One evening a few years ago, my husband, an oncologist, sat down at the kitchen table and vented his annoyance at a poorly coordinated hospital transfer. I sympathized, then shared my own frustrating tale of a disagreement with a cavalier orthopedist and a questionable operation for a patient with gout. After agreeing that surgeons can be a challenge, he replied with a story about an overbearing wife of a myeloma patient with a swollen metatarsophalangeal joint. As I was about to regale him with my next lament, my 11-year-old looked up from his computer in the next room and casually interjected, “You guys complain a lot.” He put on headphones, literally tuning us out, and wandered off. I looked at my husband. Yes, I thought, we do complain. One could say we were pretty fantastic at it. Most doctors are. But why?
In the day-to-day practice of rheumatology, it sometimes feels like we don’t have a voice. Despite our enormous personal responsibility for our patients’ well-being, we must yield to the demands and rules of various autocracies: insurance companies, pharmacy benefit managers (PBMs) and our healthcare systems. At the same time, one of the hallmarks of our democratic society is citizens having a voice in their government. Caught between our sense of responsibility and our lack of control, we may feel overcome with moral injury as we encounter situations in which we feel forced to act against our beliefs. We grow frustrated and disillusioned. We burn out. Complaining serves as a coping mechanism. Most of us are fluent in this dialect of discontent and enjoy bonding over shared frustrations. The catharsis, however, is fleeting; it is the coming up for air before diving back under. There is a way to complain constructively: advocacy. I believe advocacy is the antidote to moral injury and the key to wellness.
Advocacy is a reminder that there are democratic controls that we can access beyond the autocratic forces that constrain us. When done right, we enact change. In 2020, I joined a non-partisan group (Vot-er.org) that encourages patients to register to vote and to consider voting by mail. I wore a badge with a QR code that patients and staff could scan to register. This simple action was transformational for me. I stopped feeling so angry about the state of affairs in our country. I felt hopeful and empowered. The badge gave me a sense of agency and purpose to pass on to my patients. It helped combat the helplessness and despair I saw in many doctors around me. My unique voice as a physician mattered, and I was talking about something with my patients that felt bigger than individual treatments. It was energizing, and I wanted to do more.