Wednesday, November 9, 2016

Privilege and purpose

"Start where you are. Use what you have. Do what you can."--Arthur Ashe

When I started this blog, some years back, I did so out of a desire to have a voice, to be an advocate for change I thought would make a difference. In the last few years, as my work roles shifted and my obligations stretched into evenings and weekends, I lost the rhythm of blogging. And, if I am honest, I lost the urgency and drive, and my focus.

In 2009, the Affordable Care Act (ACA) was an idea, which became a proposal, which eventually became a law. A law that increased access to health insurance for millions of Americans and especially in communities of color and drastically reduced the numbers of children without insurance. It survived reviews by the Supreme Court, and dozens of votes for its repeal. Under its coverage, insurance companies extended coverage to adult children on their parents' plans, ended the practice of denying health insurance to those Americans with preexisting conditions, and ensured that health insurance companies would spend money on providing health insurance coverage, not just on their own profits. Americans were seeing real benefits from the law, and while not perfect, it was doing its job.

With the urgency to push for healthcare reform and accessible coverage for all, my attention wandered to other issues, which I feel are also terribly important: ensuring medical practice is free of industry influence, that we practice good stewardship and avoid over-treatment, that we speak out against the influence of politics on the doctor/patient relationship, and that we address gun violence as the public health issue that it is.

I also found my role moving away from the clinic. I became medical director of a program focused on training medical students with a commitment to provide care in medically underserved communities after they completed their training. I became the director of a course focused on teaching students about the interactions of patients, physicians and society at large. And I valued these roles, and learned new skills, and moved away from the clinic: down to just two sessions a week.

I found myself waking up today asking if all these changes had been worth it.

In the past few years in Richmond, I have tried to become more aware of my own privilege, and the struggles and obstacles faced by others. I am a white, cis-gendered, heterosexual, married, US-born male physician. I am the very picture of "privilege". I have not faced discrimination, and I carry with me opportunities and status that I have not earned, that I assumed as a part of the culture in which we live. I have tried to recognize this, and  have tried to learn about and be a partner to those who do not have this privilege.

And this is why I woke up today reassessing so many things. Has the clinical work I have done made a difference in the community? Are two sessions a week in clinic enough to be a resource to my patients and to my community? Has my focus on teaching and my non-clinical work taken me away from the people I aim to help?

The results of this election have served to reinforce my privilege. The President-Elect and his supporters have attacked people of color, women, immigrants, Muslims, and members of the LGTBQ community. They oppose a women's right to free reproductive choice. They have control of the Congress and may appoint a number of Supreme Court justices over the course of their term.

They will undo eight years of progress, all in the interest of protecting white privilege, and white male privilege to be precise.

So: as I gather my thoughts and figure out a way forward, I will try and use this space for the purpose for which it was created: to raise my voice outside of my office and the classroom, and to join the voices of so many others rising tonight in pain, and fear, and anger at the harm which is coming. This is not my fight: the privilege I have protects me. The least I can do, then, is to accompany, support, and stand alongside those for whom this fight is personal and high stakes. I can work to understand their worries and learn about their hopes and how we can make our society more just and inclusive, and I can try to be an ally. And I can prepare myself for the work ahead.

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