On the afternoon of July 26, I opened an email from Dr. Peter Slavin, president of Massachusetts General Hospital, where I work as a primary care doctor. Dr. Slavin frequently sends messages to all MGH employees, uncontroversial broadsides announcing new hospital initiatives, grant awards, promotions and retirements that often end with: "Go Sox!" (or, depending on the season, "Patriots!" "Celtics!" "Bruins!").
So I was not expecting that this latest missive would evoke any emotional reaction in me. In fact, I was deeply moved.
In his email, Dr. Slavin addressed the proposed ban on transgender people serving in the U.S. military, announced that morning by President Trump on Twitter. Dr. Slavin declared himself “saddened and angered” by the proposed ban and reassured the MGH community, especially transgender members, that “this hospital embraces inclusion and equity.” He concluded: “This morning’s short-sighted action is truly a step backwards for human rights, human dignity and social justice.”
Not only was I moved by Dr. Slavin’s strong and direct public stand against the ban, I was also a bit surprised by it, as I suspect many of my colleagues were. Traditionally, health professionals have not commented so boldly on the actions of politicians. While individual doctors and nurses have run for office or been politically engaged (anti-war activists Dr. Benjamin Spock and Dr. Bernard Lown, most famously), the average physician, nurse or hospital administrator tends to maintain a politically neutral position.
There are many reasons for this, not least of which is the desire to avoid expressing opinions that might make patients who hold different views feel their care could be compromised. In 1981, when President Reagan was wheeled into the operating room after an assassination attempt and asked his surgeons “Please tell me you’re Republicans,” his joke was rooted in understandable anxiety. (Reportedly his chief surgeon, a liberal Democrat, responded, “Mr. President, today we’re all Republicans.")
In the past few years, and especially since the 2016 presidential election, though, health professionals have been more vocal politically, even about issues that are not strictly medical.
The New England Journal of Medicine has published several editorials arguing ardently against President Trump’s travel ban and in favor of the Affordable Care Act; the American Medical Association, the American Nursing Association, and many other medical organizations have taken official positions on gun laws, health insurance reform, reproductive rights and food policy; medical personnel wearing scrubs and stethoscopes participated in the Women’s March and the March for Science; and small gestures of political inclination once unthinkable — tiny rainbow stickers and Black Lives Matter buttons — now appear regularly on the lapels of white coats.
The explanation for this trending away from political neutrality seems clear: Many of the most critical current threats to our health — including poverty, lack of access to affordable health care, gun violence, the opioid epidemic — cannot be eliminated by individuals, no matter how well-meaning. Many clinicians, frustrated by their inability to solve these problems for their own patients, have taken to writing op-ed pieces, marching and lobbying Congress in hopes of effecting broader change.
Of course, medicine has never been an entirely apolitical profession. In the fifth century B.C., Hippocrates argued that a person’s health was inseparable from the health of society. He understood “health” to include nutrition, exercise and even exposure to the arts, all of which needed support by society, and thus medicine necessarily intersected with politics.
A pioneer of political activism in modern medicine was Dr. John Snow. In 1854, a cholera epidemic swept through the district of Soho in London, killing 616 people. A local physician, Snow mapped each case and concluded that contaminated water from a single public pump on Broad Street was responsible for the outbreak. The pump was closed, the epidemic ended, and Snow spent the next several years working with — and sometimes against — London’s board of health, prison system and private water companies to prevent recurrences.
Broad Street is now Broadwick Street and the infamous pump, which served as a memorial, was moved in 2015 to make way for construction, but Snow’s contributions are not forgotten. He was the first to understand that cholera was spread by water, not air, and he’s credited with founding the disciplines of epidemiology and public health.
It seems to me, though, that Snow’s work has a more subtle and profound significance: He showed that health professionals must sometimes step outside the conventional boundaries of their roles in order to fulfill their mission as healers. I see a direct line between Snow and the clinicians now marching for science or lobbying for universal health insurance or, indeed, Dr. Slavin taking a stand against the proposed ban on transgender people in the military. (And he was not alone; Medscape reports several national medical organizations also issued statements against it.)
I should point out, lest anyone think I am merely flattering my boss here, that I have never before felt the need to comment publicly on Dr. Slavin’s work, just as I imagine he has rarely felt the need to comment publicly on a presidential edict. But I must say that I felt proud that the president of my hospital felt compelled, as a physician and leader in health care, to register his objection to the proposed ban so openly; that he recognizes that a policy based on prejudice threatens the health of a community no less than an infected water pump.
You can find Dr. Slavin's full message to employees on this page. Readers, thoughts? Do you know of other institutional responses?
Suzanne Koven, MD, is a primary care doctor and writer in residence in the division of general internal medicine at Massachusetts General Hospital.