Global Health Healthcare Disparities Medical Humanities Public Health

Medical Students as Advocates for Change

At a time when demand for advocacy is high, opportunities for medical students to develop these skills is waning. In the midst of the COVID-19 pandemic, advocating for those less fortunate is not just the duty of medical professionals’ but the correct action of any human being. 

With a long and deep rooted tradition in medicine, advocacy calls upon physicians to speak up on behalf of patients, the vulnerable and those in dire need of assistance. Due to the respect physicians have as leaders of society, and of the trust individuals have in the medical system, they are able to influence policies that benefit their patients and the healthcare system.

Therefore, as students-in-training, when given the opportunity to advocate for our patients, and positively affect interactions in medicine, these occasions ought to be seized particularly if we want to change the landscape of disparities and injustices that are rampant in America. By encouraging medical students to engage in advocacy efforts, the concept of physicians as advocates becomes a step closer to normalization as well as their humanity strengthened when engaging with the medical system outside of their usual role. 

Given the lack of awareness, or an unrealistic view of the difficulties, and interactions that prevent a successful physician-patient relationship, medical students need to be empowered with advocacy skills to create physicians who are capable of treating diverse populations such as refugees, the homeless, and other disadvantaged patient groups.

As a result of the COVID-19 pandemic, movements such as #Students_Against_COVID, Students vs Pandemics, and a Coronavirus Global Awareness Magazine have been born. These times of chaos have proved to be the fruit of innovation sprouted by the desire to serve and rise above obstacles. Besides these efforts, medical students seeing the need for personal protective equipment (PPE) created a Non-Profit Organization, MedSupply Drive which gathered medical students across America uniting in the collection of equipment required for professionals to protect themselves while serving on the front-lines. 

Other students passionate about advocacy have had to seek extra-curricular positions in the International Federation of Medical Students (IFMSA), American Medical Student Association (AMSA), American Medical Women’s Association (AMWA), Australian Medical Student Association (AMSA), Asian Medical Students Association International (AMSA International) and American Medical Association (AMA) to raise their voices for tangible and effective change. They have organized campaigns on the Affordable Care Act, MedVote, Global Gag Rule, contraception, and gun safety among others. The Global Health Committee, the AIDS Advocacy Network as well as numerous LGBT+ Communities have also met with senators and representatives to discuss important state and national bills affecting health care. 

In Canada, students have formed a coalition known as the Medical Student Response Team where they’ve created an app to efficiently distribute community support during the pandemic. Such responsibilities involve assistance at the homeless shelter, collecting grocery items for the elderly or virtual storytelling opportunities for children. Others have come up with ways to create ventilators for vulnerable populations in Yemen, Syria and Afghanistan. Medical students foreseeing the problems afflicting indigenous populations sought indigenous translators to translate COVID-19 related information into their local languages for dissemination and understanding in order to keep themselves safe.

As a result of the anti-black attitudes and of racism prevalent in our societies, students have stepped up to educate citizens through the sharing of books, websites and videos to learn more about the issues prevalent in society. Medical student, Malone Mukwenda from the United Kingdom took it upon himself to co-author a textbook, Mind the Gap, a clinical handbook of signs and symptoms in black and brown skin. This book was inspired by the lack of racial diversity in medicine as medical dermatology textbooks failed to adequately educate physicians on conditions affecting those of non-white skin. Other student initiatives have been propelled by the desire to fight the information epidemic where misinformation about COVID-19 has been spread across Latin America. Extremely dangerous and perpetrated by those taking advantage of peoples’ confusion, and fear, COVID Demystified, a group of senior undergraduate students, graduate students and early-career scientists from universities across North America have come together to bring research on COVID19 to the people. This stems from their desire to make science accessible to all, therefore the information presented in their posts are all from peer-reviewed, published studies in reputable journals. 

While support of experiential learning in advocacy is needed, much work is to be done if evidence-based advocacy training is to become readily accessible to current and future health professionals nationwide. Even though advocacy takes many forms, occurring at multiple levels of engagement such as individual, local and national, all are valuable. At an individual level for example, physicians advocate for timely diagnostic tests and regionally for groups of patients seeking funding from a health provider. At a system level, physicians advocate for activities to improve the overall health and well-being of populations and globally encourage international support for health related environmental protection. 

From letter writing, social media campaigns, to one on one discussions with authority figures, advocacy techniques and strategies may vary. When speaking publicly, physicians should be clear when their comments are made in a personal capacity or on behalf of a third party and while many physicians are skilled advocates, these abilities are not natural for all physicians. Most often, advocacy is then a learned skill developed over time .

