Physicianhood

I was at a dinner party the other night and I got into a political conversation with a friend of a friend. It was heated (warm, but not hot) and fast, fairly superficial, and we didn't completely agree with each other. It was certainly intense, but it wasn't an angry, loud or aggressive political conversation. Still, in a matter of 3, maybe 5 minutes we cleared all but 1 person out of the room (I think something like 8 people left). I know I can be overwhelming in conversation, and this guy was too, but these are my classmates, fellow medical students. These are the students touted as the cream of the cream of the crop; these are the people who are some of the most highly educated members of our society, these are the people who are supposed to change the world. And, yet, these are also the people who are made physically uncomfortable by 10 minutes of a superficially political conversation.

I left that night feeling depressed and frustrated. When did our community get so afraid to express opinions? When did our community get so passive? Of course this is not an affliction suffered by only the medical community; political apathy is one of the most insidious epidemics of our society. Among most communities in the United States, speaking of politics with any conviction is a conversational taboo worse than religious beliefs, earning power, and sex. I spoke with a friend and colleague the other night about this and she noted that labeling yourself political is almost viewed as negative – a black mark against you. It is not surprising that people have become so alienated from politics – corruption, failure, and insulation from the consequences of governmental decisions make anyone frustrated and disillusioned. But why is our accepted, indeed, encouraged, collective response detachment and distance from the political process? Why don’t injustices and suffering galvanize us to question, probe, and fight for change? Without doubt the former is easier. Some argue more that apathy is more consistent with human nature, but this theory is weak against the reality that in general, people in other countries are politically engaged. In most communities around the world, to be apolitical is abnormal; that is the socially awkward stance.

So then why, why does the most powerful, richest country in the world have the most apolitical people? Or maybe those two statements answer each other. We are apolitical because we have little to worry about (being buoyed by the illusion of power, safety, and wealth). And we are the most powerful, richest country in the world because we are the most apolitical people. And then we must ponder how? What part of our system, what shaping forces in our country’s history brought us to this point?
**
I have had several conversations recently centered on politics, medicine, and the safety net. There is no lack among future physicians of good intentions. There are only a small number of my classmates who are NOT interested in working with underserved populations in some capacity when they are practicing physicians. And we all spend much of our time volunteering in local food banks, tutoring centers, free clinics, and at homeless shelters. And most of us, myself included, do it out of a genuine desire to help, a sense of responsibility to give back. Whether altruistic or not, these are generally understood as noble motivations.

So we all want to help, which is wonderful. The gap of awareness that is disconcerting is the emphasis on charity work as an alternative to (or separate from) work towards change (which, for linguistic ease, I will call politics). There are many who believe that charity work without political work is one of the primary things that sustains and perpetuates our current societal

system. Indeed, it is possible that charity in isolation actually harms the underserved since it insulates people from the outrageous injustices being forced upon them: charity work prevents things from getting totally unbearable and it makes those inclined to help feel as though they are doing their part – thus perhaps Marx was wrong – it is charity work that is the most dangerous opiate.

I am not arguing that politics is more important than ground level work. Paul Farmer has shown again and again the importance of providing underserved individuals with basic necessities. My point is that charity and politics are intimate bedfellows – isolated, they can cause great harm to the people they are trying to help.

I first started expressing interest in medical school at a time when I was frustrated by politics. I was burnt out on activism and exhausted by dogma and political absolutism. I was having a difficult time seeing truth in anything and I felt wrong putting so much energy towards controversial, ambiguous issues. I didn’t feel right pushing my agendas on others. Politics felt dirty, unfair, and unproductive. Wasn’t it all about community anyways? Wasn’t it all about changing yourself, your relationships, and your own personal environment? I wanted to live in a Gandhian way –be the change you want to see in the world. So I started seriously looking towards medicine. At the time, I saw it as a neutral way to help people and give back to my community.

I am older now, and my understandings of politics and life have changed, as understandings and beliefs tend to do. A few years have taught me that things are oh so much more muddled than I thought they were. I now understand politics to be inseparable from life. I read Gandhi’s statement not just as a suggestion to live the way that you preach, but also as recognition of the consequences our actions and our inactions have on the world around us. It is an acknowledgement of our inherent political self – just by being we make a statement, whether we want to or not. This is unendingly powerful, and frighteningly dangerous.

So I have learned that I cannot be neutral. There is no such thing as a neutral participant in society. There is apathy, there is silence, and there is inaction, all with consequences often as forceful as the consequences wrought by passion, speaking up, and action. Not advocating for change is a statement in and of itself. So perhaps that is the gap in understanding among us medical students. We have power. . .because of our personhood, because of our citizenship, and, now, because of our impending physicianhood. Just because we don't actively use our power towards something doesn't mean that the power dissipates. It stays, and with silence and inaction, we invite others to use this power to fit their agenda.