Good Medicine explores today’s healthcare environment through the lens of one essential attribute. Last time, we discussed the importance of persuasion with Maven’s Dr. Neel Shah. And today, we’re going to explore “advocacy” with the founding member of Doctors for America and co-chair of the Board of Directors of Healthcare Without Harm Dr. Alice Chen.
Injustice and inequity are everywhere in healthcare. It slaps you in the face every day in the exam room: the patient who can’t afford their medications, the woman whose symptoms were ignored for too long, pain that is stigmatized because of a man’s race, prejudice against a past addiction, or even something so simple as getting an appointment with a specialist. It can be so overwhelming that you go numb, ignore it, keep moving forward, and go home at night to start again the next day. But then sometimes it becomes too much and you wonder if you can do something.
You ask “Why advocacy?” for this month’s edition of Good Medicine. It’s because injustice and inequity are everywhere in medicine, wrapped so tightly in its systems and structures that it can seem impossible to unravel. And yet some people decide to take a stand and pull at the strings. One of those people is Dr. Alice Chen.
She literally is the doctor advocate.
Alice’s story
The child of Chinese immigrants from China, Alice grew up in San Francisco. She was the “kid who ran every club,” not because she wanted titles, but rather she was the one who raised her hand. One time, as the leader of her environmental club she wondered “What should we do?” So she wrote a letter to the forestry department asking for tree saplings and to her surprise, they sent 40 to her school to be planted (incidentally, environmental activism has been a throughline in her life).
As I discovered during my conversation with Maven Chief Medical Officer Neel Shah last month, sometimes thought leaders have family histories that quietly inspire them throughout their lives. It turns out that Alice’s great grandfather was Fang Shengdong, a Chinese revolutionary. A man who originally wanted to pursue medicine and in fact went to Japan to study, he gave up the pursuit in order to promote democracy in defiance of the Qing dynasty. He knew his life would be in danger, but he felt he had“to do something.” Sadly, he died advocating for his beliefs but this story left an indelible impression on Alice. She felt the historical weight of a “promise he was not able to fulfill.” It made her realize that there is a “greater responsibility that each of us have…to our society, to our country, to all people.”
As Keanu Reeves might say outside the circle K…Woah.”
If we think carefully, we can almost always point to an event in our lives that irreversibly sets us down a certain path. For Alice, 9/11 happened in her third week of medical school during a lecture on cholesterol metabolism(Oddly, I was in the middle of biochemistry at the time). For her, the immediate and natural reaction was to “do something to prove that this is not what people are, that we're kind and we're loving and we look out for each other.” So she did what she could, wherever she could.
One job she took on was as a caseworker for the Chinese community in Lower Manhattan given her fluency in Chinese. The people there were struggling – the area was shut down, and they could not work,. One lesson she took from that experience was the importance of listening. When you work with someone in that circumstance, she told me, “The first thing you do, you put down your pen and you just listen. You see the person as a human being.”
She continued: “So many of them were immigrants and they had come here to pursue the American dream and take care of their family… with hard work. And all of a sudden they had failed. They couldn't buy groceries. Their kids were hungry. They were about to be evicted. And just the act of sitting and listening to them and validating them and saying, this is not your fault. We see you and we're going to help you out and you're going to be OK. You'd see them walk out of there with their heads up high like, OK, I'm going to make it.”
For Alice, this made the rest of medical school all the more meaningful. All those people she helped..they were the why behind it all.
On hearing the call
Before 2008, Alice had never been involved with a political campaign. She was a hospitalist, so she had time on her hands on the odd weekend or evening. And during this time, she ruminated on all the ways that our healthcare system was broken. The “number of people who were uninsured, or couldn’t get the prescriptions [or care] they needed…the number of people whose “health insurance was terrible.” Again, she had to do something. So she volunteered to knock on doors and talk to voters for the Obama campaign. She became the local expert on the candidates’ various platforms - both Obama and McCain’s proposals for health care - so that she could sit down with her fellow physicians to walk them through it. She both listened and persuaded (them). The rest is history.
Though Obama won the election, her patients still needed help. And so now came the hard work of getting some legislation passed. “I’d never run an organization… or helped pass a bill, but ended up creating an organization called Doctors for America,” she said. Through that group, her peers marched in the streets, learned to talk to the media, and they linked up with other organizations advocating for health care reform.
