Introduction

“As Fellows of the American College of Surgeons, we treasure the trust that our patients have placed in us because trust is integral to the practice of surgery. During the continuum or pre-, intra-, and postoperative care, we accept the following responsibilities: Serve as effective advocates of our patients’ needs …

Our profession also is accountable to our communities and to society. In return for their trust, as Fellows of the American College of Surgeons, we accept the following responsibilities:

… Advocate for strategies to improve individual and public health through communication with government, health care organizations, and industry. Work with society to establish just, effective and efficient distribution of health care resources … “

The American College of Surgeons Code of Professional Conduct, June 2003

“A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.”

American Medical Association Code of Medical Ethics

Individual physicians must decide whether, how and how much to advocate for their patients. Is it a professional obligation or responsibility? Additionally, they must decide whether and how to get involved in societal issues that affect the health of people in general. In making these decisions and considering advocacy, it is useful to break advocacy into two components: agency and activism [1].

Agency is the activity of advancing the health and well being of individual patients. Agency means speaking out on your patient’s behalf. This individual advocacy work is the component in which every pediatric surgeon and physician is already engaged. Agency may involve calling the insurance company, school, another provider or a social service agency on behalf of your patient. When individual advocacy, or agency, translates to the community, state and federal level, this becomes activism. Activism involves advancing the health of communities and populations. Activism is the focus of the resources in this topic.

The obligation for pediatric surgeons to participate as advocates for their patients is fulfilled in many valuable ways. Pediatric surgeons are active agents for their patients every day. Advocacy through activism may be less common, in part, due to a lack of knowledge and training. While the political views of surgeons are as varied as those of the citizenry of the United States, a common interest in the welfare of children is a cornerstone of our profession. These children have few powerful advocates. The public perception of our health care system is often uninformed and the financial interests in this system, that collectively makes up almost 20% of our gross domestic product, drives many policy decisions. Surgeons have busy lives with multiple important demands on their time. Who then will influence public policy as it relates to the surgical health of children? The answer, perhaps, may be you - who chooses to invest your time in reading this section of the Pediatric Surgery Not a Textbook.

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it is the only thing that ever has.”

Margaret Mead

Gerald Schiebler, MD, believed this and lived it. He was a consummate advocate for children who changed insurance law, helped develop the Children’s Health Insurance Program (CHIP) and mentored a generation of child health advocates. While finding a mentor as good as Dr. Schiebler may not be easy, by participating in advocacy for your personal priorities you will quickly be exposed to mentors and begin the process of finding out how interesting you find this work. Starting within a local community allows this interest to develop and you will learn how to be effective. Those who take this step will have lots of opportunities at a state and national level.

Jump straight to Getting Involved in Advocacy and Policy