The day before I was asked to give this speech, sometime mid-May, I was speaking with a first year student. At the time, I was two weeks shy of completing my third year of medical school — the year of school that you spend the most time in the hospital.
The field of medical ethics is often ambiguous, esoteric and paradoxically arbitrary. Discussions about ethics during training revolve around case studies of patients without health care proxies and Beauchamp and Childress’s four accepted principles — and stop there.
I only realized that I was an optimist on November 9. Crushing disbelief is cliche, and yet — as I walked home, hot-cheeked, through rain and yolk-colored streetlights just after midnight, past a dive bar where neighbors tallied states and feverishly refreshed fivethirtyeight — I felt trampled.
The call for a more global medical curriculum — one that not only recognizes, but prioritizes health issues that transcend national, political and cultural demarcations — is coming from all sides. American medical student interest and participation in international electives is considerable, and surveys indicate that its growth has accelerated in recent years.
Today, a person’s zip code is a better indication of their health than their genetic code is. We know that physical communities experience shared sickness, whether linked to trauma, viruses or unavailable nutrition, and there are established biomedical consequences to poverty and segregation. Acknowledging these links, however, only gets us so far; successful intervention demands thinking deeply about the relationship between patients and their communities. Rochester, NY is home to an innovative attempt to combating these issues. It is one that challenges traditional ideas of what factors define health and consequently, what metrics define therapy.
“And do you have a husband at home?” “A wife, actually.” “Oh, excuse me. And how long have you been with your mate?” the physician answered. He was unflustered and looked expectantly at the female standardized patient sitting across from him. For the remainder of the interview, when it came up again briefly, the physician referred to the patient’s wife as her mate.
He and I are early, and we are the only ones in the room. I sit in an office chair — the kind that swivels — around a long, industrial-looking table with another ten chairs, and I watch him as he nods, his eyes closed, to music playing through his headphones.