In 1904, Abraham Jacobi envisioned a future where pediatricians used knowledge, privilege, and power for good, at the bedside and in society.1 His vision foreshadowed the Modern Hippocratic Oath, which acknowledges that we, as physicians, are members of a "society, with special obligations to our fellow human beings."2–4 Every year, new physicians join our profession. New pediatricians conclude residencies, begin practice, or embark on further training. Our traditions ground and push us, new and seasoned, to act ethically and responsibly, to support children, and to advance and shape our field. Still, many of us are currently struggling to find our footing amid dizzying societal shifts affecting our patients, colleagues, science, and society.As pediatricians, we frequently encounter challenges that test us. Multiple ill patients decompensating in emergency departments, complex admissions arriving on already busy inpatient units, and clinics packed with children and parents anxious to be seen. We dutifully approach clinical challenges head-on, supporting families facing life-altering diagnoses, stresses of acute illnesses, or struggles finding housing or food. This same sense of duty is pushing many of us into the political arena. Approaches that have long helped us navigate harrowing clinical challenges may now help us monitor, triage, and treat societal ills.Our country is in upheaval: dissolution of supports upholding basic needs; dehumanization of neighbors, coworkers, families, and friends; dismantled research infrastructures; eliminated programs vital to global and public health, education, and employment; attacks on diversity, equity, and inclusion; experts idled when we need them most. We cannot remain silent, or be silenced, as we watch needless suffering; as our ability to act in our patients' best interests is impeded; as silence and capitulation promulgate harm, unjustly paper over our history, eliminate words from our lexicon, and denigrate members of the society to which we all belong. From Nazi Germany's weaponization of medicine to the dismantling of Reconstruction and the initiation of Jim Crow, precarious times are not without precedent. Although fear may feel new to some, for others, this moment intensifies centuries-old trauma. This moment calls for courage and action, even as we may feel stuck, overwhelmed, and unsure where or how to begin. We may feel frozen, but we cannot remain frozen.Freeze-inducing situations in medicine—critically-ill patients, busy waiting rooms—benefit from systems and infrastructure that help us grasp situation parameters, prioritize actions, and evaluate responses. Infrastructure, including early warning systems and evidence-based guidelines, can maintain health care environments as safe, restorative spaces, sanctuaries that promote healing. This moment is calling for reinforced infrastructures to promote our patients' health and extend that support to our colleagues, science, and society.During the COVID-19 pandemic,5 we learned how to organize, stabilize unstable ground, and become unfrozen amid uncertainty and fear. We built shared purpose and engaged partners in co-designed goals, measures, and theory of action. Data were then, and are now, critical. Data, and the measures they enable, can be used to mobilize, to guide action and advocacy, deepen trauma-informed care, strengthen community partnerships, and shape institutional change. Measures like those displayed in Table 1 can serve such a purpose. They should be viewed through an equity lens,6 helping to prioritize the most vulnerable, provide early warning of societal decompensation, and illuminate opportunities for intervention. Meaningful, transparently shared measures could also ensure the public is informed, capable of consenting (or dissenting) in town hall meetings, calls to elected officials, and future elections.Even with illustrative data and actionable measures, we may still be unsure of where and how to act. In medicine, we often consult, refer, and engage with others. Together, we can create or augment learning communities,6 building coalitions to generate questions, respond to pressing challenges, share resources and insights, and ensure all know their rights. Doing so creates avenues for information sharing, reaching those who are scared to leave their homes, confused by misinformation, or fearful that they can no longer receive care, honoring their core identities. Such communities can strengthen connections and trust with an increasingly skeptical public. They can also reinforce support for our colleagues who are questioning whether they are still welcome in society, for those struggling to practice medicine, maintain innovative research programs, and ensure the vitality of approaches to training future health care professionals.This moment is screaming for action. There is no single answer or strategy for how to act, but we must start somewhere. We can start by ensuring the care we provide is driven by evidence, empathy, and engagement. We can do this by 1) expanding alternative care delivery models—in safe, trusted community spaces, in homes, and via telehealth; 2) advancing partnerships with community-based organizations well connected to, and trusted by, vulnerable populations; 3) exploring ways to pool (and shift) resources, prioritizing populations and partners affected by services now scaled back or eliminated; 4) elevating out-of-the-box approaches to funding essential programs in partnership with philanthropy, business, community development, and government, directing limited resources to those who need them most; and 5) using our voice to ensure the public understands the impact of mission-critical work, particularly work centering the patients and communities to whom we have devoted our professional lives.We can also focus on building and protecting the evidence base. Just as the Modern Hippocratic Oath underscores our special obligations to our fellow human beings, so too does it push us to "respect the hard-won scientific gains," and share knowledge foundational to healing, to progress.2 We must promote research and science, protecting those entities seeking and spreading the truth. If such entities cease to exist or come to value ideology over fact, we must find ways to continue work that is vital to health and well-being. We must join (and win) arguments in favor of evidence, from vaccines to Medicaid, a changing climate to the social safety net.Bold action will clearly require advocacy, which can start with compassion in our examination rooms, a single phone call to an elected official, or an op-ed in a local newspaper. We advocate here, speaking as individuals, adding our voices to what we hope will be a national dialogue in shared pursuit of a thriving, inclusive, equitable society. We encourage our health care institutions and professional societies to join this dialogue, in alignment and with shared purpose. Such alignment could provide us with the collective efficacy we may not have if we march forward alone. It may also prove safer, buttressing against retribution. And if the work needed to provide high-quality care, strengthen our partners, and generate needed evidence is forced underground, we must ensure its roots remain strong, and proponents viable, ready to reemerge.Across history, there have been times when fear prevailed, and our profession remained silent, frozen with inaction and complicity.7 We cannot repeat this mistake. We know how to respond to stressful, chaotic situations. It is our special obligation now to speak out, to act. We can do this by being advocates, truth-tellers, and architects of liberation. We have an opportunity to not merely restore systems that have failed so many, but to reimagine what healing, safety, and equity look like across society. By speaking truth, protecting science, and centering justice, we can be a part of a future where our patients, colleagues, science, and society thrive.The opinions expressed in this article are those of the authors and the authors alone. They do not reflect the opinions of the authors' affiliated institutions.
Beck et al. (Wed,) studied this question.