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Abstract
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hysicians have long lent their voices to issues of concern to the health of the public, many of which were politically and socially controversial at the time. Physician organizations were instrumental in formulating recommendations that led to policies around alcohol and driving. Such policies are normative in much of the world today, contributing to reductions in motor vehicle–related morbidity and mortality and resulting in one of the greatest public health triumphs of the 20th century.1 Physicians have been deeply involved in advocacy around tobacco control, resulting in comprehensive tobacco legislation that has contributed to substantial declines in tobacco-related morbidity and mortality over the past decades.
Physicians have also been engaged in what is perhaps one of the most pressing and contentious issues of the present moment: gun violence. Physician organizations here have led the way. The American College of Physicians, the largest medical specialty group in the United States, has long advocated for a policy-based approach to address firearm morbidity and mortality in the United States, culminating in a set of recommendations published in 2014 about approaches to reduce the effects of gun violence. The following year, the American College of Physicians joined a group of 52 organizations in a call to action to consider gun violence as a threat to the health of the public. The American Medical Association, the largest physician organization in the country, endorsed a variety of gun control measures in 2018.
Individual physicians have capitalized on more modern means of communication to engage on the issue of gun violence. Galvanized, perhaps ironically, by a tweet from the National Rifle Association that urged physicians to “stay in their lane” and away from the issue of guns, thousands of physicians tweeted their experience of treating those who have experienced gun violence, appropriating the hashtag #thisismylane, and arguing that physicians had a unique perspective on the consequences of gun violence, and, as such, that their voices matter in the broader societal debate about gun safety.
Yet, this picture of physician involvement in public health issues of consequence omits complexity around this same physician engagement. Gun violence has been essentially endemic in the United States for the past 20 years, long before physician groups endorsed policy efforts that may mitigate the consequences of guns. The new wave of physician voices about guns trails the public conversation that has been raging since the Sandy Hook massacre in 2012. Physician voices have been weak on a range of other issues that occupy the present public health moment, including, for example, the roles of racism and income inequality in shaping health.
Physicians’ Hesitation to Lend Their Voices
Several factors may contribute to physicians’ hesitation when considering engagement with issues of public health consequences.
First, the physician’s role centers on the individual patient-physician relationship. This is canonical in medical school training, inculcated in physicians from the first day of medical school. Much about the role of physicians flows from this orientation. At core, physicians see their responsibility as being to the patient in front of them and, as such, are concerned with the determinants of health of the individual. These determinants, it turns out, are often quite different than the determinants of health of populations ...
Language: en |