Scary Word of the Day: Advocacy

by Mary Reagan Richardson, PharmD, PGY1 Community Pharmacy Resident, Mississippi State Department of Health

Advocacy is a term that is thrown around with different meanings in different settings.¹ All professional students have, at one point or another, heard the word advocacy mentioned as something they should do. But how do we advocate?  And is it something that can be taught? It seems that everyone agrees that advocacy is necessary and important but defining the competencies needed to “advocate” and measuring it are harder to come by.¹ In fact, when searching for primary literature on the topic, I found only four studies that mention advocacy.

So what is advocacy? One definition states that ”Advocacy is telling or demonstrating something you know to someone in order to improve the quality of life for others.”² The American Medical Association defines physician advocacy as, ”Action by a physician to promote those social, economic, educational, and political changes that ameliorate the suffering and threats to human health and well-being that he or she identifies through his or her professional work and expertise.”¹ There are several other definitions but they all include two central themes: knowledge propagation and a call to action.

There is a distinction between advocacy and self-advocacy. Advocacy is primarily about asking others to take action to benefit another person or a community. Self-advocacy is all about informing someone about what you or your profession can do. It is still a form of advocacy, just not done for the benefit of others. Self-advocacy is often a part of advocacy. If you cannot clearly articulate what it is you do and why only you can do it, how can you ask for an action-oriented change to occur? Self-advocacy fulfills the knowledge propagation step of advocacy.

Pharmacists, nurses, physicians, and other health professionals are all taught what it is their profession does as well as what they can or perhaps should be permitted to do. So, it only makes sense that advocacy is taught during professional degree programs. There is some evidence about the benefits for teaching self-advocacy to elementary school children, however, consensus on ways to teach how to advocate for others is not well developed.³ In my readings, it seems that advocacy can be broken down into three major types; person-to-person communication, using your knowledge to fill a need in the community, and direct, participatory communication with legislators or primary stakeholders.^1,2,3,4

For example, I am a pharmacist in a community, independent pharmacy. A patient comes in talking about how long the wait is and complains “why can’t you just put the pills in the bottle already?” There are several approaches that can be taken here: A) ignore the comment, B) apologize for taking so long C) explain what pharmacists do when filling a prescription. The pharmacy advocate would go with option C. What if that patient knew that you called the prescriber to get the dose adjusted due to an interaction with another medication? It is through these sorts of interactions, which happen every day, that we, as practitioners, educate the public about what goes on behind the scenes to improve their health. This is person-to-person advocacy.²  Calling the physician to get the dose change is also advocacy, because the pharmacist is using his/her knowledge, on the patient’s behalf, and making a call-to-action (e.g. change the dose of the medication). Advocacy in both of these circumstances enhances the public’s understanding of the pharmacist’s professional role.

Another example of advocacy is when you see a need for something in your community and take action. Like implementing COVID-19 vaccination clinics in a community pharmacy. The rules and regulations can be onerous and the additional demands of such a service can be very disruptive to a pharmacy’s workflow. However, pharmacies all over the country are implementing them to address the largest public health crisis in a century. You are advocating for your patients and community by taking on the added cost, stress, and time to administer these vaccines to improve the health of the community.

On a much larger scale, advocacy encompasses talking to local, state, and federal legislators and other policymakers about issues pertaining to your profession. However, many health professionals find it quite daunting to advocate for their profession directly to legislators. Many people are unsure of how to go about talking with legislators about what they do and the problems they encounter. The best way to prepare for these conversations is to stay up-to-date with the latest news about your profession, locally and nationally. The more informed you are as a practitioner, the better your case to a legislator will be. For example, when I spoke with a legislator in 2018 about expanding the scope of pharmacist practice in Mississippi, his first question to me was, “Have other states done this?” If I had not done my homework and known that, in fact, other states had authorized pharmacists to do similar things and the positive impact it had, that conversation would have ended right then and there. Speaking with legislators about a topic doesn’t have to be an in-person discussion. You can always send an email to your local or state senators explaining why and how you see a problem being fixed. Regularly communicating with your legislators and other policymakers is the most active and participatory form of advocacy.⁵

These examples provide a road map on ways in which we can advocate for our professions. In terms of teaching how best to teach students to advocate, there are very few published examples.  There are some residency programs that have advocacy curriculums that have been successful.⁴ Most professional degree programs include something about advocacy in their curriculums but do not have published learning objectives or competencies.⁶

I believe that there should be an advocacy course in the required curriculum or, at the very least, offered as an elective. This course would focus on how to research an issue, how to identify the major stakeholders, and how to make an “ask” (i.e. the call to action) This course should get students thinking critically about the problems their profession and the patient they serve face. A lobbyist could be brought in to discuss speaking strategies and the “how to’s” of talking to policymakers. The learning objectives and competencies should assess whether a student could effectively deliver an “elevator pitch” on an issue. Advocacy is something that becomes more natural as you practice it. For this reason, any advocacy course should have simulation activities and field-based exercises that students need to complete. Teaching students that advocacy can be as easy as talking with your family or calling your United States Senator can help make advocacy more approachable and an inherent expectation of being a professional.⁴

^References

1. RoyeaAJ, Appl DJ. Every voice matters: The importance of advocacy. Early Childhood Educ J 2009; 37: 89-91.
2. Earnest MA, Wong S, Federico SG. Perspective: Physician advocacy: What is it and how do we do it? Acad Med 2010; 85: 63-67.
3. Lee, A. (2021, April 12). The importance of self-advocacy for kids who learn and think differently. Retrieved April 21, 2021, from https://www.understood.org/en/friends-feelings/empowering-your-child/self-advocacy/the-importance-of-self-advocacy
4. Servaes J, Malikhao P. Advocacy strategies for health communication. Public Relations Review 2010; 36: 42-49.
5. Chamberlain LJ, Sanders, LM, Takayama JI. Child advocacy training. Curriculum Outcomes and Resident Satisfaction. Arch Pediatrics & Adoles Med 2005;159: 842-847.
6. Douglas A, Mak D, Bulsara C, Macey D., Samarawickrema I. The teaching and learning of health advocacy in an Australian medical school. Inter J Med Educ 2018; 9, 26-34.