A “Sermon” for Medical Students about Civic Character

 Guest Director’s Corner

A “Sermon” for Medical Students about Civic Character

Mark D. Schwartz, MD

If individual character is what we do when no one is looking, civic character is what we do when everyone is looking!
-Eric Liu “Citizen University”

I remember the excitement and fear of drinking from the fire hose as a medical student in the 1980s. I was aware of, but could not fully understand, how the AIDS epidemic was shaping and honing my professional identity, just as the current pandemic is shaping yours.

In this moment when the country is sick and suffering – when our health, our economy, and democracy are threatened and when science itself is being undermined – we need to impact the world beyond our next exam, our next rotation, our next patient, or our next scientific hypothesis.

Given the situation we are in, let’s talk about what it means to be civically- engaged physicians and scientists in this new world. Here are some simple but profound questions I have been living in, wrestling with, and trying to answer:

• Given our positions, capabilities, and resources, what are our responsibilities? And for whom are we responsible?
• What are our roles as a civic physicians, civic scientists, and civic healers?
• How can we use our professional roles and power to strengthen democracy?

I can’t tell you what your answer should be, but I do know that we need to think bigger.

Physicians have privilege and tremendous, untapped power. Power is misunderstood and mistrusted, yet there is no greater mechanism for positive change than through the harnessing of power and creating civic action. Power calls physicians to be positive agents of change in our communities.

Where and how do we begin?

I can guess what you are thinking. Listen – I get it. I am a doctor, a professor, a researcher, and a leader. I would put my “To-Do” list up against anyone’s! I know how unthinkable it is to add one more task. It is overwhelming enough to develop into the best doctor or scientist you can be.

Besides being incredibly busy, I hear other reasons why physicians and scientists are hesitant to engage in strengthening our democracy. Here are three of them:

Who can fight big money?

Science and politics don’t mix!
It’s not my job

Let me unpack these with you.

Myth #1: We shouldn’t engage in strengthening democracy because Who can Fight Big Money?

Undoubtedly, our democracy is driven by money and power. How can the rest of us ever have a voice? How can we not throw up our hands in cynicism and despair when we see how big oil, big banks, and big medicine turn policies, laws, and regulations in their favor? Here are two reasons why I am optimistic about your chance to make changes.

The first is that you have more power than you think. As voters we exercise a vital act of civic power, and forming, joining, and aligning forces supercharges your civic power. Organizations like the American Medical Association, American Hospital Association, or the Association of American Medical Colleges are out there every day, shaping how we educate, train, and practice medicine and science. When you align with your school’s advocacy agenda, national student organizations, and professional societies, your voice is amplified. Take advantage. As Samuel Adams, who incited the Boston Tea Party, famously said: “It does not take a majority to prevail... but rather an irate, tireless minority, keen on setting brushfires of freedom in the minds of men.”


The second reason why I am optimistic about your chances is that culture eats policy for lunch every day. Although policy includes the levers of public laws and regulations, culture – our norms, civic ideals, beliefs, habits, and practices – shapes our society’s norms, values, and the spirit of democracy. Culture is tied to our “civic character.” If individual character is what we do when no one is looking, civic character is what we do when everyone is looking! Civic character and behavior are contagious. If you doubt this, look around the country and notice how different regions of the U.S. have responded differently to the pandemic and our emerging social conversations.

We mimic what we see – what we do grows and becomes social norms. We are not stuck in traffic – we are traffic. We are part of the ecosystem we create. Democracy is not a machine, but a garden that needs active tending – like a garden, it needs water, sunlight, planning, understanding and respect of cycles, weeding, and adaptation.

So, what can you do in your daily life to promote civic character and to close the gap between our ideals and our practice in this American democracy
project? What does it mean to live like a citizen? John Wesley, the founder of Methodism in the 1700s, said, “Do all the good you can, By all the means you can, In all the ways you can, In all the places you can, At all the times you can, To all the people you can, As long as ever you can.”

