With the future of the Affordable Care Act uncertain under President Trump, many Americans are left worrying how they will manage without health care. The Americans who must shoulder this burden are disproportionately people of color. It should come as no surprise to those familiar with the history of health care in this country that once again our system, purportedly built to protect and promote health, is systematically ignoring the right to health care for communities of color.
Like most people, I watched the Ebola plague tear through Africa two years ago with a feeling of helpless horror. I saw the victims dying by the thousands on television, all eulogized by the same stark words: “No cure.” There seemed to be some unstoppable and malevolent force in the universe, seeking not only the destruction of human life, but hope itself.
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.
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.