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Everyday Advocacy
It is no accident that the first competency for this CanMEDS Role is the one that focus on health advocacy in the clinical context "Respond to individual patient health needs and issues as part of patient care."
Many physicians may feel that they do not perform health advocacy as they do not lead organizations, run committees or organize projects in developing countries or under-serviced areas at home. These are activities that are traditionally associated with health advocacy. However, "everyday advocacy" is just as important. This type of advocacy is not glamorous and can often go unnoticed. For example, when you make a phone call to radiology to speed up the wait time for a CT scan, the patient may not even be aware that you are doing this. And yet, this is definitely health advocacy and contributes to the individual patient's well-being.
A large portion of your work as a resident is "everyday advocacy". Residents are the backbones of the hospital system, filling out forms, writing referrals, doing the "scut work" that keeps the machine running. You know that this, often thankless, work can make a huge difference to a patient’;s care and outcome.
Advocating for a patient adds to the already heavy workload that a resident carries. As well, the need for a resident to be "medically competent" is often the priority. The balancing of these various CanMEDS Roles is an ongoing process that even the most experienced clinicians struggle with (though, they may not admit it!).
At times, one needs to recognize and accept the limitations of the medical system. As a resident you may find yourself in a situation where something about the system is blocking optimal care for a patient, perhaps something related to bed availability. At this point, there is the opportunity to advocate on a larger scale in order to address the hospital system and lack of appropriate resources. You may or may not want to take this on. This is when you could assess your own strengths and other demands, and figure out where your energy is best spent. Some people love tackling the larger, systems issues whereas others prefer the dealing with the individual. Both levels of advocacy are valid and valuable.
In the next section we will look at the Determinants of Health as a framework for considering the other spheres of advocacy. First we must be aware of inequity and disparity and then we can work with others to use our skills and the opportunities afforded us as physicians to the benefit of individuals, families and communities. Inherent in this discussion is the need to understand power and powerlessness. To be an advocate is to exercise ones power in a very specific way, the risk of using ones power, even with the most altruistic of aims, is that it will be paternalistic and actually reinforce and strengthen the power relationships that created the inequity in the first place.
We never said advocacy was easy!
Amartya Sen will tell us teaching is an act of sharing the benefits that have come to us - sometimes divesting ourselves of our power can be our greatest act of equity and advocacy. "Thinking can be very easily combined with actual action."