In 2018, I wrote about how I have treated more avocado-related injuries than gunshot wounds. I went back to see which tragedy prompted this piece, but there were 323 mass shootings that year, involving 1,670 victims.
At the time, my response was to a tweet by the National Rifle Association (NRA) stating that ‘self-important anti-gun’ doctors should ‘stay in their lane’. The following day, a forensic pathologist in California, Dr. Judy Melinek, saw this on the way to conducting yet another autopsy on a gunshot victim. “This isn’t my lane. Its my fucking highway.” she wrote.
While the gun troubles plaguing America may seem a world away in Australia, where, as a surgeon, I have treated exponentially more injuries related to avocados than I have gunshot wounds* this raised genuine questions around whether or not doctors have a mandate to comment on broader policies which affect health, who in our profession has a mandate to do so, why, when and in what circumstance.
Power as it relates to medicine has historically considered the power imbalances in medical hierarchies, and between doctors and patients. These conversations have been and continue to be critical, as abuse of power causes harm to those we work with and those we treat.
But power is not just a negative thing, used for coercion or repression, but can be productive. And power is not just concentrated in the hands of a few that proclaim to have it, but is diffuse and everywhere.
Power and truth are irrevocably intertwined. As scientists first, we strive for truths in the work we do, whilst knowing that ‘truth’ can be obscured by who has scientific funding to investigate their truth, or the statistical nous to create it. We know also that breakthroughs create leaders in a field. Thus, even in the comfort of our labs, truth is informed by power, and power by truth.
When it comes to broader social goals, this interplay becomes more complicated, as truths become more variable and power becomes more diffuse. At one end we have had politicians like Donald Trump who, reminiscent of medieval monarchs, are so confident of their power that they can ignore truth altogether. And at the other end is an individual emergency physician resuscitating someone who is actively dying, or an individual surgeon desperately trying to stem the flow of blood onto the floor, or an individual pathologist retrieving a bullet from a corpse. There is an absoluteness of truth when it comes to death.
In these moments, faced with genuine health crises, we cannot wait for power to acknowledge truth. We must turn truth into power.
Since I wrote this article in 2018, we have seen an uprising of health care workers around the world, largely but not exclusively due to the pandemic. Rather than just labouring in clinics and hospitals, separated from each other, our powers of advocacy handed over to experts and peak medical bodies, whether they be Colleges, medical associations, surgeon generals or others, we have seen health care workers in the news, on social media, strongly advocating for necessary changes – whether that be for access to health care for refugees and asylum seekers, or the environment, whether that be for PPE in hospitals or better treatment of elderly people in aged care homes.
It is not new for healthcare workers to also be writers, commentators, advocates or politicians, but it is notable that another three female doctors are about to join the new Australian Parliament – and also unsurprising that all have been attacked for daring to do so. Particularly in Kooyong, where Dr Monique Ryan ousted the former Treasurer, Josh Frydenberg, from his seat, there have been explicit criticism about her right to stand for, (and win) office.
Of course health care workers are both clinicians with a duty and responsibility to advocate for patients; but we are also patients and humans ourselves. And so, if our peak bodies are ignored by those who occupy positions of power, we can and must collectivise and turn the medical truths we know into power ourselves.
The American College of Physicians published a position paper on October 30 in the Annals of Internal Medicine titled Reducing Firearm Injuries and Deaths in the United States. It was in response to this article that the NRA explicitly asked the medical profession in the United States to please discipline themselves and stop commenting on this issue; they sought to overpower the knowledge and associated truth held by doctors about firearms related injury by suggesting that doctors did not have expertise or mandate to comment on that issue.
Instead of retreating, thousands of doctors across America responded with calm fury, using the hashtags #ThisIsMyLane and #ThisIsOurLane to detail, sometimes with graphic imagery, the individual cases they are forced to confront on a daily basis. And tens of thousands of doctors have signed an open letter to the NRA, co-authored by Dr Megan Ranney, Dr Heather Sher and Dr Dara Kass.
The solutions to complex social problems such as the environment or migration or gun control may likewise be complex and imperfect, but the truths at the heart of them can come from the medical profession, because it is the doctors and nurses and allied health professionals and other health care workers who face the carnage of broken lives as a consequence of bad policy, on the front line, every day.
And while gun injuries are not the pressing problem in Australia that they are in the USA, there are a broad range of issues that the healthcare workers who have stood for office at the recent election and the past rightfully feel is within their expertise and mandate to comment on.
Whatever the broader solutions are to these complex issues where health and politics meet head on we cannot let the health truths be subsumed by political power. Our patients, our colleagues and indeed our own hearts deserve much more than that. This is our lane. This is our highway. And we will not give way.
* While smashed avocado on toast is a staple of Australian culture, this hand surgeon would beseech the Australian public to refrain from attacking the large and slippery seed with a knife while holding the avocado half in your palm. The knife can slip off and cause significant tendon, nerve and artery damage. Please remove seeds with a spoon or a special instrument that is widely available for purchase. If you must attack the seed with a knife, place the avocado on a chopping board and keeps hands clear.