1st December 2017, Volume 130 Number 1466

Philip Bagshaw, Pauline Barnett

What is physician advocacy? Physician advocacy (PA) occurs when doctors speak up for the health and healthcare of patients and communities.1 There is an extensive scientific literature on PA, originating…

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Summary

Some doctors believe it is a professional responsibility to speak out publicly in defence of the health of patients and communities. Others think they should only give their views privately when asked by health authorities. With many healthcare systems in Western countries under increasing stress, with underfunding and growing unmet need for care, it is important that these divergent views on such professional responsibilities are quickly resolved. In the UK, where the National Health Service is in serious trouble, medical representative organisations are increasingly speaking openly about the problems. Will such organisations in other Western countries do the same, as-and-when their healthcare systems are similarly threatened?

Abstract

Physician advocacy occurs when doctors speak up for the health and healthcare of patients and communities. Historically, this was strong in some Western countries with doctors finding that it enhanced their authority, prestige and power. But it weakened in the 20th century when the biomedical model of heath triumphed and medicine became a dominant profession. In the second part of the 20th century, this dominance was threatened by political, technological and socioeconomic forces. These weakened medicine's state support, brought it under managerial control and undermined the social contract on which trust between doctors and the community was based. Defence of the profession was assumed by medical colleges, societies and associations. They had some success in retaining professional autonomy but did not undertake open advocacy, particularly on social justice issues, and did not therefore enhance their standing in the community. Opinion is divided on the level of advocacy that it is ethically proper for the medical profession to employ. Some contend doctors should only advise authorities when expert opinion is requested. Others contend doctors should speak out proactively on all health issues, and that collective action of this type is a hallmark of professionalism. This lack of consensus needs to be debated. Recent developments such as clinical leadership have not revitalised physician advocacy. However, continued deterioration of the UK National Health Service has led some English medical colleges to take up open advocacy in its defence. It is to be seen whether medical colleges elsewhere follow suit, as and when their healthcare systems are similarly threatened.

Author Information

Philip Bagshaw, Clinical Associate Professor, University of Otago, Christchurch;
Pauline Barnett, Health Sciences Centre, University of Canterbury, Christchurch.

Correspondence

Philip Bagshaw, Canterbury Charity Hospital Trust, PO Box 20409, 349–353 Harewood Road, Bishopdale, Christchurch 8054.

Correspondence Email

philipfbagshaw@gmail.com

Competing Interests

Nil.

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