Since residency application season has started, I’ve noticed interesting quirks in my fourth year classmates' Facebook profiles – first names replaced with nicknames, extra consonants being added, privacy settings tightened. It’s common knowledge that residency programs look at your social media footprint. So, people are doing what they can to make sure that they have no social media footprint for residency directors to find.
I understand people’s worries about what residency programs might see. But this Facebook-scrubbing has made me wonder – if there’s such a danger in revealing that you are a social drinker at 25 (which, let’s be real, is not exactly an uncommon thing), can it be worse if you're applying to certain residencies, to reveal yourself as pro-life (or pro-choice)? Does it color your application if your face shows up in solidarity for the 99% at an occupy (your city here) protest? What if you write about your religious beliefs or lack thereof?
The idealistic part of me wants to believe that there isn't a residency that I would actually want to be in if the residency director is not tolerant enough to understand that I may have individual views outside of my daily clinical work. But, the realist in me knows that it's not necessarily intolerance to feel unconsciously biased towards someone that has a very different set of views from you, and furthermore, it may even be reasonable when one's political and religious leanings can color the care that you are willing to provide (abortion being the common issue cited here, but certainly not the only one).
In a way, this is a risk that should be embraced when one becomes an activist in today's world. There is, fundamentally, nothing wrong with making activism part of your brand, your character, how you present yourself beyond your board scores. If I write about being a feminist in medical school and guest-post in Doctors for America about how we need to change the health care system, it shows residency programs that I am informed about the political and social issues surrounding health care and becomes a part of my brand as someone who does not just want to be a doctor, but also wants to change the world in the process. From these experiences, I would not hesitate to say that activism -- and specifically writing publicly about being an activist -- has opened doors for me in terms of mentorship opportunities, conferences and maintains my passion for being in this field even in the darkest depths of the preclinical curriculum.
Yet even when I see and have experienced the benefits, I cannot deny that I am still wary of the dangers of speaking too much as a student. There are benefits to being seen as being active in your political community, but you always have to be careful of not appearing as if you are not spending an equal or greater amount of time in class and in clinic. There are numerous issues that I can and have written about without eliciting any controversy within the medical community -- from the call for more primary care physicians to discussions of medical ethics and our social contract with society -- but for every issue I do write about, there are many more that I avoid.
I avoid writing about issues that would infringe upon patient privacy, and I avoid writing about issues that just come too close to home and may reflect badly on my institution. For the former the reasons are obvious; for the latter, I have more times than not failed to figure out how to do so without being seen as an instigator or contrarian.
Yet, I know that it is the issues closest to home where medical students and doctors may be the most able to have the greatest impact. The most inspirational talk I have heard yet about physician activism was by a doctor that spoke up when her hospital was being taken over by a Catholic medical system. She advocated for her patient's rights and though she was unable to prevent the merger, she was able to educate her colleagues and their patients about what services they were and were not able to receive under the new system, critically facilitating care and communication.
As students we also have the potential to play the role of the patient advocate within the system by virtue of having the most time to really see what it is that patients go through within our hospital system. In many cases, there are avenues for us to bring these concerns to light in a way that is noncontroversial, revealing inefficiencies in the system and ways that doctors could try to alleviate it but failed to due to lack of time. But I can't help but wonder when there will be situations where gentle reminders will not be enough and yet we will still not have the authority to speak up and really push for the real changes that need to be made to improve patient care.
I don't really have any answers for how to best navigate all these competing concerns and aspirations as a student. Perhaps the wisdom of taking things one at a time must apply here. Sometimes, you do have to start small, with advocacy programs that are led by your mentors and teachers, rather than trying to strike out on your own at a local issue. Nevertheless, regardless of what you decide to do, it is important for students everywhere to remember that activism, online or offline, is never about silence, but about choosing what you need to say.