The following day, a forensic pathologist in California, Dr. Judy Melinek, saw this on the way to conducting yet another autopsy on a gunshot victim. “This isn’t my lane. Its my fucking highway.” she wrote.
— Vox (@voxdotcom) November 12, 2018
While the gun troubles plaguing America may seem a world away in Australia, where, as a surgeon, I have treated exponentially more injuries related to avocados than I have gunshot wounds* this raises genuine questions around whether or not doctors have a mandate to comment on broader policies which affect health, who in our profession has a mandate to do so, why, when and in what circumstance.
While power as it relates to medicine has historically been extensively discussed, this has largely been around the power imbalances in medical hierarchies, and between doctors and patients. These conversations have been and continue to be critical, as abuse of power causes harm to those we work with and those we treat.
But, after Foucault, we must recognise that power is not just a negative thing, used for coercion or repression, but can be productive. And power is not just concentrated in the hands of a few that proclaim to have it, but is diffuse and everywhere. The time has come for doctors to recognise both the systems of constraint that traditional hierarchies have put around us to try and deprive us of this productive power, but also to break them down so that we can create meaningful change in the face of health crises.
Power and truth are irrevocably intertwined. As scientists first, we strive for truths in the work we do, whilst knowing that ‘truth’ can be obscured by who has scientific funding to investigate their truth, or the statistical nous to create it. We know also that breakthroughs create leaders in a field. Thus, even in the comfort of our labs, truth is informed by power, and power by truth.
When it comes to broader social goals, this interplay becomes more complicated, as truths become more variable and power becomes more diffuse. At one end we have politicians like Donald Trump who, reminiscent of medieval monarchs, are so confident of their power that they can ignore truth altogether. And at the other end is an individual emergency physician resuscitating someone who is actively dying, or an individual surgeon desperately trying to stem the flow of blood onto the floor, or an individual pathologist retrieving a bullet from a corpse. There is an absoluteness of truth when it comes to death.
In these moments, faced with genuine health crises, we cannot wait for power to acknowledge truth. We must turn truth into power.
As doctors, we are naturally divided. We labour in clinics and hospitals, separated from each other. We have handed over our powers of advocacy to experts and peak medical bodies, whether they be Colleges, medical associations, surgeon generals or others. In addition to this are societal overlays about how doctors are meant to behave. We are meant to focus on individual patients and, at a push the health systems we have direct influence over – our own hospitals and our own clinics.
We discipline ourselves. We do not speak on issues over which we do not have absolute expertise. We avoid political engagement and conflict. We know our place.
A few will seek positions of representation, whether in medico-political or professional associations, but these individuals carry a responsibility to be truly representative which may at times place their public policy at odds with person conviction. By and large though, we all save lives and make meaningful difference to the patients we see and this is seen as enough.
But increasingly, many of us worry about the big picture. We worry both about our patients, but also about ourselves, our own children and families, our own friends, and how broader healthcare policy might affect those close to us. Because we are both clinicians with a duty and responsibility to advocate for patients; but we are also patients and humans ourselves. And so, when our peak bodies are ignored by those who occupy positions of power, we can and must collectivise and turn the medical truths we know into power ourselves.
The American College of Physicians published a position paper on October 30 in the Annals of Internal Medicine titled Reducing Firearm Injuries and Deaths in the United States. It was in response to this article that the NRA explicitly asked the medical profession in the United States to please discipline themselves and stop commenting on this issue; they sought to overpower the knowledge and associated truth held by doctors about firearms related injury by suggesting that doctors did not have expertise or mandate to comment on that issue.
Instead of retreating, thousands of doctors across America have responded with calm fury, using the hashtags #ThisIsMyLane and #ThisIsOurLane to detail, sometimes with graphic imagery, the individual cases they are forced to confront on a daily basis. And tens of thousands of doctors have signed an open letter to the NRA, co-authored by Dr Megan Ranney, Dr Heather Sher and Dr Dara Kass.
Similarly, in Australia the Australian Medical Association President wrote to our Prime Minister Scott Morrison in September, calling for the evacuation of critically unwell refugee and asylum seeker children from Nauru. The government rapidly rejected this letter, and within weeks, six thousand doctors and over a dozen medical colleges and societies had signed an additional letter co-authored by myself and Dr Sara Townend, demanding this of the government. Again this letter was not accepted by the office of the Prime Minister, and so thousands of doctors have contacted their individual members of Parliament and state senators, attended meetings with those individuals and used their knowledge of human health to explain why indefinite detention inevitably causes health crises.
We cannot let power disseminate false knowledge. Just as we in Australia cannot allow a mere politician to allege that critically ill children are not unwell, or dictate the discourse around the health impacts of indefinite detention, our colleagues on the other side of the world cannot allow a lobby group to dictate the discourse around health impacts of guns.
We cannot allow ourselves to be falsely disciplined by those within established power structures for not playing to their rules. Because, ultimately, simple truths about the things that harm health need to be spoken and made clear. The solutions to complex social problems such as migration and gun control may likewise be complex and imperfect, but the truths at the heart of them come from the medical profession, because it is the doctors and nurses and allied health professionals who face the carnage of broken lives as a consequence of bad policy, on the front line, every day.
Whatever the broader solutions are to these complex issues where health and politics meet head on we cannot let the health truths be subsumed by political power. Our patients, our colleagues and indeed our own hearts deserve much more than that. This is our lane. This is our highway. And we will not give way.
Read more from Neela here.
* While smashed avocado on toast is a staple of Australian culture, this hand surgeon would beseech the Australian public to refrain from attacking the large and slippery seed with a knife while holding the avocado half in your palm. The knife can slip off and cause significant tendon, nerve and artery damage. Please remove seeds with a spoon or a special instrument that is widely available for purchase. If you must attack the seed with a knife, place the avocado on a chopping board and keeps hands clear.