Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Expression in the Teaching and Practice of Medicine
20 Plays1 year ago
Too often the conversation about expression in higher education centers on the social sciences, humanities and the law, which is why this month we are speaking with Dr. Catherine Lucey, executive vice chancellor and provost at University of California San Francisco (UCSF). We discuss the history of advocacy and community engagement at UCSF and how she thinks about current speech challenges.
Episode Resources:
- UCSF Med School Differences Matter: https://medschool.ucsf.edu/differences-matter
- UCSF Office of Diversity and Outreach: https://diversity.ucsf.edu/
- UCSF Institutionalizing Rest in Response to Racial and Sociopolitical Trauma: https://pubmed.ncbi.nlm.nih.gov/38847650/
- NY Times: "In San Francisco, Doctors Feud Over ‘Do No Harm’ When It Comes to War Protests:" https://www.nytimes.com/2024/06/24/us/israel-hamas-war-sf-doctors.html
Recommended
Transcript
Principles of Free Speech and Justice
00:00:03
Speaker
I think what we need to do is explain how our principles of free speech, free inquiry, will help serve the cause of justice.
00:00:12
Speaker
The First Amendment, the constitutional freedom of speech and freedom of conscience that is the bulwark of our democracy.
00:00:22
Speaker
There was a passion in what was being said, affirming what people consider a sacred constitutional right, freedom of speech and freedom of association.
Introduction to 'Speech Matters' Podcast
00:00:34
Speaker
From the UC National Center for Free Speech and Civic Engagement, this is Speech Matters, a podcast about expression, engagement, and democratic learning in higher education.
00:00:44
Speaker
I'm Michelle Deutschman, the Center's Executive Director and your host.
Expression Issues in Medicine and STEM
00:00:48
Speaker
When we talk about open expression, debate, and dialogue, we often do so in the context of particular schools and fields such as law, social sciences, and the humanities.
00:00:58
Speaker
We don't talk about speech in the STEM fields or speech and medicine nearly as much, which is why today's episode focuses on expression-related issues in the teaching and practice of medicine.
00:01:09
Speaker
We are far from the only ones interested in the intersection of medicine and expression.
UCSF's Focus on Medical Education and Activism
00:01:15
Speaker
Given both its reputation as one of the best medical schools and teaching hospitals in the country and its history of student activism, national attention has focused on the University of California, San Francisco, UCSF.
00:01:28
Speaker
UCSF is unique from other UC campuses since it has no undergraduate students and instead focuses solely on its medical school, the health sciences, and its hospital system.
00:01:39
Speaker
The national media has covered conversations that have been taking place at UCSF over whether or not medical professionals should share their political views about the ongoing war in the Middle East in clinical settings and over the role of social media.
Guest Introduction: Dr. Catherine Lucey
00:01:54
Speaker
As the Executive Vice Chancellor and Provost at UCSF, Dr. Catherine Lucey has a unique vantage point for observing and considering these conversations and many others.
00:02:04
Speaker
She's been at UCSF for 13 years, and we're grateful for her willingness to join us and share her insights about these challenges, which not only impact UCSF, but doctors and medical students across the United States.
Current Events and Campus Implications
00:02:17
Speaker
But first, class notes, a look at what's making headlines.
00:02:22
Speaker
We are recording today's episode on the morning of October 7th, the one-year anniversary of the Hamas attack on Israel that resulted in more than 1,200 Israeli deaths and hundreds of hostages being taken.
00:02:34
Speaker
Since that date, more than 41,000 Palestinians in Gaza have been killed as a result of Israel's counterattack.
00:02:40
Speaker
Colleges and universities across the country have been preparing for campus events and activities to mark the date.
00:02:46
Speaker
For many, this will be the first true test of new or revised policies put in place to regulate the time, place, and manner of expression on campus.
First Amendment Rights in Education
00:02:55
Speaker
We have been following a case at the University of Maryland regarding these issues.
00:02:59
Speaker
Over the summer, the campus Students for Justice in Palestine, SJP, reserved the McKeldon Mall on October 7th to host an interfaith prayer vigil.
00:03:09
Speaker
In response to pressure to cancel the event and concerns about the university's inability to maintain safety on campus on October 7th, University of Maryland's president announced only university-sponsored events that promote reflection would be permitted.
00:03:25
Speaker
In response to having their event canceled, SJP sued the university for infringing their First Amendment rights.
00:03:31
Speaker
A federal district court judge ruled in favor of temporarily pausing the plan to limit events on October 7th.
00:03:38
Speaker
The judge wrote, the decision to revoke reservations was clearly neither viewpoint nor content neutral.
00:03:45
Speaker
It came about for reasons that the Constitution simply does not countenance, fear of disruption, and anger of opponents.
00:03:52
Speaker
In a separate case, the ACLU of Indiana filed a lawsuit in U.S. District Court challenging Indiana University's new expressive activity policy, which prohibits expressive activity between the hours of 11 p.m.
00:04:05
Speaker
and 6 a.m., even if the activity is not disruptive, such as standing silently or holding a sign.
00:04:12
Speaker
ACLU alleges that the policy is overly broad and violates the First Amendment.
00:04:17
Speaker
While the case winds its way through the court system, a group of students, faculty, and staff have hosted candlelight vigil protests after 11 p.m.
00:04:24
Speaker
on a number of Sunday evenings in a direct challenge to the new policy, arguing that the policy does not appropriately balance free speech and safety.
00:04:33
Speaker
While higher ed institutions work to get things right this week and in the weeks leading up to the election, they also continue to deal with litigation related events that took place last spring.
Legal Challenges to University Policies
00:04:43
Speaker
Last month, the ACLU of Northern California filed a lawsuit against UC Santa Cruz.
00:04:48
Speaker
After participating in ongoing protest activity, more than 100 students and faculty members were banned from the Santa Cruz campus for up to 14 days.
00:04:57
Speaker
This ban included being cut off from their classes, jobs, housing, and or other campus resources.
00:05:02
Speaker
The suit argues that these bans were overbroad and that those banned were deprived of their due process rights.
