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.

Taking stock: where does the time go?

Looking at the blog, it is hard to believe that it has been nearly one and one-half years since I updated or posted anything here. Frankly, even as I write this, I am not even sure what will follow this post: blogging does not come easily for me, and other time commitments do not easily allow me to focus on the blog.

It is also interesting to think about where we are since the blog started. When I first started blogging regularly, I was working as a full-time clinician at a safety net clinic here in Richmond, Virginia. I was pushing for healthcare reform, and advocating for the legislation that eventually became the ACA. I was also a board member of the Virginia Academy of Family Physicians and had learned about the National Physicians Alliance.

From 2009 to 2014, we saw the ACA become law and now survive two Supreme Court challenges while its reforms became increasingly ingrained in Americans' daily life. We have experienced a paradigm shift in that the presumption is now that all Americans will have access to health insurance, and through health insurance access to health care. Though it is clear that there is still work to be done--and perhaps more significant reforms to come--the truth is that most Americans will no longer be excluded from the system...at least in states that have chosen to expand Medicaid.

I have seen increasingly frequent discussions on the importance of primary care and family medicine, and have become a more-active member of the Society of Teachers of Family Medicine, including serving on STFM's Communications Committee as we work to train future generations of family physicians and family medicine educators. I have also seen that a flawed approach to paying for medical care and primary care is still in place, despite the evident need for change.

I have joined the leadership of NPA as the Vice-President of Communications, and have worked with the organization's leadership to continue to encourage the implementation of the ACA while increasingly focusing on other areas of importance: bringing attention to the issues around gun violence and promoting a focus on gun violence as a public health issue, addressing the influence of big PhRMA and the medical industry device on medical practice, and encouraging physicians and patients to work together together to make good decisions that benefit patients and that conserve valuable resources and prevent harm and over-treatment.

I have moved into a leadership role teaching medical students both in a specialized honors program for medical students focused on working with medically underserved communities after completing their training, and leading a curriculum focused on the humanistic, ethical and holistic care.

I finally authored an article that was published. The article focuses on the benefit of an interprofessional service learning activity focused on providing care to Richmond's Latino community.

Finally, I became medical director at the office I joined in 2007. I took on this role in December, and have spent the past 8 months working through the challenges that have presented themselves and looking to enhance care for our patients.

So: I am going to try and pick this up again, but I am not sure where it is headed. It will probably still be an advocacy blog--as there is still much work to be done related to the ACA, and I am still committed to the work NPA is doing--but I will admit that my focus is much closer these days. Being in a leadership role in a safety net clinic has provided the opportunity for me to help make our healthcare system more responsive and accessible for everyone, and to provide holistic care for patients who have serious needs. I hope that I will be able to use the blog to describe what we have been doing in the office, what impact it has, and how we are looking to continue enhance and improve our patients' health.

I will try to be less of a stranger heading forward, and appreciate those who might come along.