You Have Agency, You Have Free Will: You Are Your Own Determinant
May 19, 2020
Dr. Plastic Picker is similar to other pediatricians. We tend to be a more liberal minded democratic leaning demographic. We tend to vote for children-centric issues, which means more funding for education and more funding for social services. I do believe in the social determinants of health, and that large structural inequities need to be addressed. And of course Dr. Plastic Picker thinks Big Oil and Big Plastic need to be reined in to prevent the plastic pollution assault on our oceans.
But I also believe in free will and responsibility. I was raised in a very different definitely more conservative Republican leaning family and community. I remember going off to Boston for college, and a close family friend had predicted that moving to Cambridge would change my political leanings which it did. I became more liberal. But in Cambridge, being a Democrat in local politics was actually the most conservative option and there were actually communist on the ballot which I found very disturbing.
As I was talking to another group of teenagers yesterday over the phone about their mental health, thinking about the still undercurrent of stress amongst our nursing staff as they are checking in and physically interacting with patients more than the MDs, and thinking about choices we have made in life to mostly #stayhome other than work and to continue working for the environment, I am reminded how important it is that we have free agency. Most of Dr. Plastic Picker’s readers are in the United States, and here we still have freedom of speech and freedom of assembly. Right now the libertarians and Republicans are exercising that right on the internet and sometimes not masked at rallies. Yes I am worried about the spread of COVID-19 but at the same time as a fellow citizen I respect their rights and I honor that.
I fundamentally believe in responsibility. I understand the social determinants of health, but what you are predisposed to IS NOT YOUR HEALTH DESTINY. I work in a large health HMO and for the most part that system produces excellent more equitable health outcomes. But what I have noticed is that a large HMO tends to attract physicians and staff who are like sheep and follow the party line. And that is dangerous. The large system works better when the individual practitioners in it are engaged, innovative and create their own professional identity. To allow a large system to control you, to take care of you, is to transfer your agency to them and give up your own freedom, your own agency, your own free will. Our HMO is NOT YOUR PROFESSIONAL DESTINY.
And also for my patients, you have so much power. I often talk in clinic when discussing vaccines, that children have to ASSENT to procedures. They do not need to officially consent to getting vaccines, but in medical ethics there is a term of ASSENT. They have to be OK with us invading their body with a needle. I refuse to have a parent hold a child down against their will, or have a nurse use any undue pressure. I will advocate for those vaccines until I am frustrated beyond belief, but I believe equally in their free will. Almost all of those children do assent to the vaccine, and I have now also taught them about the agency of their own bodies and built trust between them and me.
Mental health is complicated as well. Can a person Free Will themselves out of an eating disorder? Can you Free Agency yourself out of Generalized Anxiety Disorder? Psychiatric illness has always been my weak point. I am trying to be a better general pediatrician. I believe we lack mental health services and providers. But I also think that the answers to mental health are more than creating a nanny-psychiatric system where everyone is dependent on the medical system for never-ending therapy sessions. I think the answer lies somewhere in between. We need more open spaces. We need more parks. We need more spiritual homes. We need to restore nature. We need to rebuild a sense of connection and community. We need to fix the economic system so that more individuals can volunteer and reengage in the community, and not have to endlessly work just to be able to afford a house. And the amazing thing is that these things are more sustainable than creating a permanent system within the health care system or the government that makes all of us reliant on any institutions.
Just philosophical ramblings today. I was prompted to think of these things as some of my childhood friends who are libertarians are posting thought-provoking posts. I am grateful to the freedoms we are given. That is why I continue to blog and write. I have cared for thousands of families from all different political and social affiliations. I think I give consistent care. But I never allow the large HMO I work at dictate how I practice medicine. If I did, I would regress toward the mediocre mean. And because I believe everyone has Free Agency, Free Will and can Determine Your Outcome – that is why I blog. I believe that we are all intelligent and self-determined people who can read about fiber and choose to give your children vegetables and choose to buy fresh fruits instead of the processed plastic encased food out there.
And that is it. My philosophical manifesto! LOL.