00:05:08
Speaker
UC Santa Cruz officials responded to the allegations by saying that the decisions they made were critical to preserving safety and the regular operations of the campus.
Upcoming Supreme Court Cases
00:05:19
Speaker
Today is also the first Monday in October, which marks the official start of the term at the US Supreme Court, a date set by federal law.
00:05:27
Speaker
The docket already has cases concerning state bans on gender affirming care,
00:05:32
Speaker
a Biden administration attempt to regulate hard-to-trace ghost guns and the death penalty.
00:05:37
Speaker
According to Associated Press, only about half of the term's calendar is filled, which means there's definitely room for election-related cases should that be the need following the election on November 5th.
00:05:48
Speaker
Speaking of the election, for November's episode, we'll be joined by internationally renowned election expert Rick Hassan, the Gary T. Schwartz Endowed Share in Law, Professor of Political Science by courtesy, and Director of the Safeguarding Democracy Project at UCLA School of Law.
00:06:06
Speaker
Now back to today's guest, Dr. Katherine Lucey.
00:06:09
Speaker
Katherine is a practicing physician and leading national voice on medical school education.
Dr. Lucey's Role and Leadership at UCSF
00:06:14
Speaker
She took the helm as Executive Vice Chancellor and Provost at UCSF in January 2023.
00:06:20
Speaker
In this role, Dr. Lucey leads both UCSF's robust research enterprise as well as its highly ranked academic programs comprising four professional schools and the graduate division.
00:06:31
Speaker
She works in close collaboration with the chancellor and the leadership team to develop and implement campus priorities and vision, maintain the university's status as an international leader in health science, education, and research, and oversee external partnerships representing UCSF's best interests across the University of California system at the UC Office of the President and beyond.
00:06:52
Speaker
Renowned for her leadership, Dr. Lucy previously served as Vice Dean for Education and Executive Vice Dean for the School of Medicine, reporting to Dean Talmadge E. King Jr. In these roles, she directed the undergraduate, graduate, and continuing medical education programs at the School of Medicine and at the Office of Medical Education.
00:07:11
Speaker
A champion of diversity, equity, and inclusion, Dr. Lucy was also on the executive management team for the School of Medicine's Differences Matter Initiative and oversaw other strategic projects across the campus.
00:07:24
Speaker
Catherine, thank you so much for joining us today.
00:07:27
Speaker
We are very grateful for your time.
00:07:29
Speaker
Thank you so much for inviting me, and I think this is a fantastic opportunity to have a conversation with an expert such as you.
00:07:35
Speaker
Oh, well, it's a mutual admiration society then.
00:07:38
Speaker
So I always like to start every episode by asking our guests about their career journey.
00:07:43
Speaker
So when you completed your residency in internal medicine at UCSF, did you ever imagine that your career would take you to leading the university at which you studied?
00:07:53
Speaker
And can you tell us a little bit about how you got to where you are?
00:07:58
Speaker
I had absolutely no idea that I would end up in this particular position, and I'm so grateful that I have.
00:08:04
Speaker
I would say when I decided to go to medical school, my whole focus was to become someone's really treasured doctor.
00:08:12
Speaker
And I imagined myself returning to my hometown, Rochester, New York, and perhaps practicing pediatrics, which is the specialty I knew most about because, of course, all kids have pediatrician.
00:08:24
Speaker
So I imagined myself being in private practice in pediatrics, and I find myself being in academic leadership all the way across the country in San Francisco.
Dr. Lucey's Career Path and Activism
00:08:32
Speaker
I will say though, my work,
00:08:35
Speaker
as a resident at UCSF in the 80s was truly transformative for me as well as for my colleagues.
00:08:42
Speaker
We all started our internship and residency right at the start of the HIV pandemic.
00:08:47
Speaker
It was not known that it was HIV at the time, but we knew in fact that we saw on a daily basis, young men and women our own age coming into the hospital and dying of this very severe illness, which was eventually found to be caused by HIV virus.
00:09:04
Speaker
And now is, gratefully, a chronic disease for people who are able to access the right health care for that.
00:09:11
Speaker
So I think it changed my idea about what it meant to be a doctor.
00:09:16
Speaker
And what it meant to be a doctor was not only working with the patient in front of you, but understanding the world in which they lived, the experiences they had, the communities that supported them, and importantly, the communities that didn't support them.
00:09:29
Speaker
And it was a tremendous opportunity to see how
00:09:33
Speaker
Working with the community and community activists helped advance the research needed to find the cause and eventually the management strategies for HIV AIDS.
00:09:46
Speaker
Well, thank you for sharing that.
00:09:47
Speaker
And I know you've done tremendously impactful work in your position, but gosh, I would have liked to have had my kids have a pediatrician like you.
00:09:55
Speaker
Yeah.
00:09:56
Speaker
Do you feel like you missed actually doing more?
00:10:00
Speaker
Do you still ever get to do any of that patient one-on-one or not necessarily?
00:10:04
Speaker
Yeah.
00:10:05
Speaker
Up until the time I took this role, I always spent time taking care of patients.
00:10:10
Speaker
Initially, I was a general internist.
00:10:13
Speaker
I took care of patients in the amateur environment as well as in the inpatient environment.
00:10:18
Speaker
across all of the institutions at which I worked.
00:10:20
Speaker
When I moved to UCSF in 2011, my clinical work actually focused exclusively on taking care of hospitalized patients at Zuckerberg San Francisco General, which has always been kind of my clinical home since I was a chief resident there back in the 80s.
00:10:35
Speaker
And then when I took on this role in 2023, I realized I just cannot spend the time I would need to take good care of patients.
00:10:44
Speaker
And so I've reluctantly given that up after 40 years of spending time taking care of patients at some of the most challenging aspects of their life.
00:10:54
Speaker
Okay, but now you get to focus on other things.
00:10:57
Speaker
But before we focus on sort of current day, I want to go back to the 80s and to what you were talking about.
Integrating Activism in Medical Education
00:11:03
Speaker
The fact that one of the things that makes UCSF very unique is its long history of involvement both with the local community and its use of advocacy to make gains in medical knowledge, treatment, and access to care.
