Speaking Up about Speaking Out (What did we mean by “Get Political”?)
At our 2019 Strategic Retreat, there was agreement that it was time for our department to “get political”; to use our voices/knowledge/privilege to enable the transformational changes required to promote the health of the population, including addressing climate change, systemic racism, and the social health determinants.
Many of our faculty members and trainees have been outspoken about critical issues impacting health and health care, e.g. David Juurlink and opioids, Lisa Richardson and Indigenous rights, David Naylor and fundamental research, Andreas Laupacis and Seema Marwaha via Healthy Debate, and Samir Sinha and Nathan Stall on elder care, to name just a few. We are fortunate to have so many colleagues who are committed to educating the public, spreading truth, lending their voice and their talents “to the fight.”
But, since COVID hit, speaking up and speaking out got pretty messy.
About two weeks ago, our DoM Communications Lead, Jocelyn Lagerquist, emailed me saying, “I’ve wondered how on earth our clinicians developed such ‘thick skin.’ They are medical professionals — epidemiologists — who went into medicine to help people, and yet, when they voice scientific data (and/or opinions supported by scientific data) they are maligned and, I hate to say it, personally attacked. I’m just blown away by how committed they are to spreading truth despite, at times, very real threats.”
Jocelyn is responsible for media/social media monitoring and had been observing dialogues and commentaries in the “digital space.” And she’s right! Speaking up and speaking out in the face of injustice may be the “right thing to do,” but at what cost?
We decided to ask some of our faculty members what compels them to “get political,” the benefits and hazards, and what they’ve learned along the way. This is what they had to say.
Irfan Dhalla (Twitter @IrfanDhalla ): championing a more effective pandemic response
We all agree that each of us has a responsibility to use our knowledge to provide the best possible care for our patients. I’d take it a step further and argue that collectively we also have a responsibility to use our knowledge to advocate for better public policy. This doesn’t mean that every member of the department needs to be tweeting or writing op-eds or meeting with elected officials. But we should encourage and support those that do engage in this kind of activity.
Saroo Sharda, Aruna Dhara and Fahad Alam recently published an article in CMAJ describing an apparent tension between professionalism and advocacy. They pointed out that physicians who advocate for justice are subtly or even overtly discouraged from doing so. I’ve certainly experienced this kind of discouragement in my career. For example, as a trainee, I was called a “left-wing pinko” by a senior physician on the ward. I’ve also received a huge amount of support from mentors and leaders both within and outside the department, for which I’m very grateful.
Supporting advocacy — and even encouraging faculty members to run for office or work for government — is a great way for us to maximize our collective impact. So I’m very glad to see the leadership of the department encouraging us to “get political.”
Susy Hota (Twitter @HotaSusy): voice of clear, understandable information about COVID
I think that writing openly about the importance of advocacy and risk communication during the pandemic, in spite of the associated hazards, is really critical.
I have received threatening voicemails and been the subject of criticism, attack and misrepresentation on social media, it is true. But the overwhelming majority of feedback is that of gratitude — for providing honest opinions and credible information. I try to focus on the positive and carry on because I truly believe that public communication makes a difference. Maybe it sounds idealistic, but if my messaging helps even one person make a better, more informed choice around one of the many confusing aspects of the pandemic, then I think it’s worth it.
David Juurlink (Twitter @DavidJuurlink): critic of liberal prescription of opioids
When it comes to the opioid crisis, “speaking up” takes different forms — arguing for drug decriminalization, supervised consumption sites, more cautious opioid prescribing, and so on. But it’s definitely the prescribing bit that generates the most hate mail and vitriol, generally from people who don’t see pain management as part of the problem. Often, these same people will misrepresent my views to fit their preferred narrative.
If I had to relay one key message, it would be to not take things personally. Twitter tends to amplify the angriest voices, and it’s not a space well-suited to nuanced discussion. With an issue as complex and multifaceted as the opioid crisis, that’s the only kind of discussion worth having. Engagement is good, but debating on Twitter can quickly become pointless. Life is short, and you can’t disabuse people of beliefs they’re intent on holding.
Seema Marwaha (Twitter @SeemaMarwahaMD): Editor-in-Chief @healthydebate
There is a vocal minority who speaks up (both in and outside of the media) and the pandemic has reinforced that. It’s a lot of work to do it, fulfills a societal need for education and transparency but is often unrecognized and takes a lot of time to do. Not everyone has to do it regularly, but everyone should be able to if called upon in the right circumstance and understand the do-s and don’ts to do it safely. It is both of professional and societal value to fill this need and falls under public education and knowledge translation (to me).
