Advocacy by Physicians for Patients and for Social Change

Should physicians be expected to be advocates for their patients? How about for patients as a group? Individual physicians often must decide whether, how, and how much to advocate for their patients. Further afield, they must decide whether and how to get involved in societal issues that affect the health of people in general. In our teaching, should we expect our students and residents to be advocates? If so, how do we teach that? Is it desirable, or even permissible, to consider advocacy a core component of medical education? If so, how should we evaluate it? Should a student who does not—or even refuses to—advocate for patients be given a passing grade?

Sarah Dobson and her colleagues addressed these questions in a 2012 “Perspective” article in Academic Medicine titled “Agency and Activism: Rethinking Health Advocacy in the Medical Profession” [1]. In an important contribution, they propose dividing advocacy into two components, which they call “agency”—working on behalf of the interests of a specific patient—and “activism,” which is directed toward changing social conditions that impact health, and the effects of which are seen in populations more than in individuals. The difference, they say is that, “whereas agency is about working the system, engaging in activism is about changing the system” .

This is helpful in clarifying different perspectives on the term “advocacy.”