00:11:14
Speaker
I'm wondering if you can tell us about how this concept of advocacy and on UCSF's website, it's referred to as learner activism, is integrated into teaching new doctors at UCSF.
00:11:26
Speaker
Yeah, so I think that the idea of physician as advocate is really centuries old.
00:11:33
Speaker
I want to remind people of Semmelweis, who was a physician in Austria.
00:11:39
Speaker
who recognized that the cause of maternal death from infection was the fact that doctors were going directly from the autopsy labs to delivering babies.
00:11:50
Speaker
And in fact, Semmelweis actually identified this through a series of studies
00:11:55
Speaker
basically was kind of run out of town because it was such a fanatical view at the time.
00:12:01
Speaker
But of course, now we know the importance of hand washing and preventing infection.
00:12:04
Speaker
But it was a really radical idea at the time.
00:12:07
Speaker
And he suffered because of his radical idea.
00:12:10
Speaker
But the rest of us actually have benefited from that.
00:12:12
Speaker
So advocacy for physicians, particularly for public health and for the things that impact direct patient care has been really kind of part of the profession for centuries.
00:12:24
Speaker
It was very evident in the HIV AIDS pandemic when there were
00:12:29
Speaker
Regrettably, some physicians, even in San Francisco, who refused to take care of patients with HIV or with this, what they call gay-related immune deficiency syndrome when it first started.
00:12:41
Speaker
And other physicians had to really lobby their colleagues and step up to the plate.
00:12:46
Speaker
And so even at the time when, in fact, no one knew what was the cause of HIV, they didn't know how it was transmitted, they weren't certain whether physicians themselves would be susceptible for caring for patients.
00:12:58
Speaker
So in fact, caring for patients with this illness became a form of advocacy in and of itself.
00:13:04
Speaker
And of course, many things changed as a result of the pandemic.
00:13:08
Speaker
It's interesting that before the HIV pandemic, we didn't routinely use gloves when we were drawing blood and things like that.
00:13:16
Speaker
So we learned over time that sometimes being faced with a crisis such as this can actually improve health care for everyone as you're paying attention to what's happening around you.
00:13:26
Speaker
I like hearing about a silver lining that is coming out of really tragic circumstances.
00:13:33
Speaker
And clearly part of a medical student's experience at UCSF is learning how to advocate for systematic changes, right?
00:13:40
Speaker
To address inequities, as you've just described in our healthcare system.
00:13:44
Speaker
And I'm curious how you and others discuss and train students about when these roles of doctor and activist are merged and when they might be more separate.
00:13:55
Speaker
Yeah, so I think an important part of understanding the physician's role as advocate begins with understanding your role as advocate for the patient in front of you in the exam room.
00:14:07
Speaker
One of the most important promises we have is to do no harm, and that is the responsibility of a physician to always focus on what is going to be best in moving the patient in front of you from a situation of suffering to one of relief, from illness to health.
00:14:25
Speaker
And that requires that you focus all of your energy and attention in the exam room to the patient in front of you, regardless of what's happening in the world outside.
00:14:35
Speaker
Now, obviously, patients' lives are complicated and they bring them into the exam room.
00:14:39
Speaker
And if this is something they want you to discuss with them,
00:14:43
Speaker
then I think you have an obligation mostly to listen and respond to their concerns.
00:14:49
Speaker
You certainly can't engage in advocacy in the exam room with a patient in front of you without their permission because that would likely cause them distress and therefore harm them.
00:15:00
Speaker
So the primacy of the doctor-patient relationship in the exam room is one where the patient's needs always come first.
00:15:08
Speaker
And that can sometimes be very challenging depending on what's happening in the environment.
00:15:13
Speaker
and also the distractions that you may feel as a physician.
00:15:16
Speaker
A lot of us have learned over time that the most important part of the encounter is before you enter the exam room to clear your head and your mind from what's happening so that you can actually be fully present for the person as you enter the room and strive to help them feel better.
00:15:33
Speaker
So I think the first thing we teach is the importance of the doctor-patient relationship.
00:15:38
Speaker
Secondly, I think that there is a role for physician advocacy, as I mentioned.
00:15:43
Speaker
This is centuries old, and we've had many situations since Semmelweis and since HIV.
00:15:49
Speaker
I would point to the issue of COVID, where physicians' advocacy was really critical in COVID.
00:15:55
Speaker
helping people understand why it was important to be masked, to counter misinformation about COVID vaccines, to advocate for institutions going into communities of need rather than requiring communities of need to knock on the door of the health system.
Physician Advocacy during COVID-19
00:16:12
Speaker
Those are all forms of public health advocacy that I think were really critical during the COVID pandemic and so are good examples of how advocacy
00:16:21
Speaker
can impact the health of communities and, by extension, the health of patients in front of you.
00:16:27
Speaker
But it can also help the physician themselves.
00:16:30
Speaker
I think one of the most important things frontline workers engaged in during the COVID pandemic is the need to stay healthy and be healthy so that they can continue to care for the patients in front of them.
00:16:43
Speaker
And that required us as physicians to continuously advocate, please stay home if you don't have to go out.
00:16:49
Speaker
Please wear a mask if you need to go out.
00:16:52
Speaker
And please get vaccinated to protect not only your neighbors, but the physicians and nurses and everyone working in the hospital who is responsible for caring for you.
00:17:02
Speaker
I think a bigger issue comes up when we see things such as structural racism consistently negatively impact the health of our communities.
00:17:13
Speaker
And so I will say when we have worked with our students at UCSF around issues of structural racism,
00:17:19
Speaker
Very often they have been the instigators in that work.
00:17:23
Speaker
I remember very specifically a die-in that was held in December of 2014 to protest not only the deaths of many Black men at the hands of police, but what they saw as the institution's failure to take up this cause as a critical aspect of caring for communities of Black and brown people.
00:17:45
Speaker
What I would say is we call it learner activism, but I'd like to talk with the students about how activism may raise awareness about an issue, but what you really need to do once you have an activism event is to engage with all around you to design a different system or design a different process.
