Why do doctors fear to speak out?

for the last couple of years, i've been part of a group of advocates and activists who are working on reducing the access barriers to health care for uninsured and undocumented immigrants in albuquerque, nm. i had to step out of my department and out of my hospital to find allies willing to speak up about the horrible abuses of power that we all knew were happening in the hospital at the highest levels. the proponents of primary care had been silenced years before by threats to their funding streams and the specialists had been bought off with a shift in the mission of the public hospital to benefit their departments with more money and more prestige. noone wanted to speak out, except the labor union who was already marginalized and ignored.

it wasn't a lack of good doctors and nurses. plenty of them, compassionate and dedicated, willing to advocate and stand up for individual patients, willing to fight for access, to lie and steal and cheat to get their patients care. i saw it all done, and did it all. i ripped up ER charts and threw them in the garbage after seeing uninsured people who couldn't pay and landed in the ER for minor things because there was no urgent care available anywhere in the city. no way i was sending them a bill for $400 or $1000 for an ear ache or a cough or an early miscarriage. no fucking way.

but why then was I reticent and outright scared to speak to elected officials or the media about the systemic problems and abuse that we all knew were there? after a few years of "silent" protest, i finally found my voice when I marched with 30 patients and advocates (no other docs/nurses) on the ER to confront the CEO on the 10 worst problems at our public hospital. that day i felt my fear of speaking out full force. i was shaking and scared and ready to disappear, to give up. what got me thru the experience was standing next to young immigrant mothers and old ladies and fiery advocates whom i'd worked with for years already. i wouldn't have been able to do it alone. it was the potent memory of my patients who had survived sexual violence and physical violence and were still standing and struggling to create beauty in the world. i limped along on my fear with crutches of courage lended to me by these amazing people.

so now after two more years of "finding my voice" and organizing for social justice, launching editorials and public officials at the hospital (metaphorically speaking), we've reached a point in our efforts where other nurses and doctors are finding their own courage on their own paths and our path's are combining. i write this post to share a profound sense of hope because this is the first time in my life that i'm speaking out with other doctors and nurses, all of us prepared to lose our jobs, to be ridiculed and attacked, to speak the truth of abuse of power within our own hospital that is profoundly affecting our patients' care and our own well-being.

for those familiar with the culture of medicine, another level of hope is that the folks prepared to speak include an ER doctor, an FP doctor, a MICU nurse, an ICU nurse manager, and an outpatient NP. that's a rare alliance in and of itself. and we're just the tip of the iceberg. as people see us standing up and facing our fears, their fears are put into perspective and their integrity becomes activated and accessible to the political process. fear is so strong and so weak.

so we're meeting with four elected officials in two weeks. one small step against fear and one huge step for doctor-kind.

aziwa