Beyond the Exam Room

Why Physicians Must Address the ‘Microcosm of a Larger Problem’

When I walked into the exam room, I met Tanya*, a patient with Type 2 diabetes who was compliant with her diet and other lifestyle modifications. Yet, her blood sugar control was dangerously poor. What Tanya needed was a continuous glucose monitor (CGM) and insulin to prevent severe complications. However, her insurance plan made things difficult for her. She required a prior authorization for the CGM, and the out-of-pocket cost for insulin was impossibly high. 

When physicians see cases like Tanya’s, they are not facing a clinical challenge; they are witnessing a “microcosm of a larger problem.” Here, the solution cannot be limited to the exam room. A year ago, Dr. Ghandakly’s quote, “doctors can be advocates not only for what they see in the clinic but also for their patients’ needs. I believe we all have the responsibility to speak up and get involved”, still rings true. 

A Recap 

Dr. Ghandakly started as a lawyer, went on to become a resident physician, and is now a cardiologist in training. Speaking to us about the parallels between law and medicine, she noted that the one thing that unifies both fields is the fundamental duty to be an advocate for your client or patient. A lawyer is ethically bound to represent their client’s interests within the confines of the legal system. But the best lawyers don’t stop there; they actively lobby to reform the unjust or inefficient laws that fail the broader population. While clinical care is fundamentally about diagnosing and managing, much like the lawyer, the physician’s duty extends beyond the individual patient to reform the systems that harm them.

Patient advocacy should go beyond the examination room. By talking about factors like policy, pricing, access, and environmental determinants, we can shine a spotlight on the issues that prevent patients from even reaching the room healthy. When we prescribe a drug without addressing the very thing that makes it unaffordable, or treat an asthma attack without addressing the industrial pollution in the patient’s neighborhood, it is a half-measure. 

The Onus of Involvement

Why do so many highly educated, passionate physicians stand back from the policy arena? The major reason is not apathy, but exhaustion. Burnout is rampant, and the sheer volume of administrative tasks is overwhelming. The idea of adding “lobbyist” to this overwhelming list of duties often elicits the defensive reaction: “That’s not my lane.”

This stepping back creates a dangerous absence. The vacuum is immediately filled by interests such as pharmaceutical corporations and political factions, whose primary motive is rarely the patient’s well-being. When a doctor is forced to submit a tedious prior authorization for a drug they know a patient needs, or when they feel external forces constantly undermine their clinical judgment, they are forced to provide suboptimum care. This not only directly affects the patient but also indirectly undermines morale. The lack of agency and the inability to align one’s professional ethics with one’s actions is what truly fuels physician discontent, far more than mere fatigue.

Here’s the counter-intuitive antidote: studies suggest that physicians who engage in advocacy, even in small, focused ways, often report reduced burnout and increased professional satisfaction. Advocacy is not another burden; it’s a necessary form of professional self-care. It restores a sense of agency and purpose that is often lost in the administrative grind. 

The onus, therefore, is on us. We must leverage the daily clinical evidence and our unique, credible authority to remind policymakers that when patients forgo necessary care due to cost, our economy suffers. When communities are plagued by entirely preventable diseases, the system fails us all. Physicians are the only professionals whose data points are living, breathing human beings. It is this essential insight that compels us. Our moral, and increasingly professional, obligation is to translate Tanya’s struggle for her required medication into systemic change for all. We shouldmust look beyond the exam room and actively advocate for the health of the entire community we serve.