by Izzy Dickenson – BMBS Medicine, Brighton and Sussex Medical School
The suggestion that those devoting themselves to Medicine need inherently be aware of its wider context harks back to the Hippocratic Oath, which includes the pledge: ‘I will prevent disease whenever I can, for prevention is preferable to cure’. Of less fame, though, is the reminder: ‘I [will] remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm’.
This millennia-old vow perhaps serves as a prompt to the overlooked inability to detach the political from the medical. The dynamics between government spending and pressures on health services present a compelling case for greater political awareness and engagement by healthcare workers (HCWs). Research by the London School of Economics found that reductions in British disability and housing allowances in 2011 were found to have caused a 10 per cent increase in poor mental health in those affected from lower income households, plus a reported further 26,000 candidates for benefit reduction diagnosed with depression. It is HCWs and services who absorb the shock waves made by welfare reform.
Could it consequently be said that the boundaries of a medic’s duty extend not just laterally to the walls of the hospital car park, but also superiorly to the chambers of government in which significant healthcare decisions are legislated by non-clinicians? Advocating for patients is now a fundamental expectation of doctors – and advocacy comes in many forms.
For doctors, part of the solution could be greater inclusion of teaching that covers in more detail the architecture of health service policy, or at least facilitates greater exposure during medical training. Current national outcomes for undergraduate medical education in the UK, as set out by the General Medical Council, alight only briefly on the political facets of medical education. They state that an understanding of the organisation of health services and framework within which healthcare is delivered is a core expectation, along with knowledge of the principles underlying the development of health service policy.
True grappling with politics is, however, notably absent from medical education. Politically themed modules are mainly optional and treated as side-interests rather than core curriculum. This poses the fundamental question: how can medics safeguard patients if they cannot understand policy or its impact? Doctors are left to explore the political entanglements of their career only once qualified, being placed on an oft-used pedestal that assumes a greater awareness of the political sphere than the general public. Political interest and involvement are a personal choice. Yet for medics, great proximity to the coarseness of everyday life and suffering, a vast amount of which finds its origin in socio-political factors, is undeniable. For a career that is famed for its wide breadth of knowledge, this presents a glaring gap.
The interlacing of doctors with politics is a fraught and emotive issue, to judge by media and public reactions to the English junior doctor’s strikes of 2016. Certain quarters decried that it was ‘not the job of doctors to dictate health policy’ – rather, to treat patients. A vast burden of responsibility is laid at the feet of medical professionals: to patients, to colleagues and, of course, to the tax-payer. It is perhaps the enduring societal attachment of this responsibility to the healer role, coupled with an ever-growing expectation of its functional abilities, that invoked negative reception to those striking.
However, this reaction does not acknowledge that healthcare cannot operate in a vacuum. If, as Virchow (the ‘father’ of modern pathology) states, “Medicine is a social science, and politics is nothing more than medicine on a large scale”, Medicine could itself be considered a political science. Its practitioners, therefore, ought to be adequately schooled in the understanding of the processes which contribute to the accomplishment of their duties.
Globally, the effects of medical impact in government can be seen extending more often into other constituents of public life. Research analysing differing approaches of NGOs versus those of medical professionals in Nigeria showed a greater impact was had long-term upon local health policies by doctors than by those trained in development. Politics was seen by medical staff as inexorably bound up in their role, stating that their responsibility for their patients included ‘political advocacy as well as clinical care’. Across the USA, medical students joined the Black Lives Matter movement, creating a WhiteCoats4BlackLives campaign that staged ‘die-ins’ in support of the BLM campaign. Their activism aims to eliminate racial bias in medical practice and recognise racism as a threat to the health and well-being of people of colour.
In the UK there do exist bodies which integrate these two fields; such are the campaigns of Sussex Defend the NHS lobbying for due diligence in the governmental implementation of Accountable Care Organisations or the multi-disciplinary Sugar Smart campaign which pushed for the upcoming national sugar tax. Politics in the modern, technologically-driven age permits greater accessibility and transparency; the numbers of medical professionals involved in political movements is small compared to the number practising – amounting to over 250,000.
If we are to truly broaden the political horizons of medical students and professionals it should not be assumed that politicised medicine is for those involved in unions and those in Public Health, administered via leaflets and the sides of bus stops. It lies in being able to analyse proposed changes to policy that will more avidly affect those from social backgrounds already predisposed to higher incidence of illness. It lies in evidence-based recommendation. It lies in awareness raising within communities of the soon to close community practice or state funded support group. It lies in upholding the responsibility to those who are not now, but may possibly become, patients.
Medical students are in a unique position to engage. They are not tasked with the responsibilities of doctors, nor have to face the same dilemmas when industrial action is proposed, knowing it will impact on patients and colleagues. They do not face reprisals over pay or have to placate the angry patient who had their long-awaited procedure cancelled for the third time due to your refusal to cross the picket line. To be a doctor is not just to administer to those who are sick, it is to acknowledge the health of all society. To do this, perhaps it is time medical schools acknowledged this too.