To this day, Alice said she’s most proud of being part of the passing of the Affordable Care Act - even a small one. And she should be…The ACA was a multi-generational accomplishment! One story she told me really highlighted the impact of Doctors for America. In the summer of 2009 during the August recess, there were intense lobbying efforts to squelch the ACA. The White house was feeling pressure to drop its commitment to the ACA due to the fierce protests and its impression that the ACA might be a “losing issue.” But Doctors for America told the White House that the issue was too important to table because, as Alice put it, her “patient’s couldn’t wait... If we call it quits now, it's going to be another 20 years before we try again, because it had been like 20 years since Clinton had tried. And we were just not willing to accept that.”
The White House told Alice to secretly bring Doctors from every state for a Rose Garden ceremony where they would stand united advocating for the ACA. “We need them to fly themselves in to DC. There's no budget for this. And nobody can know about it because if the press gets wind of it, we're calling the whole thing off.”
So they had 10 days to find all these doctors. Frantically, Alice began making calls. She told me, she called up one physician and said “Hi Dr… you are in Idaho? It's a Friday night. You're in the middle of doing charts. You don't know me. I'm Alice Chen. I send you a lot of emails. And can you fly yourself to the White House in like a week and say that you're in favor of the Obama health plan? And then all of a sudden everyone flew in from all over the country.”
After the Rose Garden Ceremony, the White House was rejuvenated. They felt they had the momentum. Members of Congress had renewed resolve. Sherrod Brown, Senator from Ohio, remarked to Alice “you do not know how much that moment meant to us. All of us on the Hill, we were skittish, we weren't sure if this was gonna happen. And all of a sudden we turned on our TVs and we saw all of you in white coats standing with the president. And we said, we have to get this done.”
In 2024, we all take for granted that so many people now have access to health care, that they can’t be denied insurance for pre-existing conditions, and more. But the lesson here is that the ACA didn't just happen. Like most people at the time, Alice could have recognized the failures of the health system but just gone about the business of doctoring. Instead, she had that urge to do something. She had the urge to show herself and her colleagues that their voices as doctors mattered. And those efforts, small at first, compounded over time. Put differently, How does a dandelion break through the cement? Just a little bit of pressure every day.
On the Importance of Story
Doctors will often talk themselves out of advocacy because they don’t view themselves as the foremost expert in that area, according to Alice. But she reminded me in our interview that regardless of someone’s level of expertise or years of service, any physician can speak to their own story, their patients’ story and their own experiences.
“We are a trusted part of society - yes we have people who yell at us and don’t trust a word we say - but overall… people trust their own doctor, so when we speak up, people do take note.”
In fact, one of her most proud moments from Doctors for America was “Seeing that spark where [physicians] say ‘oh wow I just created some change!” She said that she once heard from a Member of Congress that when five doctors call his office in a single day, it means red flags are going off. Her advice is “just talk to them” (the political class) behind closed doors, because there’s a willing audience for those conversations. “We have trust that they don't have. The difference between trust in doctors and trust in members of Congress is pretty massive” so the opportunity for us as MDs to make an impact is quite substantial.
Her parting push for her fellow physicians? We “need more doctors who are out there running for Congress and running for governor and running for president. People who are doctors who are out in the public eye making decisions…is a good thing.” I did offer to start a Draft Alice movement but she didn’t bite(currently her plate is full between practicing medicine, advising Roon, community organizing, leading community health efforts, and being a mom). One can dream.
Her Book recommendation
An Immense World by Ed Yong.
‘It is so fascinating and gives you just an entire different like understanding of the world that we live in.
Her Favorite Confidant
Her husband, Vivek Murthy…he’s always “cheering me on.”
Favorite TV show
The West Wing
“Washington is so messy and there are people who are corrupt and there's all kinds of problems, but there are so many really good people who are just trying to do the right thing”
That’s it everyone! Thanks for reading and as always would love suggestions on future guests for Good Medicine.
Dr. Rohan Ramakrishna is a Professor of Neurosurgery at Weill Cornell Medicine and one of the founders of Roon. He started Roon with Vikram Bhaskaran and Arun Ranganathan because they believe that patients need trusted answers to their healthcare questions, anytime and anyplace.
Christina Farr is both an advisor to Roon and an editor for this publication.
The name Good Medicine reflects many things, but importantly, It also pays homage to Bon Jovi’s classic “Bad Medicine.” To our readers who are fans of 80s rock, this one’s for you.
