Nick Hopkinson: Canvassing—should medical students get out on the doorstep?

The price good people pay for not engaging in politics is bad government. I prefer this version of Plato’s aphorism to the more usual “rule by your inferiors” one. The guiding ethical principle should not be one’s position within a hierarchy, but rather that society should be fair and reasonable; organised in a way that could be justified to the disinterested observer proposed by Adam Smith and others; [1] organised so that the necessary steps are taken to reduce the number of people living bad lives—lives that are too short, or lack other human goods. [2]

Beyond that general principle for political engagement, I would argue that there are good reasons to propose canvassing as a useful experience for people training in medicine. For doctors, the social determinants of health are set out in textbooks, scientific papers, and reports. [3, 4] They are apparent day to day in the ward or clinic, if you are paying attention. It is important to have a sense of how people live their lives to frame concepts like compliance with medication or the weighing of future health gains against current exigencies.

Knocking on people’s doors and asking them who they plan to vote for and why, what sort of government they’d prefer, discussing the issues, takes you to places you’d rarely or never visit, sometimes to people whose lives are too disorganised to ever make it to an outpatient clinic. This, among other things, is of course what general practice is all about and this sort of exposure might help fire a sense of vocation in some or warn others off this career path.

Although as a doctor one speaks to all kinds of people and tries to help them, this doorstep interaction is devoid of the power relation that is present in a clinical setting—people are free to be friendly or hostile, thoughtful or bemused. They can mock you, a rare experience when you have a stethoscope round your neck. At the same time it is a safe space to practice active listening and the arts of persuasion; important transferable skills for clinicians. There is less individually at stake—a poor interaction is not going to translate into bad clinical care.

Finally, of course, are the rewards of commitment. If you win, participation means the glory is yours. If not, at least you can feel you did your share. After all, as Virchow said, “Medicine is a social science and politics is nothing else but medicine on a large scale.”

Nicholas Hopkinson @COPDdoc, reader in respiratory medicine, Imperial College, London.

Competing interests: None declared.

1. Sen A. The idea of justice: Penguin; 1st Edition edition (1 July 2010), 2010.
2. Honderich T. The principle of humanity. 2003.
3. Loopstra R, McKee M, Katikireddi SV, et al. Austerity and old-age mortality in England: a longitudinal cross-local area analysis, 2007–2013. Journal of the Royal Society of Medicine 2016;109(3):109-16.
4. Marmot M. Fair Society Healthy Lives—strategic review of health inequalities in England post-2010, 2010.