We need to think bigger!

Myth #2: We shouldn’t engage in strengthening democracy because Science and Politics Don’t Mix!

I teach a course on research methods each summer. Physicians and scientists venerate evidence. It is the ground on which we stand to do our work.

Were you as concerned as I was when it appeared that we were being pulled into an evidence-free world? Where truth becomes truthiness? Where each of us has our own dictionaries, our own encyclopedias, our own fragmented sources of evidence? Where national, scientific experts are pushed aside, data disappears, and evidence is ignored by our leaders?

I’ve got data, you’ve got data, we all have data. The power that you have, given your position, is to bring these data to life – with real, lived stories about how all these data play out in the world and affect real people. With cameras on computers and phones, I have been inside the lives, families, and homes of many people suffering or worried about COVID-19. Yes, I have graphs of rising and falling cases and deaths, but I also have stories of loss, fear, hope, and how families and communities are coming together to help us heal, cope, and mourn. We are in a unique position to link data to stories. People will listen.

As citizen physicians and scientists, we have the responsibility to tell these stories, to bring the data and evidence to life. Each of us can strengthen our democracy by telling these stories to provide compelling, living context for our science, our data, and our evidence.

We need to think bigger!

Myth #3: We shouldn’t engage in strengthening democracy because It’s Not My Job to Fix the Country

As a physician, my job is to help one person at a time when they come to see me.
Of course, only about 20% of health is affected by what doctors and scientists do in the office, the hospital, the lab. The other 80% is explained by our genes, our individual and civic behaviors, and the social determinants of health – where we grew up, learned, lived, worked, and played. These social determinants, with their history and the ways in which they are baked into society’s institutions and structures, all drive the disparities that the twin pandemics of coronavirus and of racially-targeted violence and injustice have made undeniable.

Each day, we look into the eyes of the patient in front of us, to plumb the depths of a scientific problem, and stare into the computer to do the work we are preparing to do. That is difficult, valid, valiant, and vital work, but it is not enough. If we want to have a larger, more enduring impact, we must lift our eyes from the patient, problem, and computer and embrace the context and culture of our populations and communities.

We need to think bigger.

I teach a course on health policy, and so I get to watch students learn the language, the anatomy, and the physiology of how health policy is made. Their brows furrow and their faces get heavy as they grasp our crazy-complex policy machinery. They discern how policy is shaped by money and by self-interest.

But I have also seen their faces brighten after they pick a policy issue about which they are passionate, prepare and practice their advocacy pitch, and visit their representatives in Congress. They are surprised how easy and how important it is to engage as citizens and to leverage their power as future physicians and scientists. Participating in acts that engage our civic character strengthens our democracy and repairs the world, given our position, our capabilities, our resources, and our power.

A central tenet in Judaism is the responsibility we each have of Tikkun Olam, that is, to repair the world. We can’t do the entire work, but we are called to do what is in our reach to knit together the broken ends and to partner in the work.

So, I leave you with the questions with which I began:

• Given our positions, capabilities, and resources, what are our responsibilities? And for whom are we responsible?
• What are our roles as a civic physicians, civic scientists, and civic healer?
• How can we use our professional roles and power to strengthen democracy?

As a leading rabbinic scholar, Rabbi Tarfon, taught 2000 years ago, "It is not your responsibility to finish the work [of perfecting the world], but you are not free to desist from it either.” My charge to you is to wrestle with these questions, connect with one another to engage the world where you can, and spend your careers searching for the answers. By developing and sharing your civic character, your work can lead to lasting change.

Thank you.

Dr. Schwartz is a Professor of Medicine and Population Health, Vice Chair for Education and Faculty Affairs, Department of Population Health, New York University Grossman School of Medicine. In 2010, as a Robert Woods Johnson Health Policy Fellow he “staffed” the Ways and Means Committee in the U.S. House of Representatives while they wrote the Affordable Care Act. He leads pre- and post-doctoral fellowship programs in population health and health policy.