00:18:05
Speaker
And so when we think about the types of activism that
00:18:09
Speaker
that UCSF is known for, it always is followed by advocacy and collaborative work to redesign systems that have not been appropriately designed in the first
Activism to Systemic Change in Healthcare
00:18:21
Speaker
place.
00:18:21
Speaker
And so I think activism without advocacy is often just noise.
00:18:25
Speaker
And it's a little bit like social media these days where
00:18:28
Speaker
people kind of, you know, scream into a void and use bumper sticker phrases.
00:18:32
Speaker
That may raise awareness of a problem, but true solutions to the problem really require that people advocating for something work with existing systems to redesign them.
00:18:44
Speaker
And that's what we've done in medical education and healthcare at UCSF with many, many interesting, interested, committed people.
00:18:52
Speaker
Some who were late to understanding the concepts of structural racism,
00:18:57
Speaker
But now, once we sort of, we talk about something being a threshold concept, once you fully understand what structural racism is, you cannot not see it.
00:19:06
Speaker
And we have been always careful, however, to tackle issues that
00:19:12
Speaker
in a way that impacts the institution, the university, the medical school, the healthcare system, and to commit first to doing what we can do to redesign our environment to be as welcoming, as inclusive, as equitable an opportunity as we can as an institution that cares for patients and educates the next generation of healthcare providers in four different disciplines.
00:19:38
Speaker
I just wrote down activism with advocacy because I think that is such a brilliant way of talking about it because I think sometimes people think those are synonymous and sometimes people only think of one of those.
00:19:51
Speaker
You had mentioned misinformation on social media and so I'd like to talk a little more about that because certainly one of the huge differences between the 80s and 90s, right?
00:20:00
Speaker
is the advent of the internet and social media.
Social Media's Impact on Medicine
00:20:03
Speaker
And I'm curious if you can talk about, you know, either or both positive ways it's helped with creating systemic change in medicine, but also some of the ways that maybe it's been counteractive.
00:20:15
Speaker
Yeah, I think social media, as you say, is...
00:20:19
Speaker
it's neither all good or nor all bad, right?
00:20:22
Speaker
I mean, I think this is part of the challenge that we face though in social media is that often it takes a very complex topic and attempts to make it into a binary one.
00:20:31
Speaker
And that's where, again, I would say activism and advocacy often differ.
00:20:37
Speaker
So in activism, you're right or you're wrong, you're on the right side of the issue or you're wrong side of issue.
00:20:42
Speaker
In advocacy, you're working to help others understand your viewpoint,
00:20:47
Speaker
to listen to their concerns and address them, and to hopefully arrive at a strategy that allows you to move forward to a better future.
00:20:56
Speaker
So social media is really well designed for activism.
00:21:00
Speaker
And sometimes that activism
00:21:02
Speaker
is good.
00:21:03
Speaker
For example, there have been lots of ways in which, again, I'll relate to the COVID pandemic.
00:21:10
Speaker
People, doctors took to the social media to talk about the importance of what was happening, to help explain things, to use their kind of social media pulpit to encourage people to do things correctly, like get a vaccine or stay home if they didn't have to be out and around in large groups and things like that.
00:21:31
Speaker
However, social media also is unfiltered.
00:21:35
Speaker
So everyone on social media has a voice and they can, in fact, talk about things that they're not expert about.
00:21:43
Speaker
And it's very difficult for people to understand what's true and what's not.
00:21:46
Speaker
So I think that the lines between truth, mistakes, misinformation, disinformation are very blurry.
00:21:54
Speaker
And it's very hard for the average person to understand what is factual when information about health is provided by a wide variety of individuals.
00:22:04
Speaker
I would say, too, I think you are the experts in free speech and civil discourse, and
00:22:10
Speaker
One of the challenges with social media is there are no conversations in social media.
00:22:15
Speaker
Freedom of speech is really designed to allow people to have their own viewpoint, but to kind of debate them in the public square.
00:22:24
Speaker
And you can't really debate on social media.
00:22:26
Speaker
I guess you can, but it doesn't happen in real time.
00:22:28
Speaker
And most people are not in social media listening to change their opinion.
00:22:34
Speaker
Particularly as it's designed now, because the more provocative you are, the often more likes that you can get.
00:22:40
Speaker
And there's a little endorphin that kicks up when you sort of say, oh, I have all these likes.
00:22:44
Speaker
So I think that free speech in the social media era has been challenging because there is no opportunity really to engage in thoughtful conversation.
00:22:55
Speaker
because it's all asynchronous, right?
00:22:57
Speaker
It gets out there and then it's out there forever.
00:22:59
Speaker
So even if you changed your mind and later on wanted to repost differently, your track record is still out there for others to see.
00:23:06
Speaker
So it's an effective tool when used well.
00:23:09
Speaker
It's also an extremely effective negative tool when used poorly.
00:23:14
Speaker
You are singing my song about some of the challenges of social media and conversation and the binary.
00:23:22
Speaker
I'm going to not get on my soapbox right now because we're focusing on your expertise.
00:23:27
Speaker
And in fact, you know, what you were just saying made me wonder a little bit about this whole idea of expertise, right?
00:23:33
Speaker
That like medical professionals and health professionals go to school and go through so much rigorous training.
00:23:39
Speaker
And right now, a lot of that is being placed in doubt.
00:23:43
Speaker
by people getting on social media with a quick missive that sort of throws doubt on areas of science.
00:23:51
Speaker
And I'm just wondering, yeah, how that gets managed and talked about in the classroom and in the clinical settings, because I imagine it must come up.
00:24:01
Speaker
When it comes up is really in guidance to
00:24:05
Speaker
students, residents, faculty about taking care with social media platforms and social media information.
00:24:13
Speaker
You'll see on social media, board certified physicians disagreeing with one another.
00:24:18
Speaker
And that causes a lot of fury sometimes from people who are saying, how could you let this person be posting this about COVID?
00:24:26
Speaker
And this other person said, well, how can you let this person be posting this about COVID?
00:24:30
Speaker
And I think that
00:24:32
Speaker
This is an example where we try and say to our students and our residents, if you have a debate, a medical debate about a particular set of recommendations, the place to have that debate is not in social media.
