connecticut. Dr Begg served as liaison between the EMS squads and the ED. “At some point, when I realized the scope of the tragedy, I just looked up in the air and said, ‘We have got to do better. I have got to do better.'”
As a result of Sandy Hook, “I’ve accidentally found my place in medicine,” Dr Begg says.Since that awful day, Dr Begg has given innumerable interviews and advocated for gun violence prevention before dozens of groups, including the US Senate and the American Academy of Emergency Medicine. Every March, he participates in Sandy Hook Rides, cycling from Newtown to Washington, DC, and speaking before packed houses along the way.
“When something like this happens, you try to make sense of it,” he continues. “Something positive has to come out of such a horrific, unspeakable tragedy. In the memory of those who died, we have to make some change in their name.”
Gun violence is a massive public health issue, Dr Begg says.
“If we approach it that way—like smoking, texting and driving, or alcohol abuse—we can have an impact. We have an opportunity to save dozens or hundreds or thousands of lives, rather than one life at a time.”
Fed Up and Ready to Do Something
Some physicians, such as Paul Teirstein, MD, chief of cardiology at the Scripps Clinic in La Jolla, California, are goaded into activism when an annoyance becomes an intractable problem.
“I didn’t go into this because I’m an activist,” he says. “I went into it because I needed to fulfill a responsibility.”In early 2014, Dr Teirstein launched a crusade to overhaul the maintenance of certification (MOC) process after trying to apply for recertification on the American Board of Internal Medicine’s website. Frustrated by the cumbersome process, and by MOC modules he felt were of little value, Dr Teirstein asked other physicians about their experiences with the recertification process. The response was overwhelming and vituperative. Dr Teirstein had stumbled on a hot-button issue.
Recognizing that complaining wouldn’t fix the problem, Dr Teirstein created a petition, which roughly 22,000 physicians signed, and a noncompliance pledge. When those measures failed to achieve the desired reforms, Dr Teirstein and like-minded physicians created the National Board of Physicians and Surgeons (NBPAS) to provide physicians with an alternative route to recertification that enables them to use continuing medical education credits from accredited programs, rather than MOC modules, as evidence of lifelong learning.
Dr Teirstein says MOC reform now commands about 20% of his time. That’s a lot, he admits, but the progress has been rewarding. “You can’t just complain,” he says. “Physicians are really good about complaining: We complain, see our patients, and then complain in the lunchroom again. I think the surprising thing for a lot of physicians is, if you spend a little time on these issues, we can make progress. It’s been a real eye-opener.”
Planting the Seeds of Change
For many activists, Dr Duncan says, the decision to take action is an amalgamation of many forces. It’s about serving family and community, righting wrongs, and addressing frustrations. But above all, she says, it’s about the future. “They have a desire to make the world a better place or to leave a legacy.”
Over the years, Roberta Gebhard, DO, a hospitalist in Jamestown, New York, and a board member for the American Medical Women’s Association (AMWA), has become comfortable asserting herself. She traces the seeds of her political involvement to an experience 6 years ago.
“She loved to travel and to go to the meetings,” Dr Gebhard says. “I don’t think she fully understood what we were doing at first, but she learned to speak up.””I wanted my daughter, who was 12 at the time, to realize she could have an impact,” she recalls. At the time, Dr Gebhard was AMWA’s representative to CARE, a humanitarian organization fighting global poverty. So when she and other AMWA representatives traveled to Washington to lobby on behalf of CARE, she took her daughter along.
Today, Dr Gebhard is a frequent visitor to Washington, where she lobbies on such issues as pay equity two or three times a year. Her daughter is a college student contemplating a career in diplomacy or politics. They still make an annual trip to Capitol Hill to represent CARE.
It’s not easy to find the time to be socially active, Dr Gebhard says, but not finding the time would be far worse.
“Sometimes I think you don’t have time not to be involved,” she explains. “It’s so important to have your voice heard. If you don’t, then you have things happen to you that you don’t want to happen. You want to be in a position to change things.”
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