Warming up my dinner in the microwave, I habitually open the YouTube app to see what's going on in the world. Before the microwave can finish whirring, though, it suddenly occurs to me: do I even like this stuff?
I’m talking, of course, about politics.
I must, right? For a pill I take religiously every day, multiple times a day, which occupies an embarrassingly large chunk of my attention, you'd think it would be something I at least enjoy. The thing is, though, for me, it doesn't feel like a choice. It's not voluntary, nor is it just a hobby or a game. It's an obligation.
I would be lying, of course, if I told you it didn't give me that addictive rush, complete with the Netflix-like drama and cliffhangers that keep a person coming back for more. I fall down social media and news media rabbit holes as I ravenously devour new social, political and economic studies, polling, data, investigative work, news, and even opinion pieces. I get excited about participating, happy when my team is winning and frustrated when they're losing.
However, while it's easy to use trite analogies, the politics of today is anything but a game. Human lives are at stake each and every day. As abstract and unlikely as it sounds, even small acts of activism can help alleviate some of their suffering, bring them justice and make their lives easier. At the same time, our silence can do the opposite.
As future physicians, whose job it will (hopefully) be to care for the sick and vulnerable, and who take an oath to work for the greater societal good, knowing where to throw our political weight and understanding the power structures that operate to affect countless aspects of people's lives is a hefty yet important responsibility to carry.
Yet carry it we must – and while we're at it, help others to carry it as well. To remain disengaged or apathetic plays into the hands of those few in the system who work tirelessly (knowingly or unknowingly) in ways un-aligned with the public interest. If we're not present and ready to throw out the people who either aren’t working for us or simply aren’t the best candidates for the job, it serves as permission for them to keep doing what they're doing. Likewise, if we like the way things are going, we should show and up and make that known, or risk it changing under our noses. Our democracy relies on public accountability: accountability, that is, to you and your patients.
It's not enough to stick our privileged heads in the sand and refuse to engage, or engage with an air of entitled self-interest. Silence and blinders are statements in and of themselves. In a democratic society, these are choices we cannot escape with disengagement.
Nor is it enough to narrow our engagement to that which can be labelled as "healthcare related," like on topics of pharmacare, mental health, and MD remuneration. We may have the most expertise here, and valid opinions on the issues, but it would be short-sighted to stop at this.
Virchow once famously said that “politics is nothing else but medicine on a large scale.” It's true – a persons health is inseparable from the rest of their life. Their wages, working conditions, education, housing, food, stigma, discrimination and more all play roles. Broader issues like wealth inequality and climate change are also linked to health outcomes in countless ways, both subtle and overt, in Canada and around the world. Indeed, sometimes we become so focused on individual impacts on the people in our offices (ex: how disease presentation may be affected by social and environmental determinants) that we lose sight of the patients we may never meet face-to-face (ex: populations displaced by increasingly-harsh weather events or wars, or those prioritizing finding family housing over their health). Much like in clinical decision making, insular mindsets can deter us from taking properly-informed, well-nuanced stances on social issues. And especially as people of privilege, we have the opportunity to sway the people around us. This is key, as the medicine of politics is one that must be administered by a collective – both the choice of treatment and its dosage is controlled by collections of much smaller units.
Furthermore, for a truly holistic view, as citizens of a relatively wealthy, privileged, and influential nation, in order to give the global community we serve our full support, we must fight for the well-being of our patients not only here but beyond our borders, starting by staking clear stances on fundamental human rights. Our scope should include everyone -- from the workers struggling to pay rent in Toronto, to the rural Indigenous family without access to clean water, to the starving child in Yemen who has known nothing but war. We should feel a responsibility towards anyone who's life and health could be affected by our actions, no matter how far down the line.
I know it can be overwhelming to think about. Luckily, not everyone needs to become a politics junkie overnight. Start small. Have informal conversations with knowledgeable people, read and watch the news, maybe even get your friends involved to learn together. I understand that no one can do everything at once. The days are long and exhausting. However, it's worth asking ourselves at the end of the day: are we simply perpetuating what doesn't work, or are we doing our best to take part in changing it?
Making my tiny contribution to greater societal change is what I signed up for as a doctor-to-be. Politics is an inseparable part of that.
So, maybe I do like it. Maybe just a little.