00:24:46
Speaker
The place to have a debate is in a conference room or in a paper that you publish in a journal or at a national meeting of a professional organization.
00:24:56
Speaker
It's not a conversation that the public square should have to
00:24:59
Speaker
weigh in on and vote in on in order to decide that that's not the way science works.
00:25:04
Speaker
Science works where scientists show the data, challenge one another, engage in really important disagreements.
00:25:12
Speaker
That's how science gets advanced.
00:25:14
Speaker
And over time, sometimes that views change because of the scientific conversation that's happening.
00:25:21
Speaker
So I think there are plenty of opportunities for people to debate the situations in medicine and science that people may have valid reasons to disagree with.
00:25:30
Speaker
I'm not sure it's well served to do it on social media because I think that it can very easily lead to escalation of misinformation if people aren't careful about how they present their viewpoints as being, this is my view, others disagree.
00:25:45
Speaker
That's probably a good disclaimer for people to get used to.
00:25:48
Speaker
But you have to realize that if you put MD after your name, sometimes say like people will say, oh, a doctor said this on Twitter, so it must be true.
00:25:56
Speaker
So we've talked a little bit about some of the potential pluses and some of the harms of social media.
00:26:02
Speaker
And I'm going to like hook into that word harm because do no harm is a key portion of the Hippocratic Oath.
Doctors' Political Advocacy vs Patient Needs
00:26:10
Speaker
And I know there's been some conversation as of late, especially about whether or not doctors should be putting aside their political advocacy in order to prioritize patient needs a little bit about the rub that you were talking about before.
00:26:25
Speaker
While other feel, you know, some people feel like it might be harmful to share your political beliefs, but other people feel like it's harmful if you're not calling out the things that you see in the world that are harmful.
00:26:36
Speaker
And I'm wondering if you could just talk a little bit about this debate and we'll go from there.
00:26:41
Speaker
Yeah, I think it's a particularly challenging debate on campuses that have health systems and campuses where you are educating people.
00:26:50
Speaker
future nurse practitioners, dentists, pharmacists, physical therapists, physicians, where the workforce is being educated in order to sustain excellence in the care delivery of patients.
00:27:03
Speaker
So I think that once again, I want to say that
00:27:07
Speaker
Physician advocacy or health professional advocacy is part of who we are, particularly around public health threats in your own community.
00:27:15
Speaker
However, I think when you're in an exam room with a patient, your focus has to be on that patient.
00:27:22
Speaker
And if you are saying something or wearing something that creates uncertainty on behalf of that patient,
00:27:33
Speaker
about whether or not you are going to be their advocate, their own advocate, their patient's advocate, that's a problem.
00:27:40
Speaker
And I think that you never really know who the next patient is in your room.
00:27:44
Speaker
And you might have, for example, when I was a general internist and I was taking care of patients, I would take care of them for years.
00:27:50
Speaker
And so I knew them.
00:27:51
Speaker
And very often I learned a lot about their views and their beliefs.
00:27:55
Speaker
And I was able to sort of engage with them, meet them where they are, understand the community in which they live, their beliefs.
00:28:02
Speaker
And I could use that to make sure that I was addressing their concerns without disrespecting their own viewpoints or without bringing my viewpoint into the encounter with them.
00:28:12
Speaker
Because it's really not about me as the doctor.
00:28:14
Speaker
It's about what the patient needs.
00:28:16
Speaker
So I think we have to be really careful about that.
00:28:18
Speaker
I know a lot of the conversation recently has focused on what about wearing buttons or attire in solidarity with a particular oppressed group.
00:28:30
Speaker
I think it's problematic in the doctor-patient relationship, in the healthcare environment.
00:28:35
Speaker
I would just say perhaps a health professional patient relationship because you really don't know whether that person in front of you will be offended at the least or frightened at the most by buttons that actually demonstrate your particular political viewpoint about something that isn't right there in front of you in the patient's room, the patient's needs.
00:28:58
Speaker
I think that there's lots of controversy here about that because buttons have been historically something that we've used to communicate to our patients, you are safe here.
00:29:08
Speaker
I'll take, for example, the pride flag.
00:29:10
Speaker
That's been something that has been worn at UCSF for as long as the pride flag has been around, particularly during pride month.
00:29:17
Speaker
And one of the questions we have is like, should we continue to allow providers to wear any kind of button on their white coat, on their nursing uniform, on their
00:29:29
Speaker
you know, on any third or lanyard that you wear around your, you're not going to have to hold your ID badge.
00:29:34
Speaker
And there are those who would say, absolutely, we want to use those buttons to signal our understanding of the need for us to pay special attention to groups that have been historically marginalized or excluded by the healthcare system.
00:29:49
Speaker
And others would say, you know, I'm not sure that's such a good idea because, you
00:29:54
Speaker
the absence of wearing a button then becomes viewed as potentially a political statement in its own right.
00:30:01
Speaker
And so you don't really want a situation where people will only seek out a provider or only feel comfortable with a provider wearing a button that endorses their right to healthcare because every patient deserves high quality, equitable, patient-centered, culturally congruent care by a provider who at the moment is thinking nothing
00:30:25
Speaker
about anything other than what that person in front of them needs.
00:30:29
Speaker
And I think when we use buttons to signal what we believe in, there is no coat that actually I could put on that would have as many buttons as the types of identities of patients that I have that come into the office on a regular basis.
00:30:45
Speaker
And I think we're in the care environment, the safest thing is to insume
00:30:49
Speaker
that every provider is going to provide that kind of compassionate, culturally congruent and patient-centered care.
00:30:55
Speaker
I'm not sure buttons signal that.
00:30:57
Speaker
And I do know that there are situations where buttons can be viewed as very harmful by some patients.
00:31:03
Speaker
So if we really want to talk about do no harm, then I think we really have to be careful about how we express our advocacy for particular groups in the healthcare environment.
00:31:13
Speaker
Now, if you're out and about in the community, if you are
00:31:18
Speaker
on campus going to a rally, even on campus going to a classroom.
00:31:23
Speaker
I think
00:31:24
Speaker
In that environment, you're surrounded by people with whom there is no power differential.
