Symposium: social paediatricsAdvocacy and the paediatrician
Section snippets
Definition
Advocacy is arguing or speaking out on behalf of a particular issue, idea or person.1 Paediatricians advocate for children because they are vulnerable and not usually able to speak for themselves. Arguably, the parent is the best advocate for a child, but parents may not be effective in ensuring the best outcome for their children. Sometimes advocacy must extend beyond what the parent might consider as his/her remit e.g. tackling systems and issues within society; paediatricians may be better
How is advocacy relevant to the work of paediatricians?
Paediatrics differs from other medical fields because it is as much about the life and health of a child as it is about disease. It is rare for management to include only diagnosis and provision of treatment. In almost every case, consideration of the effect on nutrition, growth, development, education, and psychological and emotional relationships is required. For example, in newly diagnosed diabetes, the child’s understanding of the condition, school meals, and future monitoring of growth
Training paediatricians to be advocates
Experience shows that training can help paediatricians understand the need for advocacy, and ways to improve implementation.6
Fundamental to developing advocacy skills is the incorporation of advocacy-related competencies into postgraduate training curricula.5, 7 There is no greater motivation for acquiring skills than being assessed as competent at them, but there is a distinction between being trained in advocacy and consistently practising it.
Perceived barriers to advocating
The barriers proposed by trainees to incorporating advocacy into everyday practice (Table 4) should be appreciated because solutions can then be sought.
Overcoming barriers to advocating
Counter to the arguments proposed in Table 4, paediatrics has much potential for advocacy (Table 5). There is a fine line between maintaining a professional stance and speaking out when it might not be received favourably. Advocacy does not mean storming the White House or number 10 Downing Street; instead, it is using the wherewithal of professional expertise, credibility and experience to draw attention to issues and execute beneficial changes. ‘Silence is the voice of complicity’ is the
Practical suggestions
Practical suggestions for getting advocacy into everyday practice are detailed below.
Use study leave for advocacy courses.
Undergraduate curricula: integrate advocacy training into undergraduate curricula (e.g. as in courses at Cardiff University, UK, and East Anglia University, UK).8, 9 The earlier trainees get engaged, the more natural it becomes.
Postgraduate curricula: ensure advocacy is included in postgraduate masters child health courses (e.g. as in MMedSci10 at Leeds University, UK)
Resources to assist advocacy
Various tools can expedite the task of advocacy for the paediatrician wishing to speak out (Table 6).
Advocacy in practice: case studies
Four examples are given from different levels of practice: local, national and international.
Summary
The paediatrician who includes advocacy in their daily practice will find that the difference it can make to children’s health ranks with prescribing antibiotics or organizing nebulized corticosteroids for an asthmatic. It requires working together, thinking ahead, partnership with parents, and plenty of persistence. Working together with young people can also be immensely rewarding.
We hope that this contribution helps more doctors and trainees to ensure that they develop competency in advocacy.
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