Medical education is known for its stress, with high rates of mental illness and burnout often attributable to a toxic work environment — even in the absence of a pandemic. But I firmly believe those in the medical profession aren’t destined to become lifeless drones. They have the agency to change these conditions. Medicine and political activism can go hand-in-hand.
For instance, in my limited spare time in medical school, I co-organized a meeting between Occupy Wall Street and Tahrir Square activists from the 2011 Egyptian revolutionary movement. This meeting was intended to culminate in a joint protest and mutual nonviolent arrest in Zuccotti Park in 2011, as well as a trip to Cairo. The project failed for multiple reasons, including poor management as well as likely behind-the-scenes interference involving the Egyptian government. But nevertheless, it was a unique experience for a medical student.
I have often hidden my political beliefs from my co-workers throughout medical school and residency. Mainstream media may depict universities as hotbeds of radical thought. But in my experience, elite U.S. colleges tend to reward centrism and moderation over confrontation.
Moving Outside Our Comfort Zone
Whether intentional or unintentional, medical school socializes doctors into incrementalism. Beliefs that “change comes slowly” and “compromise is necessary” fit comfortably with the upper-middle-class lifestyles we obtain after residency. Any deep recognition of structural inequalities or class privilege would ultimately lead us to implicate ourselves in that system of privilege.
Not all physicians fall victim to this mentality — as witnessed in multiple organizations, such as Physicians for a National Health Program, Physicians for Human Rights, Physicians for Social Responsibility, etc. But many in our profession value comfort over ambition.
In the COVID-19 era, however, class privilege will no longer keep us safe. The pandemic will affect all socioeconomic strata, including millions in traditionally affluent developed countries. Unprepared hospital systems are overwhelmed by a disease that spares none. Health care providers are no longer protected. Health profits are no longer protected.
Global economic depression will affect millions of skilled workers, including health care workers. Even highly lauded medical specialties are experiencing the politics of austerity, as layoffs and budget cuts are occurring for many “nonessential” but highly trained specialists in light of this crisis. A doctor’s career is no longer insulated from political realities.
COVID-19 may be a radicalizing moment for many health care workers. Doctors and nurses will witness longstanding structural inequalities in the U.S. health care system, as they are thrown into surge-capacity mass casualty events. Health care providers will become sickened patients themselves, suffering physical and psychological consequences for decades to come. In the next 12 months, I suspect every physician in the United States will witness at least one or two colleagues unnecessarily killed due to federal inaction on protective equipment.
Other lower-income front-line workers, such as respiratory therapists and nursing assistants, may suffer even more severe health consequences. Ironically, even though these front-line workers have even more face-to-face time with patients than physicians or nurses themselves, they have even less access to protective equipment.
Americans can laud health care workers on social media as “heroes on the front lines.” But regardless of virtue signaling, a large portion of the U.S. public still support politicians who mismanaged this disaster in the first place. We need to become more confrontational as a professional community. We cannot work as doctors without engaging the political systems that influence doctors. No longer can we remain on the periphery of these conversations, in technocratic or suburban bubbles.
Fortunately, physicians are generally held in high regard. We have a level of public trust that we can use to advocate for change. Perhaps if we are more politically active, our opinions will win over the Beltway pundits that dominate our media landscape.
Elections and Physician Pressure
It is time to hold elected leaders accountable, not only now, but at the polls in November as well. Trump’s current administration has been a menace to COVID-19 prevention and treatment. His administration’s inaction is responsible for a bulk of current COVID-19 deaths. He has openly ridiculed hospital requests for face masks, and he has transformed his bully pulpit into a pseudoscience platform. He is literally rationing hospital supplies and doling them out to his political supporters.
Medical professionals must also hold our professional communities accountable for electing these officials in the first place. Health administrators often regularly support profit motives over patient lives, so it would make sense that their political preferences reflect this profit motive. Hospital CEOs and physician leadership organizations should be shamed publicly if they financially support re-election campaigns for politicians who failed in their responses to COVID-19. It is important for investigative journalists to identify “dark money” donations from these leadership organizations. Additionally, physicians must also point fingers at themselves. Let us not forget that a substantial minority of physicians voted for Trump in 2016.
