“I Know My Voice is Important:” Advocating for Patients & Public Health Policy

uvmmedicine blogger Allicia Imada '18
uvmmedicine blogger Allicia Imada ’18

If you asked me a year ago if I would ever advocate for any kind of public policy, especially on a national level, I probably would have laughed and said definitely not. I’m an introvert, and I don’t really like public speaking or politics in general. But after joining the American Medical Association Student Interest Group because I was drawn to the community service aspect of the organization, I found myself becoming more interested in policy issues as well. Little did I know that I would help author and push through one of the more controversial resolutions at the national medical student section interim meeting in Atlanta this fall.

Hearing Senator Christopher Ottiano of Rhode Island speak about why we as future physicians need to advocate for ourselves so that we can best advocate for our patients was a turning point for me in my journey to embracing policy work. Ottiano, a physician, described how their governor signed a bill removing the supervision requirement for Certified Registered Nurse Anesthetists, to the dismay of anesthesiologists who didn’t get involved until it was too late. For the first time it started to make sense for me. My dad is an editor for a newspaper, and my eyes used to glaze over when he watched political news. I didn’t think it applied to me, since I have never been interested in a political career. However, as a physician it will be my responsibility to advocate for my patients, so I want policy governing what I can and cannot do to be in their best interests. Who better to contribute to those conversations than medical professionals?

My first foray into being involved on a national level was as a member of the Minority Issues Committee. Our section at University of Vermont College of Medicine authored a resolution asking the AMA to support justice reinvestment initiatives, which we are excited to say passed without trouble! We worked with Thomas Simpatico, M.D., who plays a large role in our state’s Jail Diversion Recovery Program. I also happened to give feedback through my committee on a resolution supporting autonomy for patients with difference of sex development. After helping them tweak a few things, they asked me to be an author on it before it was submitted. Next up was presenting it to the section for adoption.

Heading into the meeting I didn’t think that it was going to be difficult to get our medical student section to support our resolution: We asked the AMA to affirm that medically unnecessary surgeries in individuals born with differences of sex development are unethical and should be avoided until the patient can actively participate in decision making. The United Nations in 2013 stated that medically unnecessary surgeries on these infants are “human rights violations.” We had support from many experts, including the Gay and Lesbian Medical Association, all of whom stated how damaging these surgeries can be. I brought the resolution to our region – which includes the New England states and New York, but many schools wouldn’t support us. They thought that specialty societies should weigh in on a case by case basis, even though we had support from many of these societies. They thought the term “medically unnecessary” was too controversial, even though the term is used by medical professionals and the United Nations. Overall, it seemed like many of the big powerhouse schools in New England didn’t want to have a hand in such a controversial resolution, even though they acknowledged that they liked the “spirit.” We lost the region vote.

Surprisingly, after the region meeting ended many students came up to me individually saying that they supported the resolution, but couldn’t get their school’s majority to agree. They made suggestions about how to proceed in the general assembly, and some of them volunteered to testify in support. It made me feel empowered, like I was trying to do something meaningful and important. I met with the other authors and we came up with a strategy for the general assembly, which we had postponed until the following day.

We weren’t sure what to expect during the general assembly, but we were ready. After many other resolutions, ours finally came up. I had typed up testimony, but found that I didn’t even need to use it. California’s region flooded the microphones, and there were many statements of support from friendly regions and schools. After many of these supportive statements and only one negative statement, we decided to call to question and vote since the keynote speech was next on the agenda. It was a little risky, since many more people were lined up at the microphones to speak, but with most of the testimony for us it ended up being the right choice. Our resolution passed the way we wanted. It was all so exciting, and I welcomed the rush of adrenaline that I finally acknowledged when the keynote speaker came on.

Since I’m a second year medical student heading into clerkships, I’m not sure if I will be able to attend another AMA meeting, but the experience I had with the organization has helped me appreciate how I can make a difference. As physicians, we have the great privilege to hold others health and lives in our hands. With this comes the responsibility to advocate for our patients, even on a national level. I am not going to be a politician, but I know that my voice is important.

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