00:31:30
Speaker
And in fact, if you are wearing a button and I'm sitting next to you and I don't understand that button or don't understand what it means, and I can engage with you in a one-on-one position where I'm not feeling particularly vulnerable because I'm not sitting there in a hospital now waiting to be examined by a physician.
00:31:45
Speaker
So I think that the difference for me in the environments that we live in is that campus is an opportunity for people to gather who are
00:31:54
Speaker
at similar levels and can actually have those conversations that First Amendment was designed to support.
00:32:01
Speaker
The healthcare delivery system, and particularly the exam room, I don't think is the right place for us to use buttons to signify our activism or our advocacy.
00:32:11
Speaker
That is a very helpful distinction, and I appreciate your really kind of drawing that out.
00:32:17
Speaker
I think my only follow-up was the power differential between a faculty member and a student, which would be in the classroom setting and how that comes up, or do you feel like that's part of the educational process?
00:32:28
Speaker
Yeah, I think that you're really right on target with saying there is a power differential there.
00:32:34
Speaker
It may, in fact, stymie conversations.
00:32:37
Speaker
If, for example, a faculty member is wearing a particular advocacy t-shirt, cannot be certain that your students all have the same level of passion or commitment as you do, or even are on the same side of a very complex or nuanced issue.
00:32:52
Speaker
I think as faculty, our obligation when we talk about complicated and complex issues is to always bring in
00:33:00
Speaker
information that helps people understand the complexity of that, which means not just sort of presenting something as this is the right viewpoint.
00:33:09
Speaker
And I want you to embrace this viewpoint.
00:33:12
Speaker
Teaching is not about telling people what to think.
00:33:15
Speaker
Teaching is about teaching people how to think.
00:33:18
Speaker
In order to teach people how to think, you often do have to bring in tensions.
00:33:23
Speaker
There's a whole...
00:33:26
Speaker
educational theory called transformative learning theory.
00:33:28
Speaker
That's all about what they call managing disquieting dilemmas.
00:33:33
Speaker
And I just love that phrase disquieting dilemmas, because in order to manage a disquieting dilemma, you have to surface it.
00:33:39
Speaker
You actually have to be able to say, you know, there are challenges here.
00:33:44
Speaker
There are nuances here.
00:33:46
Speaker
There's complexities here.
00:33:48
Speaker
And what we need to do is be able to show you all sides of a situation that
00:33:54
Speaker
not both sides, all sides of a situation, and help you navigate through those to arrive at what we hope is an understanding that advances society that doesn't undermine it.
00:34:07
Speaker
Every classroom, right, should be like that, ideally.
00:34:11
Speaker
It's hard, though, it's hard, right, because faculty are humans.
00:34:16
Speaker
The students don't always think so, but they are.
00:34:17
Speaker
Faculty are human.
00:34:19
Speaker
And all of us have different viewpoints.
00:34:21
Speaker
But entering a classroom as a teacher, it's not the same as entering a patient care room as a physician or as an advanced practice nurse.
00:34:29
Speaker
But entering the classroom, you have to keep reminding yourself, all of these people in my class come from different lived experiences.
00:34:36
Speaker
All of them are coming to us with strong viewpoints already.
00:34:40
Speaker
My job is to help them think.
00:34:42
Speaker
And learning is really about taking in new information, comparing it to what you have in your brain already, and then advancing your understanding of the situation.
00:34:52
Speaker
So that's when true learning happens, as opposed to telling people, this is what, you know, memorize this for the test.
00:34:59
Speaker
And medicine, by definition, anything involved in health sciences,
00:35:04
Speaker
is all about teaching people how to continuously learn, how to confront new information, how to look and see if the old way of treating gout or rheumatoid arthritis or cardiovascular disease should be changed based on this new information.
00:35:18
Speaker
So teaching people how to think and incorporate new information is really the foundation of what we need to teach health providers for the future.
00:35:27
Speaker
Advocacy is just another one of those elements that we have to help people understand
00:35:32
Speaker
Because to understand the elements of advocacy, you have to understand how different humans are going to address this and understand this and feel this as it impacts potentially their health or the health of their communities.
00:35:45
Speaker
One of the other things I wanted to draw from was when you talked about how if you wear pins regularly, then the absence of a pin might be read to mean something.
00:35:56
Speaker
Sort of like when universities make statements, then unfortunately the absence of a statement can be read as, you know, some people say, well, silence is complicity.
00:36:05
Speaker
those kinds of things.
00:36:06
Speaker
And so I kind of wanted to talk a little bit about this idea of institutional neutrality, which has become very popular, especially in the last year, as universities have tried to kind of weather the things that have happened on and after October 7th.
00:36:21
Speaker
And now a lot of people are adopting the Calvin Report and sort of trying to be even more strict about neutrality.
00:36:28
Speaker
And I'm wondering, given all of the things that you've already shared with us about sort of the connections between the community
00:36:35
Speaker
and the world and medicine, what factors are considered when UCSF decides if and when to speak with its institutional voice?
UCSF's Response to the Dobbs Decision
00:36:44
Speaker
You know, and certainly one perfect example I felt like was what the Department of Obstetrics, Gynecology, and Reproductive Sciences said in the wake of the Dobbs decision.
00:36:54
Speaker
And I'm sure you have many other examples that you might be able to share.
00:36:58
Speaker
Yeah, I think that this is an issue that I think over the past year has become very top of mind, but was always on their radar even before that.
00:37:10
Speaker
I will say, when we started as a medical education program, so not institutionally, but as a medical education program at UCSF in around 2014 and 15, when the issues of police brutality came up, we started talking about those with our students and we started
00:37:28
Speaker
sending messages because our students said they needed someone to recognize that events that happened, like the death of Michael Brown or the death of Philando Castillo, when that happened, it was extremely distracting for students.
00:37:44
Speaker
And I'll say another one, the Tree of Life Synagogue Massacre.
00:37:49
Speaker
And
00:37:50
Speaker
other sort of events that were really shocking and targeting specific people who shared identities with many of our students.
