"Service: Never have this word on your lips, but keep it in your hearts."--Albert Schweitzer
In January 2010, a group of pre-medical students asked me to join a panel discussion at the University of Chicago on volunteerism in medicine. I agreed, and the organizers met me over dinner to discuss what the panel's approach would be. After our meeting, they switched the topic in our private e-mails to civic engagement in medicine. In the invitation to the undergraduate body, they described the topic of the evening as community service in medicine.
Suddenly, I didn't know what I was supposed to talk about. I was stumped by the differences between these interrelated topics: volunteerism, civic engagement, community service. The day before the panel, I turned to Wikipedia to help me out.
Civic engagement suggests the collective wisdom of our age, is "individual and collective actions designed to identify and address issues of public concern."
The American Psychological Association describes civic engagement as community problem solving, regular volunteering, active membership in a group or organization, and fund raising for charity. There is also the electoral/political voice side of civic engagement—contacting elected officials, the print media, broadcast media, protesting, petitioning, boycotting and canvassing in the name of what you believe in.
My participation in Doctors for America is civic engagement, as is voting. Every time I write a letter to the editor or call an elected official, I am engaging civically. I do all these things. But that is not what I do every day in my clinical work in a federally qualified health center. Nor am I a volunteer, exactly.
Volunteering, according to Wikipedia, is done for altruism, to promote good, meet others and make professional contacts. That didn't describe quite what I do in my day to day work as a family physician in a community health center. I promote good, I meet my colleagues and my patients (who on occasion invite me to music in the park or, my favorite, bring me buckets filled with tomatoes and pimento peppers). But I get paid for my altruistic work, albeit at a rate far less than what I could earn if I were working elsewhere. So perhaps I do volunteer about two fifths of my time, for a two fifths lower salary and a job I love. Is my day to day work in a community health center community service?
Wikipedia defines community service as a double edged sword. It is part altruism in one's community, with people working on behalf of others without payment. Or, on the other side, it is punishment. Instead of jail time, you do community service. In order to graduate high school, you do community service. So serving the community becomes a hurdle to stay out of prison or be released from high school.
What I do day in and day out, I realized as I toured volunteerism, community service, and civic engagement on Wikipedia, is linked to a fourth category of altruism in action, called service learning. Service learning is a method of teaching, learning and reflecting with experiential education and community service. The instruction I get comes from my superiors, books and colleagues. The experiential education is going to the clinic every morning and taking care of patients, dealing with diseases and personalities and social systems, all of which can be causing illness in the patient in front of me.
The reflection is something I set up for myself, as a way of consolidating all I learn. I learn medicine, of course, raw facts and differentials and diagnostic and treatment plans, as I need to expand my knowledge to take care of patients. More importantly, I learn how to handle difficult situations, difficult patients, difficult social systems and the craziness that is American medicine today.