Panda commits an error probably all too common for ER physicians: patients are how they are because they are who they are, and their situation and environment has but a small impact. Fundamental attribution error well at work.

Mr. P. Bear believes that doctors are helpless to help their patients and improve their health outside of the hospital or office–and even argues that advocacy work somehow “dilute[s] the only real authority they [doctors] have, the authority to make medical decisions on behalf of the small subset of the population who are their actual patients.” (I swear, Panda and I are opposite ends of a magnet.) To say that physicians are powerless to improve people’s lives is laughable, ridiculous, and more an effort to ignore our responsibility to do so than anything. Distributive justice is one of the four pillars of medical ethics, and I don’t know how Panda can so quickly write it off. I don’t care how hard we work, we are our patients’ advocates, and we should be demanding that they receive not only the best care possible but that they should have healthy environments outside of the realm of doctor’s office or hospital.

Panda Bear says “We have no special powers of persuasion denied to the general population… we are not magicians.” I beg to differ. The Cochrane Database reports that even “brief advice” from a physician increases the likelihood that a smoker will quit smoking, leading to a absolute reduction of smokers by 2.5%. If you consider all the cost and suffering continued smoking will cause, that’s not bad for “brief advice.” We are seen as knowers of the body and authorities of health. When doctors talk, patients do listen. It’s like when my dental hygenist puts the fear of god into me for not flossing enough and threatening me with a deep cleaning: she knows about oral health. I listen and try to change my behavior. (Flossing daily now, thank you very much.)

Doctors’ beliefs and advocacy does not fall on deaf ears. When doctors speak, people are happy and eager to listen. Often it is the opposite–they know that doctors’ time is valuable and rare, so any issue that physicians choose to spend their time on is even that more important. One of the great memories that has driven me through med school is a meeting with pediatricians, Chicago aldermen, and researchers at Children’s Memorial Hospital in Chicago . The pediatricians were upset that lead levels in many communities were on the rise, and wanted to bring the issue to the attention of the aldermen. They knew that no, they couldn’t go into their patients’ houses and make sure that they were eating healthy, balanced meals, but they also realized that their patients were being affected by an environmental hazard that lowered their IQs and made them chronically ill. So they decided to do something about it.

Who are people going to listen to on health matters? A physician, or an individual parent or patient? If you say anything but the former, you’re kidding yourself. We have so much power and influence when compared to most of our patients that to not speak for them is an injustice and an abdication of our responsibility as physicians.

Can we fix everything about our patients’ lives? Of course not. But are there areas where we as physicians can truly make a difference? Absolutely. Just because we can’t do everything doesn’t mean we shouldn’t do something.

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