Stiffen the sinews, summon up the blood, and strain upon the start: enfranchising the medical profession for clinically proximate advocacy of improved healthcare

Abstract

Objective: To discuss and reflect upon the role of medical practitioners, including psychiatrists, as health advocates on behalf of patients, carers and staff. Conclusions: Health advocacy is a key professional competency of medical practitioners, and is part of the RANZCP framework for training and continuing professional development. Since advocacy is often a team activity, there is much that is gained experientially from volunteering and working with other more experienced health advocates within structurally and financially independent (of health systems and governments) representative groups (RANZCP, AMA, unions). Doctors may begin with clinically proximate advocacy for improved healthcare in health systems, across the public and private sectors. Health advocacy requires skill and courage, but can ultimately influence systemic outcomes, sway policy decisions, and improve resource allocation.

Reflections on, and responses to, managerial adverse reactions to healthcare advocacy by psychiatrists and trainees

“…This can be underpinned by healthcare governance boards assuming responsibility for staff well-being and workplace culture, 18 and enfranchised medical practitioner representation in corporate and clinical governance. 6…”

“…2 These managerial failures place psychiatrists and trainees at risk when they speak out in healthcare advocacy on behalf of their patients. 6 Advocates might be concerned about threats to their professional careers and negative reactions extended to their colleagues. This has been exemplified in a recent survey at the Bunbury Hospital regarding workplace culture where, in a survey with a 71% response rate (56/78), 83% of the respondents stated they 'feared victimisation as a result of raising concerns about decisions taken by Senior Executive....' 7 These issues may be accentuated by managers' reactions to negative media attention.…”

“…Advocacy for safe and effective healthcare requires interaction with patients, peers, managers, healthcare organisations and NGOs, governments, politicians and the broader community. 6 While doctors and others can collaborate on advocacy, doctors acting as advocates may also encounter resistance, including negativity, incivility and bullying, especially within healthcare organisations. Having previously discussed practical strategies to promote effective healthcare advocacy, 6 we focus here on managerial-level adverse responses such as workplace bullying and harassment, and present advice on countering such resistance.…”

“…3 Recent recommendations have called for the implementation of specialist ID mental health (IDMH) services to support mainstream services. [4][5][6] However, there is a lack of evidence regarding the optimal design of mental health services to meet the needs of people with ID. 7 To address this, our team undertook a scoping study of the need for an adult tertiary IDMH service in New South Wales (NSW).…”

The Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA): Aims, model, outputs, and implications for clinical academic advocacy

“…The CAPIPRA network provides independent evidence-based advice, informing policy discussion, development and implementation through synergy with medico-political advocacy groups. 31 It has been an intellectually stimulating, enjoyable and rewarding experience. While recognising there are political differences between the countries, we encourage Australian and New Zealand researchers to collaborate, and are especially interested in mentoring early career researchers.…”