Insights on Identity: How I Use My Power as a Doctor to Advocate for Others

 

PCP’s Insights series was created to bring an interprofessional and diverse range of stories as told by the PCP Network into our Relational Response Initiative (RRI), a program originally designed to deliver our Relational Leadership curriculum virtually to support healthcare professionals and medical students during COVID-19. In that time, the tragic deaths and unconscionable acts of racism and violence against Black communities recommitted our focus and purpose for the PCP Insights series. Please contact us to share your story about your passion or work to advance health equity, racial or restorative justice, and to help PCP lift up stories from Black communities. This post is one of the many perspectives on Identity.

I have always been a learner, someone that likes to sit down and take in what is going on around me. Here’s an example to show what I mean: in elementary school, I was the kid who got in trouble for secretly reading books instead of going to recess. Turns out this isn’t “normal” for most eight year olds, who knew? 

That same drive to learn (with admittedly less unlawful reading time) continues to serve me well in medicine. Passive learning, although valuable with past experiences, has shown to be less helpful when in the hospital or clinic. At the start of my clinical rotations in medical school, I would stay silent instead of attempting to create plans or diagnoses. I felt more comfortable learning about what’s happening and building confidence in the subject matter before providing my answer; this was my recess reading of medical school. I didn’t see the value of learning through doing and making mistakes, and how much I could learn from these mistakes. Ironically, my fear of failure, and avoidance of situations where I could “fail” in the eyes of my superiors, limited my personal growth. I know this is a common feeling in medicine and is an experience I have shared in prior PCP trainings to help others out of this similar trap.

But nonetheless, this is how I worked in my first couple clinical rotations of medical school. I knew the information, did well on the exams, but remained quiet and made sure I didn’t stick out in hopes of passively absorbing the education going on around me. I was complacent in this role and thought I was good enough. But I will never forget my first official grades of clinical rotations in medical school…or rather, the crushing disappointment I felt when I saw that my scores were mediocre. This was unexpected. After all, I made my way to medical school this way, why would it be any different once I was there? Even more, I consistently asked for feedback during rotations and was almost always given generic, uselessly supportive statements, which helped build my ego but did little to challenge me and change my practice. I felt lost and needed some help. 

Prior to this point, I felt like I needed to get everything perfect on the first try, and held my tongue if I was uncertain. This way, I wouldn’t reveal that I was in actuality a clueless beginner masquerading as a healthcare “professional” in a white coat. If I was making mistakes and, in my mind, detracting from patient care, how could I really be anything else but a drain on the team? By staying silent a majority of the time, I could keep up this illusion of competence. 

Now, it’s clear to me that we need to embrace our failure, and learn from them, in order to actually make progress.  But I didn’t come to that conclusion myself. Luckily, I had a trusted mentor who made sure I didn’t keep going on this way. After those two rotations, she sat me down and told me the truth my passivity was holding me back. She knew that I knew the information, but was concerned that I was “hiding” in the group by rarely speaking up and that my knowledge never saw the light of day.

To be a better student and healthcare provider, I needed to shift my identity from that of a passive learner and embrace the growth mindset necessary for strong teams: I needed to be bold, make plans, and take action.

It is critical that healthcare professionals understand our own identities and how they inform our perspectives and actions. PCP’s Identity and Impact Toolkit has a variety of resources and exercises to help you better examine your own identity, and some recommendations on how to apply this learning into action.

My identity as a medical student and medical provider changed completely after that meeting. At the time, I was working on the inpatient family medicine team in a community hospital. With my change in perspective, I started to learn through my actions. It wasn’t always pretty, since I was an early learner, but I felt more confident and less afraid of my failures. I knew I was going to fail once in a while, but the next time I had a similar problem or question to answer, I now knew what to do. I wasn’t content with sitting back any more. I wanted to jump into the fray, become an active member of the team, and be more proactive in influencing the care of my patients. Not only did my evaluations improve from that day forward, but my job satisfaction increased I was truly happy while learning and felt an even stronger connection to my field and team.

That is why I wanted to start with that story — it shows how concepts of identity are not static. They change all the time with both internal factors, my self-reflection, and external, like my mentor’s words.

I’ve been through a similar process with my identity as an advocate. In medical school, I felt content sticking to learning about issues, staying informed, and observing what was going on around me, but rarely took action. I was worried about making a mistake, afraid to take the first step into a more active role, and felt that I couldn’t make a difference. What would happen if I failed? How would peoples’ views of me be impacted? Why couldn’t I remain in the background, out of the limelight?

About a year ago, I graduated medical school and became a doctor. This meant I had to take a close look at myself, and figure out the doctor and person I wanted to be. Because of my strong network of mentors, colleagues, and role models, I had concrete goals to aim for. I realized I was not content with letting a certain privilege the respect and power given to  physicians go to waste. I was determined to not fall into a sense of complacency like I first did during medical school.

I wanted to move from my armchair advocacy out into the real world, putting myself out there and taking risks to advocate for others.  

I’m proud to say I’ve finally started taking steps to become more of an advocate. In particular, I have always been passionate about reproductive justice, but I have historically been more passive without much active involvement outside of organizing seminars and other educational events in my medical school. This is definitely necessary and helpful in educating my peers, but it is nowhere near what I know I can do as a physician.

One example of my increased advocacy is what I have been doing this year for reproductive rights. I reached out to a local reproductive rights organization to make new friends and connections in my new home. Prior to the COVID pandemic, I was attending local rallies and events, speaking with some politicians or their staff directly to advocate for reproductive justice. I have seen my privilege in action firsthand: I see the double take I get when I mention I’m a doctor at a meeting, the increased level of attention I get when speaking directly with the staff, and the extra level of interest they give me over my other attending peers. I am writing Op-Eds as well, working closely with organizations to help spread messages of equitable health care, including reproductive health, using the “M.D.” after my name to amplify the voices of those who unfortunately lack as much systemic power as I do.

And finally, I am writing this post, coming out of my comfort zone to show the start of my journey into advocacy, and hopefully nudge others to do the same as well.

Brendan Prast

Brendan Prast is family physician at Maine Medical Center in Portland, ME. He has been involved with Primary Care Progress since 2015, first serving as a local team leader at the University Of Rochester School Of Medicine, a Trainer and Facilitator at PCP Leadership Summits, and most recently, a Lead Coach for PCP National and the Faculty Advisor for PCP Maine. Outside of medicine, Brendan also loves to play music (a violinist at heart), play tabletop games, hike, and cook whatever comes to mind.

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