Clinician Advocacy at the Bedside: A Pro-Con Debate

Abstract: In an increasingly polarized society, where some individual and public health issues have become politicized, clinicians commonly advocate for public and societal issues that can impact health outcomes. The United States Healthy People 2030 initiative describes social influencers of health including economic stability, access to and quality of education and healthcare, and neighborhood contextual and social issues. Clinician advocacy outside the clinical setting includes providing expertise on issues like access to reproductive health, school vaccination requirements, efforts to curb gun violence, and impacts of racism or environmental matters.

While most consider advocacy by clinicians outside the clinical setting appropriate, less consensus exists regarding the appropriateness of advocacy by clinicians within the clinical encounter. Such advocacy may be implicit, for example wearing of stickers or pins on badges or clothing, or explicit, through direct conversation with patients. Some argue that such advocacy related to societal matters within a clinical encounter is appropriate as it addresses issues that could positively impact patient health. Others argue that such advocacy is inappropriate because it can negatively impact patient care by creating an environment of discomfort and mistrust for some families, particularly when clinicians and patients have divergent views. We will debate whether advocacy for public health and societal issues thought to impact health outcomes should extend to clinic encounters. Specifically, we will ask “Does “bedside” advocacy by clinicians, through wearing of stickers or pins with messages pertaining to societal and/or public health issues, violate professional boundaries in clinicians’ relationships with patients and families?”

Keywords: Advocacy, Boundary Issues, Medical Home