When I was first invited to host a Beyond Illness Roundtable, I was told that we were supposed to bring together medical students to discuss their idea of a modern physician: What characteristics would they have? What kinds of skills would we want to cultivate in this increasingly technological age? What kind of doctor would be necessary to meet the needs of the health care system now and into the decades ahead?
I was interested in having this conversation with some friends in medical schools across Philadelphia who were deeply involved and committed to social justice and looking to apply that to a career in medicine. These were people who I had met through organizing with White Coats for Black Lives and Students for a National Health Program and with whom I had bonded over the shared experience of being a medical student-activist. Although each of these friends and I have ongoing conversations about fighting for justice in a profession that often values profit and prestige over people and personal conviction, these conversations were, however, relatively siloed by school and by class year. I saw the Roundtable as an opportunity to bring all of these friends together and to build stronger connections among organizers at Penn, Jefferson and Temple. Invitees were in different stages of training — from those who were not yet done with their first semester of medical school, to those who were on the residency interview trail. The plan was to connect folks earlier in the fall, but due to scheduling conflicts, our Roundtable was postponed until early December. I did not know it then, but this unplanned delay was a blessing in disguise.
By early December, we had slowly begun to settle with the post-election reality, knowing that we were heading into four years with a president who had bluntly and unapologetically expressed his disregard for the health of the vast majority of Americans by promising to repeal the Affordable Care Act. This move, we knew, would prevent many of our patients from being able to access or afford the health care they need and the care that we would want to give as future physicians.
In addition to the threat to our patients, we were personally at risk under this new administration because we, as individuals, and the communities that we come from have been insulted and threatened throughout his campaign. For those of us at the Roundtable, imagining the kind of doctors we would want to be and the kind of doctors that our increasingly diverse country needs, is directly tied to who we are and the identities we claim.
After confirming attendance for the Roundtable, I prepared my apartment to host eight medical students for a potluck dinner. Our group, by some wonderful accident, looked nothing like our medical school classes; we were recruitment-brochure diverse. We were all women — and most of us were women of color. Several us were immigrants, or the daughters or granddaughters of immigrants. We came from all sorts of socioeconomic backgrounds, had different sexual orientations, and grew up in different parts of the country and world. To say it was a nice change of pace from the usual medical environments we find ourselves in would be an understatement. There is an immense comfort in finding people who know what it is to be the only woman, person of color, LGBTQ person, or the only person at the intersection of multiple marginalized identities in rooms full of people with more structural privilege than you do. With only marginalized voices at the table, conversation flowed in ways that they often do not and cannot when your perspective is viewed as “divisive” or makes others uncomfortable.
Even before getting to discussion questions, I felt a certain freedom being in a room with people who did not seek to silence or censor anyone. The future of medicine not only looks more like our Roundtable group, but it will find its strength in the diversity of voices and perspectives.
More than that: our strength was not because we were marginalized folks, but rather, because we were united by our common purpose and motivation to see medicine as a tool for social justice. That motivation and focus on social justice is, ultimately, what we concluded that the clinician of the 21st century needs — and what our medical institutions have failed to instill in its trainees.
As future physicians, our job revolves around improving the lives and health of our patients and their communities. Our training largely emphasizes one aspect of health: the mechanisms of disease. Our curricula as pre-medical students and then as medical students is grounded in basic science — and for good reason: Understanding disease needs to have its basis in our most up-to-date understanding of molecular biology, microbiology, immunology, and a host of other subjects. Health, however, is more than pathogen and host; it also encompasses the environments that we live in, the sociopolitical structures that constrain our ability to live healthily, and the historical realities that have shaped those social structures. This sort of education cannot be learned with a social medicine course here and a doctoring course there; it must be fully integrated throughout our education and training and remain central to our mission and practice throughout our careers.
Being a socially conscious and justice-minded clinician also means we need to take a close look at the healthcare system we have created, and the unjust systems that we contribute to and perpetuate. It requires self-examination as individuals and as a medical community, followed by radical action. It is the sort of action that bucks institutional priorities to “generate revenue for hospitals” (Priyanka, MS2), bolster rankings, and grow reputations; it is action that completely reinvents the way we teach medical students, interact with our patients, structure our medical teams. It deconstructs the ways that “physicians do a lot of knowledge […] and skill hoarding” (Kayty, MS3) but instead involves “redistribution of knowledge” (Prachi, MS2) such that we are better educators, always finding ways to show our patients something new about how their bodies work with each visit.
The clinicians of the future will need to redefine health and redefine what it means to be patient advocates or to, perhaps, return to what Dr. Rudolf Virchow’s idea of a politically-involved physician:
Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution. […] If medicine is to fulfill her great task, then she must enter the political and social life… The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.
As “attorneys of the poor,” we must fight to put resources and policy behind efforts we already know improve health. These efforts are largely social, as “there is more to your health than pills” (Tina, MS1). Some of the ideas that our Roundtable generated included: championing social policies like paid family leave and provision of free diapers and formula for the first year of life; guaranteeing that everyone is “able to access the level of care they need” (Priyanka, MS2); supporting a single payer health system; bolstering mental health resources; and offering accessible and comprehensive women’s healthcare, including abortion services and free contraception. Physicians are already involved in these efforts, but it is not necessarily normalized within medical culture. Commitment to collective, rather than individual, well-being is critical in the days ahead.
But this physician of the future cannot and will not develop naturally within the medical system we have today. Ours is a healthcare system and medical culture that is deeply entrenched in our own interests and in upholding the status quo. The future our Roundtable wants — the future our country needs — is one in which physicians are unafraid to buck norms in the pursuit of justice. It is the kind of doctoring that is more human in an era of technological advancement; it is the kind of doctoring that is political in an age when we are told that good doctors are “apolitical.”
This renewed vision of a 21st century physician requires us, right now, to take a stand for just causes, though they may be unpopular among our colleagues or may draw the disapproval or ire of our administrators. Now, more than ever, we need to unequivocally stand for our patients who will lose their health insurance with the repeal of the ACA — and go beyond accepting the status quo to fight for the healthcare of patients who were unable to afford healthcare even under the ACA. We need to be bold in fighting for the rights of our international residents who are blocked from entering the country under the Muslim ban, and we need to stand up to our institutions who are willing to withhold residency acceptances from international applicants based on their country of origin. Now is the time for civil disobedience to protect our undocumented classmates and patients, which, yes, may require us to refuse to comply with unjust laws. It means being ready to provide medical services pro bono for those who are unable to access our hospitals and clinics or to serve as street medics at protests. It means fighting for clean water in Flint and in North Dakota. It means unabashedly declaring that #BlackLivesMatter, that no person is illegal, that we refuse to build walls or institute racist and xenophobic bans, and that mni wiconi — water is life.
So what does the physician of the future look like?
It is you and me, infusing our medical practice with politics that create a more just, more equitable, and healthier world in the here and now. Our humanity and the soul of our profession demand it.