As healthcare providers and leaders, physicians can help improve and sustain the health systems by approaching issues with transparency, professionalism and integrity. Through informed perspectives and the use of evidence-based facts to help persuade others, now more than ever will patients continue to look to their doctor as a trusted source for healthcare information and support. Consequently, advocacy efforts will only increase in importance as the rise in injustice, neglect and falling economies continue and although advocacy’s definition in healthcare is evolving, physicians may show leadership by remaining engaged, committed and seeking to advance their viewpoints in a professional appropriate manner; for then only may they truly serve humanity before anything else. 

Written by,

Leah Sarah Peer

General Narrative Public Health

Storytelling and Patient Advocacy

Yesterday, I received a perfectly-timed message on a group thread. My friend wrote that she loves patient advocacy.

“Me too,” I thought, as I filed away notes from a Planned Parenthood of Southwest and Central Florida Meeting hosted by the Leadership Action Team (LAT). What was the purpose of that meeting? To train volunteers on how to employ storytelling in their advocacy work. Planned Parenthood trains all of its staff members, and now volunteers, in the “Story of Self” curriculum created by Get Storied® , which is a program designed to teach businesses how to create social change through the art of storytelling.

The meeting began with introductions and a moment to safely process the recent shooting in our hometown. A young volunteer explained how the event affected her and her family:

I learned about the shooting on Facebook…And honestly, all I saw was, ‘Massive Shooting,’ and thought, ‘Oh, another shooting,’ and kept scrolling. I didn’t understand the gravity of the situation, until that night while watching the news with my mom. I looked over at my mom and she was crying. She just said, ‘I am afraid for you.’ She’s never before expressed concern about my activities. But now she says, ’I am afraid for you.’

This volunteer was young, but her voice carried a surprising amount of assuredness. I felt her confusion and fear. The next attendee shared their story, and then the next, and so forth as the meeting progressed.

We learned that there are three key components to one’s story of self: a challenge, a choice, and an outcome. Zac, the chair of the LAT, shared his story of self, which described the healthy relationship with his mother and the openness with which she educated him regarding sexual matters when he was an adolescent male. The two-to-three-minute story, complete with a joke about educational materials containing graphic penis pictures, ended powerfully with the line,

When I walk into a Planned Parenthood, it’s the same kind of environment my mom created for me for talking about sex.

We received our first assignment, which was to reflect on the experiences in our lives that have shaped the values which call us to leadership. The program will later have us refine the various details of our stories, practice in one-on-one and group sessions, identify ways in which we plan to use storytelling in our advocacy work, and take action. We had five minutes to silently reflect.

Ok, what is my campaign? Women’s health. Yeah, but what specifically? To help women access and achieve the best reproductive health care possible. Nice. So why do you want to do that? Because reproductive health is the most important thing in the world! Ok, but why?

Figures of maternal morbidity and mortality popped into my head. I could see again the absence of a clitoris and labia in my Nigerian patient who underwent female genital mutilation as a young girl. I remembered the way the vaginal introitus feels beneath my hands—stretched and strong—as a baby’s head begins to crown. The voice of an adolescent girl echoed, “I mean I want to have sex, but like, I’m not a slut.”

It is easy for me to think of patient stories that depict why I am pursuing a career in Obstetrics and Gynecology. But a story of self is just that. A story of SELF. I struggled to think of inspiring personal experiences.

Time is up! No.

Each person in my small group shared their story and received feedback. My turn circled around and I rambled on about women’s health. I managed to state two strong lines, “I volunteer at Planned Parenthood because it still remains the one place to offer judgement-free care. Not even my own gynecologist can say that.” But my story lacked focus and a compelling personal example.

That night after receiving my friend’s text, I began to think more about the meaning of patient advocacy. As a medical student, I think my primary role in patient advocacy is to ensure that my medical team knows about our patients’ health histories and needs. During my internal medicine/family medicine clerkship, in order to help care for a patient, I compiled a short document of excerpts from the World Health Organization, Centers for Disease Control, and American College of Obstetrics and Gynecology regarding HIV prophylaxis treatment in pregnant women with negative HIV status who have regular, unprotected sex with an HIV positive partner. In that instance, helping my resident defend her treatment plan was my way of advocating for my patient’s health. Patient advocacy means that I volunteer monthly to escort patients safely into Planned Parenthood clinics. It is the reason why I study exercise and pregnancy, so that I can advocate for pregnant athletes seeking to find a balance in the pre- and post-partum periods. Additionally, patient advocacy means that I write on the MSPress Blog about topics that matter.

Stories in medicine can break stigma, help people relate to the struggles of others, and empower someone to raise their voice.  Stories identify why we should care about an issue, and can inspire others to take action. Although I do not yet have an organized understanding of the many personal experiences that inspire me daily to fight for reproductive health care, I think I am well on my way to becoming a strong patient advocate. Fortunately, I do have a clear goal: support the improvement of access to reproductive healthcare and higher quality of reproductive healthcare for all.

Quoted persons in this paper gave permission to be on the record.

Featured image:
Story by Alexander Affleck