00:37:57
Speaker
And so our students felt like it was important for the administration to recognize that something that happened has caused a great deal of distraction and pain and suffering for them.
00:38:07
Speaker
And they might not be at the top of their game.
00:38:09
Speaker
I mean, I think part of a challenge in medicine is that our students go to class every single day.
00:38:15
Speaker
They're in the class from like eight to five.
00:38:17
Speaker
It's a very fast-paced curriculum.
00:38:19
Speaker
And what they needed was someone to say, it's okay for you to take the day off and just engage in some self-care.
00:38:26
Speaker
And what we tried to do is use messages to communicate not only to our students that we see you, we understand this is traumatizing or triggering for some people.
00:38:37
Speaker
We want you to feel comfortable taking care of yourself, but also to do the same for our faculty who sometimes have the same experiences.
00:38:46
Speaker
But others were just not as aware.
00:38:48
Speaker
We wanted our faculty more broadly to understand, hey, something happened in the world that was very distressing for our students.
00:38:55
Speaker
And we need to make sure that we are taking good care of them as well as we're helping them develop into this really important role of a health care provider.
00:39:05
Speaker
What we tried to do with those messages is acknowledge the pain and suffering, talk about why this was important for us to talk about, and then try and provide something educational for the people to, if you want to read a little bit more about this, or if you want to understand the roots of this problem.
00:39:23
Speaker
So we tried to make it into an educational missive, I would say, part of the education that students got.
00:39:29
Speaker
And it worked very well.
00:39:30
Speaker
And in fact, our students even...
00:39:32
Speaker
helped us turn that strategy into a formal program that we use called the Racial Justice and Social Trauma Protocol.
00:39:41
Speaker
It's not quite the right name, but, and which basically says we activate this when we think a large number of our students are being negatively impacted by something that has happened.
00:39:51
Speaker
One of the challenges we have found, though, with these institutional messages is
00:39:55
Speaker
is that not everyone agrees with them, and some people, in fact, have found them offensive.
00:40:01
Speaker
I can remember very specifically being visited by a very passionate individual who was a resident in one of our institutions who disliked a message that I had sent out that focused on issues of structural racism.
00:40:14
Speaker
And...
00:40:16
Speaker
By and large, it makes you think like, all right, well, I think this is an obvious right answer to this situation, but they aren't always obvious right answers to the situation.
00:40:27
Speaker
And part of being an institution is to make sure that you're trying to support everyone.
00:40:32
Speaker
And in an environment where there are deeply polarizing concepts at play, such as what we've seen in the last year,
00:40:40
Speaker
When we try and support one set of individuals, another set of individuals has become very, very frustrated by that.
00:40:49
Speaker
And what we have done in exchange, like many institutions, have been to try and walk the line more finely, in which case people are basically like, your message is so neutral that it's insulting to everyone, right?
00:41:04
Speaker
There was no point in you putting out a message about some of the issues that have come up.
00:41:08
Speaker
I will say that Carol Christ from Berkeley gave an interview, I think, in The New Yorker back in December, where she talked about the differences in institutional statements and also challenges to institutional statements that she's seen.
00:41:22
Speaker
And we've certainly seen that in that people have really wanted you not only to put out a statement, but to use their statement, their words.
00:41:29
Speaker
And if you don't want to use their statement or your words, then there's these accusations of being complicit.
00:41:34
Speaker
So what we've tried to do is focus our efforts to things that are happening right on our campus and calling them out.
00:41:43
Speaker
For example, anti-Semitic graffiti.
00:41:45
Speaker
Calling that out as anti-Semitic and inappropriate or anti-Arab hate graffiti.
00:41:51
Speaker
Calling that out as anti-Arab hate graffiti.
00:41:53
Speaker
or something that we are deeply, deeply experts in.
00:41:57
Speaker
For example, the Dobbs decision, as you talked about.
00:42:00
Speaker
The Dobbs decision affects women everywhere.
00:42:03
Speaker
And we are a healthcare environment.
00:42:07
Speaker
We need to pay attention to reproductive justice for all people.
00:42:11
Speaker
And that is deep in our ethos, but it's part of our requirement as being a physician to do no harm.
00:42:17
Speaker
And it's harmful to women when you don't provide them
00:42:20
Speaker
the opportunities to access healthcare that is evidence-based and necessary for them at a particular moment.
00:42:26
Speaker
So the Dobbs decision, I'll go back to HIV.
00:42:29
Speaker
It was HIV advocacy was really important.
00:42:32
Speaker
COVID advocacy was very important.
00:42:35
Speaker
And anything that's happening on our campus is important and merits attention.
00:42:40
Speaker
But I do have to say that I think it's, I've never been a big fan of the Calvin issue of institutional neutrality.
00:42:48
Speaker
I feel it's too stark.
00:42:49
Speaker
particularly for a healthcare environment.
00:42:51
Speaker
But I think there's some value in each institution
00:42:55
Speaker
trying to make an a priority decision about under what circumstances will we issue an institutional statement and what circumstances do we not.
00:43:04
Speaker
And then I think we have to let people know about that.
00:43:06
Speaker
I think part of the challenge is things have been moving so quickly in this past year that it has been difficult to make informed decisions, not in the heat of the moment, and communicate those not in the heat of the moment.
00:43:21
Speaker
Thank you.
UCSF's Educational and Community Focus
00:43:22
Speaker
That, like all of your answers, was so thoughtful and so nuanced, which I think we need more of.
00:43:27
Speaker
And I guess I've just been thinking about some of the things that you said, which is about...
00:43:32
Speaker
always connecting to education in the statements and also the focus on messaging to and for your community, which seems to me to be one of the things that I think in the last year sometimes got lost, which was seeing statements that may have been written not necessarily for people in the community, but for as a response to things happening and pressures outside the community.
00:43:56
Speaker
I think that is helpful to think about.
00:43:58
Speaker
And I tend to agree with you.
00:44:00
Speaker
I think the Calvin report is a little too all or nothing.
00:44:05
Speaker
And I have to believe that there's a way to not kind of, as the saying goes, throw the baby out with the bathwater.
