This is the root conflict when considering any social determinant of health in regards to the treatment of a patient. While it could be argued that medical doctors are not trained in political and social advocacy and stepping into that space would be presumptuous/overreaching, I (along with many others) argue that we cannot fully treat the patient’s disease without considering the patient’s conditions. Just as I would not ignore the potential effects of a comorbidity like diabetes on a patient’s cardiovascular health, studies show that I should not ignore the effects of poor housing, food insecurity, SES, or race/ethnicity on the same outcome.
However, simply recognizing the impact of social, structural, and economic environments in my personal cohort of patients is different from advocating for public health policy changes on the basis of their harmful/helpful effects. I, personally, think physicians should enter this sphere and become advocates for their communities, but they should not work alone. Knowing that a social determinant affects health negatively is far from knowing how to adequately intervene. Using the expertise of government officials and public health department leaders to implement change is a vital part of the process, especially because well-meaning but ill-informed/unexperienced people can do so much damage.
I think it is permissible and encouraged for doctors to be advocates in the fields that they also conduct research in. Everyone will have a disclosure or conflict of interest, but assuming that the goal of both the advocacy and the research is to improve patient health, I think research simply adds to that doctor’s wealth of knowledge. Advocacy also usually means more work with the community, so it could have a positive impact on the research, making it more culturally and socially conscious. Balancing the influences of advocacy and research just takes recognition on the part of the physician that one could affect the other. Additionally, collaboration with others in both pursuits would be useful.