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Patient Advocacy in Trump’s America


emily fu

It’s been a hard week. Hard, of course, because this election has caused an unprecedented wave of fear across our nation. Hard because those whose lives have been invalidated by our newest president elect are already exhausted by the daily struggle of living in a hostile country. And — not to be discounted — hard because bad days in medical school hunt in packs and pounce all at once.

I am, as always, in awe of my classmates’ grace and resilience. Some are calling for organization and action. Others need time to mourn — either because the election has confirmed their suspicions about this country, or because it has shattered their faith in it. Both responses are important and impressivegiven that we are organizing and mourning while fulfilling our responsibilities as students.

It seems absurd to put aside the world for hours and memorize facts. The afternoon after Election Day, I left my bed only to attend a mandatory ultrasound class. While trying to identify the thyroid, I felt an acute sense of disorientation. It was as if that darkened room was an alternate universe in which all that mattered was my ability to distinguish between shades of gray. I wished everyone who was afraid for their future could be in that warm and orderly place. Or, no — I wished myself out in the world with my loved ones. I wished I were reading editorials, crying, yelling at senators and checking in on friends.

Now, more than ever, I am struggling to focus on school, though I’m lucky that Trump’s promised policy changes and his supporters’ bigotry don’t immediately threaten me. As a cis-gendered, straight upper middle-class Asian-American woman with no experience of disability or sexual assault, I feel no less physically, emotionally or financially safe than I did a week ago. While I have always felt afraid in certain spaces and while I have always been subject to certain slurs, my body is not subject to the same violence as the bodies of black or brown, undocumented or non-gender conforming folks. My well-being is not as unstable as the well-being of those who rely on government programs for food, housing or health care.

I am afraid not for myself, but for my friends, acquaintances and future patients. When I become a physician, I want to provide abortions or refer my patients to abortion providers. I want to put to use everything I’ve learned in workshops on LGBTQA+ care. I want to work towards subverting beliefs that racial disparities in health are based on biological differences and that non-white, non-male doctors are anomalous or incompetent. And I am afraid this work will be harder than ever for two reasons.

First, Donald Trump’s America will prevent members of marginalized communities from entering care centers — through violence, intimidation, or poor insurance coverage. Second, if these people become my patients they will be so hurt and weary, and I will be so limited by a flawed system, that my ability to help them will be minimal. These fears are borne of my belief that being a doctor will not be enough in a society that has always been a white supremacy, and now is even more so as evidenced by this election’s exit polls.

In order to help work against systemic injustice, I wonder if one has to be both doctor ­and­ policymaker, doctor and lobbyist, doctor ­and writer, doctor and researcher, or doctor and educator. All these addends fall under the vague umbrella of doctor and advocate, a dual identity to which I aspire. I think, though, that it’s possible to be a doctor-advocate just within the context of the clinic. There’s a way to practice allyship through the provision of thoughtful care, and central to this practice is a willingness to bear witness.

As doctors, we will be asked to validate our patients’ pain and qualify their disabilities, to lend our authority to reports of abuse, assault and mental illness. We will be expected to know more about our patients’ suffering than they themselves do; our narratives will be believed over the narratives of those who have experienced trauma firsthand. In light of this, we will have the awful responsibility of bearing witness to the violence that has inflicted and will continue to inflict people of color, LGBTQA+ folks, Muslims, immigrants, survivors of sexual assault and people with disabilities.

Donald Trump aside, this violence has always been a reality and the medical establishment has always been complicit. Sometimes, provider participation in social injustice is active; doctors have assaulted their patients or refused to engage with queer or black patients. But, I believe that most physicians are not evil or even ill-intentioned. Rather, most physicians perpetuate harm by assuming that their medical authority allows them to overrule a patient’s truth. These physicians hurt patients by making assumptions about their patient’s sex or sexuality, underestimating their patient’s pain based on race or gender, dismissing their patient’s struggles with mental illness, or questioning their patients experiences of disability or assault.

Failure to see the truth in patients’ narratives is common. We all know doctors who label their upset patients as “crazy” or “dramatic,” doctors who assume certain demographics of people are med-seeking or doctors who refuse to recognize abuse without physical evidence. We all know doctors who amend patients’ stories to fit their preconceived notions of suffering. Moreover, we have all done so ourselves because this is a core principle of our training: the translation of a patient’s “subjective” symptoms into our “objective” truth.

Sometimes this is an understandable strategy for providing care; after all, we have experience with medicine that our patients do not. However, given the exclusive nature of higher education, our patients will have experiences with bigotry and poverty that many providers never will. We cannot ignore these experiences on the basis of our medical authority — especially when Donald Trump’s victory has made it clear that these experiences don’t matter to 47 percent of voters.

Even before we do the work of debating and protesting, we as caregivers can practice anti-oppression by bearing witness to our patients’ experiences in the midst of a society that fails to do so. As future physicians, we must not do the same lest we become complicit in the inhumane system that Trump’s bigotry has so recently highlighted. This means taking cues from our patients instead of assuming that they’re subject to our authority. It means never dismissing a patient as an unreliable historian. It means using our social currency as physicians to affirm rather than silence marginalized voices.

The first step in this process is educating ourselves so our patients won’t have to. Among other things, physicians must learn why respectability politics might lead us to believe one patient and not anotherwhy undocumented people might avoid seeking health care, and how to provide trauma-informed care for sexual assault survivors. We must follow, of our own accord, a curriculum more humanistic than that of cells and molecules. We must come to understand discrimination as a risk factor and a dangerous personal tendency.

We will continue to see the ills of modern-day America inflicted upon our patients long after the shock of this election has passed. Our work must also be ongoing; after all, allyship is a practicenot an identity. Years from now, we who have promised to fight against Trump must continue to ensure that our clinics are safe havens from the bigotry for which he stands.

Emily Fu Emily Fu (2 Posts)

Writer-in-Training

Warren Alpert Medical School


Emily is a medical student, crossword fiend, and backpacker. She likes reading poetry, cleaning her bicycle, and talking about medical education. Email her! She'd love to chat.