Patient presentations are a strange sort of voyeurism. Though they resemble medical interviews in many ways — the history-taking, the assessment of emotional state and physical function — what was once a private interaction becomes a public play. What was once a conversation intended to benefit the patient becomes a performance to satisfy the curiosity of so many medical students.
A ubiquitous hierarchy pervades all levels of medicine. Medical students are anchored firmly at the bottom of medicine’s social ladder, rendering them functionally powerless. Although students theoretically have a “voice”, their precarious position low down makes them apprehensive to use it. Students’ grades, evaluations and recommendations, etc.– which have real, tangible impacts, not only on students’ academics, but also their future careers and lives — are contingent on appeasing those higher up on the so-called social ladder.
While I could list close to 100 lessons, I believe focusing on three of the most important ones would aid other future health professionals in managing and ultimately treating the chronic illnesses that will become even more prevalent in many of our future patients. As a disclaimer, I do not claim to be an expert on this topic, but these ideas spring from my own personal reflections.
In light of this recent occasion, I would like to draw attention to the sexual harassment of a particularly vulnerable population that is a result of a unique power dynamic: they have no income, they have amassed significant debt and they depend on the subjective opinion of their abusers for validation of their work. Most frustrating, is that many of the corrective actions taken over the last 25 years have had a limited effect on changing this specific culture of abuse. This specific population is medical students.
Medical students are subjected to a barrage of advertising that inevitably leads to a physician-industry connection that can be harmful to our health care system. Medical students’ exposure to pharmaceutical marketing begins early, growing in frequency throughout their training.
Almost every morning, one of our physiology lecturers asks a question. Usually, it’s a question to which most of my 200 classmates would know the answer. Every day, the professor asks their question, often losing their rhythm in the twenty seconds it takes to shake an answer out of us. The silence lingers until finally they get a response, often whispered like an embarrassing secret by someone sitting near the front. The timid self-consciousness on display in this small ritual is a major part of the socialization that happens in medical school.
you may have seen / serpents before / on a white coat lapel / or a hospital door
A 45-year-old with no past medical history presented to the emergency department with altered mental status. He was found face down in his driveway with no memory of an inciting event, or of his ride to the hospital. In the emergency department, the patient revealed that for the past two months he has experienced headaches, dizziness and left-sided weakness. On a hospital admission two months prior the patient reported similar symptoms but left against medical advice before any meaningful diagnostic testing could be conducted.
On November 27, 2015, a horrific shooting at a Planned Parenthood clinic in Colorado Springs left three people dead. This tragedy is a stark reminder of the grave consequences that may accompany inflammatory political rhetoric and poor legislation. After his arrest, Gunman Robert Dear declared “no more baby parts” to investigators. Dear’s terrifying actions have been linked to the national ongoing attack on reproductive rights as well as inadequate gun control laws. As a medical student, I fear that we will have many more Robert Dear’s in this country unless we make sure that political interests do not continue to impede on patient-provider relationships.
I am honored by this opportunity to offer you some advice on how to prepare for your professional career in what has become a treacherous health care system. I will not elaborate on why I think the health care system is “treacherous.” I will assume — and even hope — that you have at least some inkling that things are not rosy in the world of medicine.
Approximately one in three women under the age of 45 have had an abortion. Approximately one in three women under the age of 45 have a tattoo. Think about your community. How many tattoo parlors can you think of? How many can you easily access? How many abortion clinics can you think of? How many can you easily access?
As physicians-in-training, it is tempting to accept that we have no place to stand up to our colleagues or superiors. That we should just hold our tongues, keep our mouths shut, dodging confrontation like the plague. This is false. From the day you received that acceptance letter in the mail, you committed your life to protecting others. What was it uncle Ben said to Peter Parker? “With great power comes great responsibility.” At times, this might mean getting uncomfortable to do the right thing.