Primary care physicians are uniquely positioned to go beyond the immediate needs of their patients. Everything from writing a prescription to examining the larger, more daunting socioeconomic and environmental factors that affect their patients’ health and well-being falls within their scope of work.

“When physicians have a trusting relationship with their patients, there are things that are disclosed between the walls of an exam room that many people would not disclose otherwise,” says Brittany Watson, MD, Harvard Commonwealth Fund Fellow. “It's important for all clinicians to remember that they are an advocate in that space, because our patients don't necessarily know how to navigate and access the things they need.”

Patient needs are often symptoms of societal and systemic shortcomings. This is where the role of the physician becomes more external-facing, requiring physicians to not only treat their patient's medical concerns, but also champion changes on a larger scale.

Climate change advocacy

Gaurab Basu, MD, MPH, climate and health curriculum theme director at HMS, suggests a primary care physician needs to have “an expertise in embracing the bigness.”

Basu has shown this desire in his own work as he led the effort to add climate change and health as a theme in the HMS M.D. curriculum—an initiative that was approved earlier this year. Beyond individual patient care, this new theme will be woven throughout students' learning, helping them to connect and better understand the negative health effects that result from climate change.

While the effects of climate change may feel overwhelming, this enrichment of the curriculum will, in the words of Caleb J. Dresser, a Climate and Human Health fellow at the Harvard School of Public Health, “be increasingly important for people in leadership roles in health care and other industries to integrate climate change and climate-related hazards into their strategic decision making as they lead organizations.”

Advocacy through enablement

Advocacy must be sustainable. This is important not only for the longevity and empowerment of communities but also for the energy and health of the physicians.

“Over the past 10 years, the public has moved away from viewing the physician as a savior, which is really critical,” said Basu.

Juliana Morris, MD, EdM, a family physician based at MGH Chelsea, is a physician advocate who collaborates with grassroots, community organizations. Morris uses what she has learned over the years to support advocacy work led by directly affected community members. “Initially when changes are first happening, it can be tough,” said Morris. “It's important to be rooted in the community you are working with.”

Prior to her current fellowship, Watson was a primary care physician at a federally qualified health center in a state that had not expanded Medicaid. “All of my patients had significant external challenges that affected their health,” she said. “It can be hard to triage and prioritize everything in a 15-minute visit. There are big issues and figuring out where to begin can be a challenge.”

Watson suggests advocating for advocacy time during the workday. “Having that time is important and putting a value on that time can be difficult,” she said. Traditional fee-for-service payment models rarely account for this, but value-based payment models create the structure and time needed for care teams to collaborate on improving patient outcomes and population health—both of which could tie into advocacy opportunities.

Patients are often shut out from the halls of power they need to access to advocate for themselves. This is where primary care physicians come in, sharing tools to speak up, opening doors, and continuing to be close to the patient, offering their own voice when needed and able.

Grand rounds to reimagine care

The Harvard Medical School Center for Primary Care is hosting primary care grand rounds that reimagine primary care in an era of opportunity. Watson, Basu, and Morris discussed advocacy in primary care during a grand rounds session; the full recording can be viewed here. Visit the Primary Care Grand Rounds webpage to register for upcoming live sessions and earn CME credit.

**Feature photo obtained with a standard license on Shutterstock.

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