Advocacy for change: An important role to undertake with care

Physicians have a long history of speaking up on behalf of patients, countering clinical misinformation, and advocating for healthcare improvements. The CMPA supports physician advocacy, but there may be times when advocacy efforts can create medico-legal risk. Consider the following before engaging in healthcare advocacy.

You may need consent before engaging in an advocacy campaign

If you work in a hospital or institution, you may need consent from your administration before embarking on advocacy activities that may be seen as directly involving the hospital or healthcare organization. Even if consent is not required, you should follow appropriate channels and notify administration in advance of engaging in an advocacy campaign.

You should also consider whether it is necessary or appropriate to discuss your proposed comments or activities with other parties who may be affected – such as members of a healthcare team or patients and family members.

Whenever you are engaged in advocacy, you should be clear about whether your comments are being made in a personal capacity or on behalf of a third party, such as a hospital or healthcare organization.

If you work in a hospital or healthcare organization, you may face specific requirements

Physicians working in hospitals or healthcare organizations may face specific requirements when advocating for patients or system change. For example, doctors working in facilities are generally expected to channel their recommendations for change through committees or department heads. In some instances, there have been disagreements between individual doctors and hospitals or health authorities where the hospital or health authority had guidelines, bylaws, or policies governing advocacy but these were not followed.

It is generally not considered appropriate to advocate for system changes at a hospital or healthcare organization through public platforms such as social media or traditional media without permission from the hospital or healthcare organization.

Despite these challenges, physicians can play a much-needed role in helping improve and sustain the healthcare system. This can include being involved in structural changes, priority setting, resource allocation decisions, quality improvement projects, advocating for health equity, or initiatives to improve patient safety. Everyone who advocates within the system should demonstrate recognition of competing demands.

When advocating within your institution, we recommend that you:

• Try to approach issues with transparency, professionalism, and integrity. We recognize that these terms can be defined in various ways, but try to remain mindful, and keep this approach on social media. For example, use appropriate language, and review the entire thread of a conversation or any embedded links before retweeting.
• Work within approved channels of communication. For example, do not publish comments on social media or in traditional media regarding system changes without first obtaining permission from your hospital or institution.
• Discuss concerns, suggestions, and recommendations calmly.
• Provide an informed perspective, and seek the perspectives of patients and other healthcare professionals.
• Use evidence to help persuade others.
• Remain open to alternative suggestions or solutions, and try to build on areas of consensus.
• Recognize that not everyone may share your views on the changes you feel are necessary, and even if your proposal is considered a good idea, not all ideas can be implemented at once, or at all.

Review College and organizational policies and resources

Many medical associations, federations, and organizations have developed programs, policies, and statements that define the role of physicians in advocacy. For example, the Royal College of Physicians and Surgeons of Canada CanMEDS Framework recognizes health advocacy as a key competency and responsibility of physicians , and the Canadian Medical Association offers an advocacy coaching program  for physicians and medical students.

Colleges have also made efforts to clarify how physicians can advocate responsibly. For example, the College of Physicians and Surgeons of Nova Scotia’s Professional Standards and Guidelines Regarding Advocacy and Public Communications by Physicians  emphasizes that when physicians are advocating, they must “ensure all public communications are grounded in science and address matters within their scope of practice.” In Ontario, the College has a policy on Physician Behaviour in the Professional Environment  that recognizes advocacy as an important component of the physician’s role. In Québec, the advocacy role is embedded in the College’s Code of Ethics of Physicians . 

Some Colleges also have policies or guidelines concerning social media use, which may apply to advocacy conducted over social media platforms. Examples include the CPSO’s Social media policy  and the CPSA’s Social media: Advice to the profession .  

Additional reading

• Media requests: Points to consider if you are asked for an interview
• 10 tips for using social media in professional practice

DISCLAIMER: This content is for general informational purposes and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. Your use of CMPA learning resources is subject to the foregoing as well as CMPA's Terms of Use.