At the close of 2020, I was struck by two instances of doctors speaking their minds and facing the consequences for it. As both took me greatly by surprise I thought writing through it would help me organize and process my thoughts.
The first instance I wanted to think back on was the issuing of a transphobic statement by one of the hosts of the Accad and Koka Report podcast ultimately costing him his Twitter account. When I first encountered this podcast I thought I had found an intelligent and well-researched window into perspectives on medicine I had never before considered. Nothing in my prior experience raised questions about the NRMP’s motivations for developing the current testing paradigm or whether such frequent maintenance of certification testing is truly justifiable. The hosts themselves seemed like the same type of polished and educated professionals that I interacted with on a daily basis during clinical work. Given that both my family and I lean more to the left I viewed the podcast as a means of achieving a broader understanding of the profession I would soon be entering. Outside of medicine, I found myself fascinated by the creators’ reflections on the merits of school lotteries simply because it was the first time I saw academically inclined children of immigrants like me placed at the center of the discussion. Given my background in medical history, I have devoted a great deal of thought into how, and if, we can justify the achievements of historical physicians in the context of their overall lives and sociopolitical actions. However, I never expected to apply this towards someone whose work I had come to respect, if not agree with, in the current era. Making this still more difficult growing up with a fellowship director as a parent, being active in my own school’s admission process, now applying for residency myself, and most of all having respect and close friendships across the spectrum of sexual identity, no justification for his sentiments can be made in my eyes. While the statement itself is beyond my understanding the seeds, which in this case sprouted to a unique and tragically robust degree, are not. Having seen the frustration of my more conservative friends and a professor with whom I am close as a result of the pervasive and assumed leftward bend of those within the medical school, I can see how in the case of someone who feels particularly alienated by the system they can fester over decades into broad-ranging vitriol.
The other incident and one that shook me enough as a future doctor to finally put finger to keyboard was the firing of Dr. James Phillips of Walter Reed. While details are still coming out at the time of this writing I never anticipated that a doctor protected by first amendment rights would find himself suddenly taken off the shift schedule simply for issuing a statement in line with his training and knowledge. In my limited practice up to this point, I have had to deal with VIP patients, some of whom were far from happy with the messages I conveyed on the part of a team. What gave me the confidence as a medical student to face these influential individuals was an infallible belief that so long as I spoke the truth and had the backing of my colleagues I was secure from any serious reprisal. Dr. Phillips’ case forces me to question whether any such security exists. Related to this is a natural concern about a worsening of the already well-documented paradigm of VIP treatment of patient’s leading to an inferior quality of care. Now that deference for status may additionally be tinged with fear of reprisal I certainly see no reason care of elite patients would improve.
When I first entered medicine I naively believed that it was a realm where data governed and open discourse was admired. As I advanced in my training, and particularly endured the year 2020, I have been disillusioned of this perception. Doctors interact more in public through the expansion of social media and societal pressures pervade deeper into all aspects of life as a consequence of increased polarization. Medicine is reaping the ill effects, whether in the form of forced silence of minority views until something genuinely unacceptable manifests in the mind, and subsequently in the public view, or with an increased climate of fear for those healthcare providers simply speaking their minds in light of their experience.