Current evidence suggests that much of human health is influenced more significantly by contextual factors like the social determinants of health than the direct receipt of health care. This relatively new understanding has challenged the notion of “physicianhood” and what it means to improve the health of entire populations and communities. With the influx of issues that the pandemic has brought with it, this new model for being a highly effective physician has become even more important.
We will recall when, during the summer of 2020, the moral and political duty to engage with the most momentous anti-racist movement since the 1960s reanimated a nation paralyzed by fear. By the fall, cataclysmic wildfires on the West Coast poisoned the air from San Francisco to New York City. Coronavirus, cultural upheaval and manifestations of climate change all bore down on us as we entered the most consequential and divisive national election in living memory.
Mercedes drove two hours to the nearest healthcare clinic to get her first physical exam in ten years. I met Mercedes while shadowing a primary care physician, Dr. L. In the clinic, Mercedes divulged to me how nervous she had been driving in – she knew what the meeting held in store. Her fears were confirmed: just five minutes into her exam, Dr. L advised her, “Mercedes, you have to lose weight.”
Failure was never an option for me. // Every time I fail… / I am reminded that I have let my country down.
There is a cost crisis in medicine: the healthcare industry accounts for about 18 percent of the GDP in the United States, and predictive models see this increasing in the coming years. This is a problem for the country as a whole as an estimated 41 percent of working Americans have some level of medical debt.
Now, I am a fourth-year medical student standing at the foot of a tall ladder. The hierarchy of medicine requires that I follow some unwritten rules in order to climb. Throughout my training, I have gotten the sense that one of those rules is: avoid trouble, good or bad. Of course, now, doctors are beginning to find their voices through movements like White Coats for Black Lives. But as a young trainee, I sometimes feel the sentiment directed at James in 2018: shut up and doctor.