A Medical Economics Web Exclusive

Who will lead, if not us?

By Paul Jung, MD
Internist/Baltimore

When we decided to become physicians, we did so presumably to "help people" and act in the best interests of our patients. While clinical acumen and disease management skills are essential tools for our profession, these skills alone won’t take us far in the face of our health care system’s true problems–lack of access, managed care bureaucracy, unaffordable medications. When we said we wanted to "help people," how far were we willing to go? Given our oath as physicians, if we are truly interested in helping people, it is our natural responsibility to extend our efforts beyond our office walls.

Rick Stahlhut, a physician friend of mine from Michigan, has taken that message to heart, turning his doctor’s bag into an activist’s toolbox and limiting his practice to a single patient, the US health care system.

"I saw how big health systems with good mission statements became distorted and difficult to fix from the inside," he recalls. So he threw down his stethoscope and white coat and set forth to improve health care on a grand scale.

Originally intending to focus on education and physician training programs, his experiences have required considerable investment in learning new skills: media relations, public speaking, community organizing, and even a formal course in political economics.

Stahlhut has discovered that health care is so enmeshed in all aspects of society that it is impossible to fix without tackling other, larger social issues. Accordingly, he joined the World Bank/International Monetary Fund protests in Washington, DC, and the Republican National Convention protests in Philadelphia before settling down to run a local election campaign for a state legislator. He spends time with various activist organizations, making speeches and writing articles, and was recently elected to the board of trustees of the American Medical Student Association, a volunteer position.

Most of us probably think he’s crazy for doing what he did. The media portray an "activist" as a purple-haired wacko with tattoos and a pierced nose marching for whale rights, while physicians tend to call themselves "patient advocates," evoking a more genteel, temperate, earnest beast. But their goals are the same, and they both provide the opportunity for physicians to make that difference–to help people.

That is not the type of work we expected or were trained for in medical school. There’s plenty of talk nowadays about medical "professionalism," where the boundaries of our work and practice are debated. Stahlhut’s example is exactly where the rubber meets the road. We cannot separate ourselves from the system in which we operate, and we cannot speak of our professional duty only to ignore our responsibility while our profession, and our patients, are being attacked.

No doctor I know thinks the current system is either desirable or sustainable. The question is, then, who will decide on the next system when the current one fails? As Stahlhut says, "We desperately need people working on the big problems of our society, and not just hoping someone else will do it. Physicians still have credibility in our culture, which gives them the opportunity and responsibility to lead."

Not everyone should be expected to just dive in like Stahlhut, or to commit to a cause while living on a shoestring budget. (He and his wife support themselves with interest income from investments, honoraria from his writing and speaking, and her PhD student stipend.) Short of devoting ourselves to the activist life, there are many things we physicians can do in our communities to make a difference, whether that’s running for the school board or fighting to keep the electricity from being shut off in a poor neighborhood during the winter. Every election affords opportunities to get involved in local, state, and national politics. Many physicians are appalled at how little politicians know about health care; getting involved will help legislators understand the issues that are important to us.

Instead of focusing simply on patients in our offices, we must maintain and promote a longer, sustained view of the entire health care system and our role within it. And if our health care system is not what we expect it to be, if it doesn’t allow us to treat our patients effectively, why not get involved on the grand stage? What do we have to lose? It is our duty as physicians. The plain fact is, it will be left to us to decide what is left to us.

To communicate with Rick Stahlhut, go to stahlhut@net-link.net. The author, internist Paul Jung, can be reached at pjung@jhmi.edu.

For another look at a physician who has taken the plunge into public life, see the article by North Carolina State Senator and family physician James S. Forrester, "Why politics—like medicine—is a noble calling," Medical Economics, April 24, 2000.

See also "Into the Streets," an article on physician protests that appeared in the October 2000 issue of The New Physician, the publication of the American Medical Student Association.

The author is a Robert Wood Johnson Clinical Scholar at The Johns Hopkins University.

Paul Jung. Who will lead, if not us?.

Medical Economics

2001;9.