It’s usually disproportionately male and non BIPOC for a variety of reasons. Most often it is because the media goes to who they know and who has spoken up before. You hear familiar voices often. Women and BIPOC department members do experience more online harassment and trolling so it’s a deterrent. I often have people comment on my appearance, gender, relative qualifications etc. and my skin is pretty thick now. There are more senior male DoM members than female and it’s often more senior voices that are approached. You also have to have the schedule flexibility to write and speak up, which clinical teachers often have less of. There is a lot to this aspect…this lack of representation is a problem and much of it is structural
There is a conflict between what is encouraged of us in training/via CANMEDs and what is acceptable once hired/to get promoted. It’s similar I find to the dichotomy of what’s expected of you to get into medical school and what you actually have time to do when you get there. You need to demonstrate advocacy and speaking up in training but it’s not so straightforward to once you are hired. The risk aversion and need for unified messaging often butts heads with speaking up and speaking out about frontline or patient issues.
Andrew Morris (Twitter @ASPphysician): covidemails.com, COVID data and anti-microbial stewardship
I have actually tried to minimize my overall media exposure, believe it or not, except where I feel it is beneficial — primarily in the role of advocacy. It is why I am rarely on TV, where that opportunity is less. I probably say no to about 80% of requests.
There are clearly two different approaches to media at present that you will see: advocacy and education. They are not mutually exclusive. I try and do both.
I have personally received snail mail and electronic hate mail, and my family and especially extended family have taken heat for my positions and advocacy, and colleagues — also prominent in the media — have made clear disparaging reference to people like myself.
The pandemic has brought out the best and worst in people. I try and spend most of my time with those in whom it has brought out the best.
Samir Sinha (Twitter @DrSamirSinha): advocating for seniors and the need for drastic changes to long-term care
I think something we have struggled with is our DoM Strategic Mission — i.e. Get Political— which I think means raise your voice to be effective advocates for change.
We cannot tell people not to advocate — but some people’s advocacy may complicate matters further. I think we need to speak openly about the issues of the gender/BIPOC gaps in advocacy as well. We are trying to encourage more female and BIPOC voices.
Nathan Stall (Twitter @NathanStall): CSTP Trainee, Assistant Scientific Director of Ontario’s COVID-19 Science Advisory Table, researcher and advocate on long term care and COVID-19
I am in the pre-contemplative/contemplative phase of leaving Twitter, or at least going on a hiatus — it's hard not to let all the nasty things you read about yourself get under your skin/keep you up at night.
Brian Goldman interviewed me for White Coat, Black Art about this today (with Dr. Jennifer Kwan.)
It is essential that all doctors and scientists who choose to advocate have the right to do so and are supported by their hospitals and universities; of course, it is always important that you check with and follow hospital communication policies (including seeking permissions to use your hospital credentials, and to always make clear you are not speaking on behalf of an institution but as an independent physician and scientist).
I have struggled with how to effectively advocate in the media while not excluding myself from opportunities “within the tent.” I am also mindful that, if you choose to advocate and express your views publicly, and if you express criticism, you must be open to receiving constructive criticism (I don't believe that as physicians and scientists we should have any sort of immunity). However, as you become more visible, you open yourself up to the darker side of the internet and society. I think we could work across the University to try and encourage and support additional departmental members to assume advocacy roles (if they are interested, willing and able).
Lisa Richardson (Twitter @RicharLisa): Strategic Lead in Indigenous Health @uoftmedicine, Indigenous health
I do the work that I do because it is meaningful and so important. Community members come to me and ask me to help; the inequities are so significant that it feels like a responsibility.
The upsides: I love the partnerships and the work feels very meaningful; I have seen lots of changes—have had the opportunity to change policy both locally and federally (presenting to standing committees, the Senate, federal ministers, etc.)
The downsides: it is not abstract but is very personal work for me as well: it’s a heavy weight to carry. Attacks can be really mean/vitriolic/personal and heightened for women, I think. People critique not just your ideas but how you look, speak, etc.
The Bottom Line
As academic physicians, we have a responsibility to use our knowledge to advocate for better public policy to ensure equity in access to health promotion, diagnosis, treatment and the best possible health outcomes. Why else do research or teach but to advance our profession and improve the health of Canadians?
We must encourage and support those that do engage in this kind of activity.
There are myriad ways to “get political”— speaking up and speaking out publically is only one. Others are sitting at the tables where decisions are made (OMA, CPSO, MOH, Ontario Health, RCPSC, etc.) Others do so through their work with NGOs and professional societies. Still others do so through their medical outreach and the focus of their clinical activities. Some do this as individuals, others as communities of practitioners or thought leaders. All are valuable, all are valued.
The next step? As a department, we think it would be useful to identify a few “issues” around which we can gather our collective energies to advocate for change. We look forward to your thoughts and ideas about which issues to tackle first.