Over the past year we have seen the best and the worst of human nature. The outpouring of selfless acts of care and generosity for those afflicted with COVID-19, hunger, poverty, and homelessness are manifestations of our sense of commitment to community, sharing, and compassion. Acts of kindness and altruism large and small have brought light at a time of great darkness. Paradoxically, we have witnessed an escalation of hatred and violence. Senseless murders, mass shootings, racially and religiously motivated attacks, and viciousness at the hands of those pledged to protect us have stunned our senses, raised fear and anxiety, and divided us as Americans. Some of this violence is seemingly random and directed at innocent bystanders, yet it affects us all. Recently, much of this hatred and violence has been directed against communities of color, Asian Americans, and those of Jewish and Sikh faiths.
As a community of physicians and educators, we have responded with words of comfort, words of outrage, and calls for justice. As those dedicated to improving the health and well-being of individuals and communities, we cannot sit idly by as lives and futures are lost through senseless violence. Yet we as caregivers often feel powerless to address the deep roots of the problems that lead to this violence. Still, we yearn for solutions that support the creation of a just society, one which recognizes the dignity and value of every human life. As important and powerful a force as health care is in the United States, we are not the primary or most powerful movers of these issues. The other societal structures, such as the public safety net, the legal and law enforcement systems, community and religious leaders, and our local and national political leaders, are the mechanisms of culture change on which we must rely. We must support these societal structures to make positive change. We must reach the heart of each member of our society.
We must not abdicate our responsibility to assist, align with, and energize the efforts of others. If we as individuals in the healing arts espouse and model behaviors and actions that demonstrate compassion for others and speak with understanding and respect for every person we encounter, we have the collective power to move our shared culture in a positive direction. As a major part of the economy and as an employer of a significant portion of the population, American health care can demonstrate its commitment to human dignity. Through the elimination of racial and other biases from our hiring and promotion practices and by ensuring that no individual working full time in our health care systems has an income below the poverty level, we can have a powerful impact on the health, safety, and well-being of many thousands of individuals.
As health care providers and practitioners, we cannot do this work alone. We must collaborate with people, institutions, and social systems that seek to ameliorate the circumstances that lead to violence. We must acknowledge our limits as clinicians and recognize the strengths that others – perhaps not typical partners of health care – can bring to address these challenges. As we have learned from our experiences with COVID-19 vaccination and other efforts in population health improvement, to be effective, we must develop outreach and partner with community groups to make good on our commitments and make a positive difference. We must expand these efforts.
This cycle of violence that relegates the death of a child in a McDonalds parking lot to an afterthought on the evening news must end. We must not tolerate the assault of an elderly Asian woman on the street as a curiosity, or the death of a person of color (or anyone else) at the hands of the police. We must not accept mass murder in our society… just as we as physicians cannot tolerate the loss of any life entrusted to our care when we have the power to heal and improve that life.
As an organization with a strong set of core values, the ACGME pledges to make its behaviors, both within the organization and beyond, a model for the profession. With humane and civil treatment of one another, and respect for our colleagues and patients, we can establish the foundation for a civil and respectful society. This is a nidus, but this is not enough. We all must move beyond our own organizations’ values and behaviors and come together to face this difficult challenge. It is a challenge that we, as an entire profession, must answer if we hope to live in a world where all are treated fairly and with respect for human dignity.
Medicine’s response to the COVID-19 pandemic has given us the moral platform to address these critical issues more broadly. Now is our moment. We must use it or lose the opportunity to change the dehumanizing, self-destructive patterns we’ve witnessed throughout this last year to one of hope, solidarity, equity, and well-being for everyone in our society. We each can make a difference. To paraphrase Anita Roddick, “If you ever think you are too small to make a difference, you haven’t been in bed with a mosquito.”
Thomas J. Nasca, MD, MACP
ACGME President and Chief Executive Officer