Social Justice and Professionalism in Psychiatry

Dec 21, 2017

In 2002, the American Board of Internal Medicine (ABIM) and the European Federation of Internal Medicine (EFIM) issued a "Physicians Charter" entitled "Medical Professionalism in the New Millenium." The charter espouses three fundamental principles of professionalism: the primacy of patient welfare, patient autonomy, and social justice. It is the third principle I want to focus on here. What is "social justice" as it pertains to professionalism in psychiatry? What are the implications of how we define "social justice" for training and for AADPRT?

The Physicians' Charter includes in its definition of social justice improving quality of care, advocacy for a just distribution of resources, and promoting scientific knowledge. A recent resident retreat on social justice at my medical school, (organized by the Cambridge Health Alliance general psychiatry residency program), included topics such as diversity training, DACA, refugee mental health, privilege, racism in psychiatry, LGBT trainee experience, health care disparities, advocacy, the Goldwater Rule, and racial bias. Another retreat, this one for faculty members, focused on promoting respect across differences as part of improving the learning environment.

This year AADPRT's Steering Committee (SC) has been asked to support a variety of issues that might fall under social justice: Legislation to promote NIH funding for mental health research and education; advocacy efforts to support medical students and trainees affected by the DACA repeal; and an effort to promote language about diversity among residents, faculty, and staff in ACGME requirements. In the case of AADPRT, the SC weighed each request for support in the context of our educational mission "to promote excellence in the education and training of future psychiatrists," and supported initiatives that felt consistent with our mission.

Learning psychiatry through didactics and seeing patients is a contextual activity. ACGME has recognized the importance of the "learning environment" at an institutional level. Should the boundary stop there? This year, societal context has seemed more important and broader than ever; our allied organizations such as AAMC, AACAP and APA have issued statements in response to a number of political actions. AADPRT's leadership has actively considered how our mission and role as an organization of psychiatric training professionals fits into today's society. Where should the contextual boundaries of AADPRT and psychiatric training lie? How do we practice and teach "social justice" while respecting the different views--political and otherwise--of our residents and members? How do we protect what we believe is important in psychiatric training without overstepping our role as a non-lobbying organization? How do we come to consensus about, acknowledge, incorporate, and perhaps advance societal change?

Similar to the current debate about the Goldwater Rule, AADPRT will need to continue to think about its identity in relation to social justice. Will we narrowly define our role to what we have direct "expert" knowledge about? Or will we embrace a role in a "social contract," (as the Physicians Charter describes), in which affecting social context is part of what we do?

Warmest wishes to you all for 2018. See you in the Big Easy!

Sandra M. DeJong, MD, MSc