Systems of power are upheld when people believe they are powerless.
In the aftermath of the election season, thoughts of concern for my undocumented patients have frequented my headspace. While there has been longstanding discussion around organ allocation and kidney equity for those who are not US citizens, my internal focus has shifted beyond the kidney to the whole person and what implications or changes to US policy may have on those we care for. What it might mean for the young person on dialysis, awaiting transplant, if their social support network were to be abruptly deported? What impossible choices might need to be made at the balance between remaining with one’s familial unit and caring for one’s personal health?
Engaging in the endless internal feedback loop of ‘what ifs’ may lead to feelings of hopelessness and helplessness. By design, systems of power have the ability to contribute to these feelings, merely by their vast size and perceived immovable impact. Stephen Covey’s Circle of Influence framework helps us to shift the paradigm to channel our efforts effectively. At the outermost circle, we find the Circle of Concern – or the domain that we have no true control over in terms of outcome. In this scenario, while I may be concerned about the legal status of the patients I care for, I also have no control over whether this feared outcome occurs. In the centermost circle, we find the Circle of Control, or the things that we can directly impact through thoughts, words, and actions. For example, I can recenter my thoughts to not be paralyzed by the world’s injustices. Participation as a JELF scholar has allowed me to utilize my voice with those within the political landscape – again focusing efforts back to what I can control.
Between Control and Concern is arguably the most important area, the Circle of Influence. This is where we can take our concerns – the ones we can’t directly control the outcome of – and influence others in positions that are proximal to systems of power. Meeting with the staffers of State Representatives and Senators around legislation that will have direct impact on our patients is how we can move from feeling powerless to powerful. Having an awareness of which bills are under review and tying these back to patient stories, like the patient who will navigate the nuances of kidney transplant alone; or tying this to objective data, like the financial cost that will be billed to Medicaid for every additional inpatient hospital day – we can incrementally impact those systems of power. Once we acknowledge what is in and out of our control, we can begin to harness small persistent efforts that expand our circle of influence. The JELF Scholars program provides a platform to advocate in this way and progressively move towards hopefulness and helpfulness.
