Two interesting opinion pieces published a few months ago inspired me write this column: one from Tal Fortgang, a Princeton freshman defending his “white man privilege,” and another from Max Ritvo explaining what exactly that white man’s privilege is. To summarize their points, the former author laments that his academic success is shadowed by society attributing his successes to being genetically a white man. As a result, society believes he is able to attend an Ivy League school because of his privileges in life as a white male instead of his personal merits. The second piece highlights that the white man’s privilege is not in the form of money or social connections, but rather the English language and the default culture that every other race tries to assimilate.
Regardless of which side of the argument you stand (if there is even an argument), it’s clear that our upbringing and experiences shape our personal identities, as well as our cultural identities. In fact, in Malcolm Gladwell’s “David and Goliath,” he argues that even a “disadvantage,” such as dyslexia or a rough childhood, may empower one to find their own path to successes later in life. Perhaps in the microcosm of the medical profession, there are also advantages we take for granted, as well as disadvantages, that turn out to be necessities in the path to becoming a physician.
I began my first clerkship a few weeks ago in pediatrics. As I walked down the hallways in the hospital, nurses eyeing me suspiciously as if they knew this was my first real clerkship, and small children looking apprehensively at my scary white coat, I could not help but wonder what people assume what are my privileges. Do they assume that my white coat signifies an authority that I do not quite deserve yet, or do they see my short white coat and know that my clinical knowledge is limited to buzz words from a book, and not stories from real patients?
When we learned how to take a patient history, we were told to keep the questions open and to empathize with our patients’ stories. We develop a habit of asking questions pertaining to the history of present illness, past family history, recent travel, etc. What we do not think about is the logic behind a structured history taking: history of present illness implies a disease process that is time-dependent, family history implies that genetics play a role in our body habitus, and travel history speaks to how the environment can greatly influence our state of health. Eventually this manner of reasoning becomes habit and we can’t imagine taking a history any other way.
The consequence of all this training is that what we now think is common knowledge is actually the product of a decade of schooling. For example, we often ask about smoke exposure in the home when admitting an asthmatic patient. Whenever the parents say “yes,” we are taken aback, especially coming from parents who are otherwise caring and responsible. The reason we are taken aback though, is because we are well versed on the effects of smoke on systemic vasculature, and its exacerbation on airway remodeling from long-standing uncontrolled asthma. We are not perfect and sometimes it is hard not to pass judgment on some of the life choices we encounter during our time in the hospital. But perhaps we can also accept that part of our job is to educate patients with our privileged understanding of medicine.
Inevitably, we encounter the patients that we cannot relate to personally. This can come in the form of non-English speaking patients, those born into lower or higher socioeconomic statuses, or simply those with completely different worldviews. While this gap in communication appear to be a disadvantage in our provider skills, it also makes us grossly aware of our shortcomings and empowers us to do better by our patients. In these situations, our common sense tells us to listen to the patient and acknowledge that no matter what backgrounds they come from, most patients come to the hospital to be healed. I will be the first to admit that this simple truth is not easily taught through a textbook — it is a combination of objective scientific training and the practice of humanism in our personal interactions with patients of all ages. In the end, our clinical reasoning becomes second nature. Our acquired common sense becomes our biggest privilege.
Many of us go into med school with big visions for bettering modern medicine, but as we go through this journey, we realize that there is still a long way to go, and we can’t do it all alone. This column is not meant to be extremely profound or didactic but simply a reflection on the what it means to stay human in midst of society’s expectations and our own expectations.