Political change also encompasses more than the presidency. Many state and district Republicans took steps behind the scenes to downplay the severity of the COVID-19 crisis, to impede access to medical treatment and to block essential stimulus payouts to ordinary Americans. We must hold these local officials accountable, in addition to our national congressional and presidential candidates.
Thinking Beyond Elections — Physicians and Protests
But in reality, the potential for substantial political change may be too limited in our current political system. Regardless of good voices, both the Democratic and Republican Parties are often driven by corporate donations and opportunism.
It would be easy if party politics could solve all our problems. But the COVID-19 crisis partially reflects the failures of our institutions to provide a proper social safety net. To a significant degree, the current iteration of the Democratic Party also contributed to these budget cuts. While compromise is understandable, the COVID-19 crisis demands a safety net far more substantial than anything viable in our current political system.
Therefore, we must weigh whether to transcend our political comfort zone. We must consider the role of broad social movements for change — including protest movements — to achieve health care justice in the post-COVID-19 era.
Many experts predict future pandemics as inevitable, especially in an era of worsening climate disruption and habitat destruction. This will not be the only pandemic in our lifetime. Nor will it be the only pandemic-associated political fight in our lifetime. Medical interventions won’t do that much for communities, especially if a medical crisis is accompanied by economic instability and “shock doctrine” special interests. Thus, physician participation in large social movements may become necessary to truly adhere to the Hippocratic Oath.
Physicians already serve as whistleblowers for high-risk COVID-19 groups. Doctors have led the fight for vulnerable incarcerated patients and immigrant detention patients. Nurses have publicly protested anti-quarantine marches funded by right-wing groups. We should think about how our individual actions could translate into larger collective action.
Imagine strategically targeted strikes of physicians and nurses in non-surge settings, if a hospital’s administration was unwilling to meet the demands of their workers for personal protective equipment. Imagine groups of health care workers from each district permanently occupying their congressional offices in civil disobedience, if upcoming stimulus bills failed to adequately protect ordinary Americans. Imagine an increasing number of U.S. physicians and organizations supporting Medicare for All. (In case you’re unaware, most health care lobbying groups that supposedly represent physicians oppose Medicare for All.)
Ultimately, it would not be surprising if physicians in the United States gravitated toward anti-austerity social movements. Anti-austerity protests serve as a vanguard to protect the social safety net around the world. They reveal and oppose entrenched power systems, such as the corporate administrators and special-interest lobbyists that dominate our health care systems. One can argue that the entire Sen. Bernie Sanders presidential campaign was a homegrown tribute to these anti-austerity movements.
I still encounter antipathy and distrust when I attempt to discuss protest movements with my doctor colleagues. But U.S. hospital administrators continue to cut provider jobs, occupational protections and hazard pay, even while in a disaster response scenario such as the COVID-19 pandemic. In this environment, protests may become increasingly appealing.
Political Action as a Form of Healing
If we’ve learned anything from the last few months, it is that previously unquestioned political norms may change in a crisis. The whole discipline of pandemic prevention was previously a side hustle in D.C. politics, relegated to the same feeding frenzy pool as other federal contract requests. But it is now the forefront of major news headlines, for weeks straight.
Americans without public health training now take to Twitter to discuss the obscure math of “flattening the curve.” Trump now confesses to the press that there are benefits to universal health coverage. Emergency medicine previously had some of the most lifestyle-friendly hours of the specialties. But now, emergency room doctors are literally dying on the front lines of a war. Up is down, black is red. We now live in an alternate universe.
Although U.S. physicians are largely reared in comfort and privilege, we are now literally facing our own mortality, daily, at work. Our sense of moral injury will only intensify as the true death toll kicks in for all cities. If most U.S. cities resembled the scorched landscape of New York City, will we still regard Medicare for All as controversial? Will we still regard progressive political candidates as overly divisive? Will mass protests receive our mass support?
These are questions we must consider, if doctors want to transform their collective post-traumatic stress into a movement that can heal the country. Previous public health crises in U.S. history have often reached a boiling point. Environmental health issues in the 1970s, including the Superfund movement and the anti-nuclear movement, resulted in sit-ins and civil disobedience. Union fights have been a longstanding part of hospital politics for decades. AIDS activists went so far as to shut down the entire New York Stock Exchange in order to draw attention to the cost of antiretrovirals.
If doctors want to make a difference in the COVID-19 debate, we need to think at the same level of political intensity.