This may sound strange coming from me given my academic history and some of my writing on this site but I have increasingly come to feel that a separation of medical school curricula proper from the role of the physician as an advocate is necessary. By this, I do not mean that medical students should not advocate for those causes they believe in, but simply that our educational institutions should not impose upon students in this regard. What motivated me to address this now were statements by Perelman’s Dr. Stanley Goldfarb and the response to them by his colleague Jason Ji Seung Han, MD.
Like Dr. Goldfarb, I believe there is simply so much of medicine proper to learn that to devote time to having students learn how to address the societal burdens of our patients while building our foundations as practitioners lead to reduced effectiveness at doing both. To operate optimally in whatever role, we assume it is important to build comfort before adding additional moving parts. The other concern is to judge from my school at least the powers that be seem to have well-established views of the right way and direction in which to approach various issues. As much as things are changing, medicine is still a fairly hierarchical system particularly early in our training, so formally being presented such viewpoints can be tantamount to silencing those who do not share them. The heart of advocacy is a commitment to the cause and this can’t really emerge from external imposition.
As Dr. Han addresses in his rebuttal to Dr. Goldfarb, medicine is increasingly public and answers to many problems within the field increasingly appear to be found in the broader society. Where I disagree with him is that while he feels this means, we need greater encouragement of medical student engagement in social action I hold that it makes having a protected time to learn and develop all the more important.