Ten years ago, I earned my MD at the UCLA David Geffen School of Medicine, and was honored to be chosen as the student speaker at our graduation ceremony. Having endured residency, enjoyed a policy fellowship, and practiced as a general pediatrician in an inner-city community, I was wondering what I would tell today's graduates, as my doctorate turns ten years old. The following would be my hypothetical commencement address for those fortunate enough to join the medical profession.
About a week after the United States dropped atomic bombs in Japan to end World War II, my father was born in India. I have often wondered what our family's life would have been like if my father had instead been born in Virginia, like me. He would have been born in a country where his access to education, health care and jobs would be limited because of the color of their skin.
My father immigrated to a very different America over 20 years later. He earned his second masters degree in civil engineering at the University of Florida, was hired by a great engineering firm, and lived on the Virginia-West Virginia border to help build a state-of-the-art hydroelectric power plant. I see my father's contribution to electric power for his neighboring Americans as a sort of karmic gift. The first chapters of my father's American success story, and our family's subsequent fortunes are directly related to the power of everyday Americans standing up for their civil rights and for equality, years before he immigrated to this country. My family is indebted to ordinary Americans in the civil rights movement, taking risks and making sacrifices so their families could survive and thrive, regardless of the color of their skins. Had it not been for the efforts, my father's hard work and determination may have been futile instead of fruitful.
A hero of the civil rights movement, Reverend Dr. Martin Luther King, Jr, once said, "Life's most persistent and urgent question is, 'What are you doing for others?'" The answer feels relatively obvious for graduating medical students and for physicians in general, but before you rest on your new laurels, let me share some concerning statistics about physicians -- as citizens. According to a 2007 survey of thousands of doctors published in the Journal of General Internal Medicine, physicians voted 9 percent less often than the general public and 22% less often than lawyers. To be fair, that survey obviously did not include the historic 2008 and 2012 elections, where hopefully more of us chose to participate. But voting 9% less often than our patients is a significant gap, and a disappointment after all the sacrifices made by women suffragists and civil rights activists.
Some of you might ask, "but what about all the hard work we do for patients?" Allow me to answer with a two word question: "And then?" Our patients' health does not depend on us physicians as much as we would like to think. What states our patients live in, the condition of their homes, how much they earn, and the cleanliness of the air they breathe are just a few of the many factors playing a role in the health outcomes of our patients. These environmental factors and social determinants of health can not be treated by prescriptions or devices, but physicians can and should find ways to make an impact. We need to ask -- and answer -- a tougher version of Dr. King's question: What are we doing for others outside of clinic?
The good news for you graduates is that civic engagement is not as difficult as your other achievements. Voting -- not just for President, but for your Senators, Congressmen, Governors, state legislators, mayors, and city council members -- can shift the directions of policies on wages, housing, education, and safety. Many of you have grown up using Facebook and Twitter to express your opinions on everything from Kim Kardashian's wedding to Lebron James cramping. In the time it took for you to share those brilliant insights, you could also tweet your elected officials to expand Medicaid, reauthorize CHIP, address gun safety, and/or pass the HEAL Act for immigrants.
To be clear, none of this is meant to diminish your efforts as physicians. Every time we alleviate an elderly patient's pain; every time we counsel a pregnant woman about nutrition; every time we identify an autistic child's learning needs, we are starting a positive ripple in those families' lives. We are part of the "inescapable network of mutuality" described by Dr. King decades ago, long before the internet was even born. The ripples of hope and positivity we start impact families and communities. Those ripples should not be undermined when our patients leave our clinics because of low wages, inadequate insurance, shoddy housing, or needless gun violence.
Civic engagement is another opportunity for us to care for our patients. Many of us have our medical doctorates because ordinary people stuck their necks out for us. Mothers and wives advocated for women to have the right to vote, and continue to fight for equal pay. Factory workers and janitors rallied for the minimum wage and workplace safety, and continue to struggle for these and other labor rights. Students and pastors demonstrated to end segregation and continue to uphold voting rights. All of these people cleared injustices from our path, often taking risks that many of us will rarely face. Voting and participating in civic life are how we honor the sacrifices of the past and empower others to follow a just path for future endeavors.
Congratulations, welcome to the medical profession, and I look forward to having you join me and thousands of other advocates at our patients' bedsides; at our communities' curbsides and countrysides. Whether we are in clinic, at the courts, or on Capitol Hill, let's raise our voices to lift the lives of our patients!