00:44:11
Speaker
Because I do think it is important for students and faculty and staff who are, you know, living and working in this environment to be seen, especially in times that are challenging.
00:44:21
Speaker
And this has been a very challenging time.
00:44:25
Speaker
I also want to point out that Howman's statement was originated at a time when universities were much more homogeneous with regard to both their faculty and their students.
00:44:34
Speaker
You know, it's easy to be
00:44:37
Speaker
neutral if you are confident that everyone around you already knows how you think and what you're supposed to think.
00:44:45
Speaker
It's much harder when you're dealing, as we are now, fortunately dealing with incredibly diverse student bodies, incredibly diverse faculty, incredibly diverse patients, and so who all do need to believe that their institution sees and feels their pain.
00:45:03
Speaker
But I think there are different ways that we can communicate that we see and feel their pain.
Personalized Communication and Trust Building
00:45:07
Speaker
Unfortunately, we've kind of gotten into the habit of expecting that that gets communicated very broadly in broad-based messages.
00:45:16
Speaker
And in fact, it probably is better to be known for the institution that reaches out to those we know who will be injured, distressed, harmed by current developments.
00:45:30
Speaker
and trust in that institutional empathy that doesn't rely on a broadcast message for all issues.
00:45:38
Speaker
I was going to say, we always end our episodes by sort of focusing on somewhat of a to-do for our listeners.
00:45:44
Speaker
Based on the kind of the things that we've talked about, is there something that higher ed professionals who are the ones largely listening to this might take or do or think about as it relates to our conversation?
00:45:55
Speaker
I always tell people, I'm not an expert.
00:45:57
Speaker
I'm just here to, as a colleague, to talk a little bit about our own experiences and my own reflections on those experiences.
00:46:05
Speaker
You're definitely an expert in this field.
00:46:08
Speaker
I would say that the most important thing, one, is to work on trust in your institutions with your, and not necessarily trust.
00:46:17
Speaker
At the institutional level, people aren't going to trust in the chancellor, but at the education level, the faculty level, your students need to trust that they can be who they are with you and that you will listen with an intent to understand and perhaps change your mind and to model that.
00:46:35
Speaker
That's so important.
00:46:35
Speaker
So becoming a trustworthy institution, a trustworthy faculty member,
00:46:40
Speaker
that's where I think a lot of support for people in times of distress comes.
00:46:46
Speaker
They know that you want them to turn to you and to understand that regardless of what they feel, you're still going to be there to support them.
00:46:53
Speaker
A second thing I would say is decide in advance what you want to do.
00:46:57
Speaker
And I think
00:46:59
Speaker
Oftentimes that's a rose-colored retrospective scope.
00:47:02
Speaker
You sort of say like, it's always easy, the Monday morning quarterbacking.
00:47:06
Speaker
But I do think that spending some time now saying, this is how we communicate concern
00:47:13
Speaker
This is when we will communicate broadly.
00:47:16
Speaker
And this is why we make the decisions that we make.
00:47:19
Speaker
Guiding principles, as it were, for institutional statements that aren't necessarily binary.
00:47:24
Speaker
We never do, or we always do.
00:47:26
Speaker
Or we only issue statements that are neutral.
00:47:28
Speaker
In which case you have to ask yourself, like,
00:47:30
Speaker
you know, why have a statement at all if it's totally neutral, right?
00:47:34
Speaker
But I think all of us could make decisions when things are quiet about the best ways for us to communicate concern, a need for advocacy with our environment.
00:47:43
Speaker
And then the last thing I would say is, it is so important for us to understand the power differentials
00:47:51
Speaker
One is the doctor-patient relationship, and you brought up, importantly, the faculty-student relationship.
00:47:55
Speaker
And when there is a power differential, that makes it that much more important for you to be careful about what you say and when, because some of us have louder voices than others, and we have to make sure we understand that and don't abuse that in the roles that we have in institutions.
00:48:15
Speaker
Thank you.
00:48:15
Speaker
I think those are all such important points, especially going back to trust, the building and rebuilding of trust that's going to need to happen, especially after this year, both on an individual level and on a, you know, there's a lot of studies about the loss of faith in the trust and institutions and even in the value of higher education.
00:48:37
Speaker
That's, you know, so important.
00:48:39
Speaker
And I just feel really grateful that I have had the privilege to talk with you and learn from you and exchange some ideas.
00:48:47
Speaker
And I think it's going to hopefully be really helpful for people to be able to sort of think a little bit more about how these issues come up in health care and in sciences, because I think largely...
00:48:59
Speaker
you know, the debate doesn't focus on that.
00:49:01
Speaker
And I'm just really grateful for your time and want to ask if there's anything else that you want to add before we have to close.
00:49:07
Speaker
No, thank you so much for this.
00:49:08
Speaker
I really appreciate being asked to do this.
00:49:11
Speaker
And also I appreciate the work that you're doing.
00:49:12
Speaker
So wishing you strength, endurance, resiliency, and hope to see more of your work going forward.
00:49:20
Speaker
Well, thank you.
00:49:21
Speaker
And to you as well.
00:49:24
Speaker
That's a wrap.
00:49:25
Speaker
Thanks again to Dr. Lucy for joining us for this important conversation.
00:49:29
Speaker
Every voter should know where to find the tools and information they need to cast their ballots with confidence.
00:49:34
Speaker
That's why we're celebrating National Voter Education Week here at the UC National Center.
00:49:39
Speaker
All week long, voters across the country can take part in a nonpartisan campaign to make sure they're ready to show up in force with this fall's elections.
00:49:47
Speaker
Celebrating National Voter Education Week means helping voters find their polling location, learning what's on the ballot and making a plan to vote and inspiring others to get involved.
00:49:57
Speaker
Each day is an opportunity to help yourself and others prepare to make your voices heard.
00:50:01
Speaker
Take these steps and learn at nationalvotereducationweek.org.
00:50:06
Speaker
Tune in next month following the 2024 national election for a conversation about democracy and voting with legal scholar and Professor Rick Hassan.
00:50:14
Speaker
And in the meantime, go vote.
00:50:16
Speaker
Talk to you then.