The pressure and anxiety surrounding Step 1 is one of the main reasons cited by the USMLE to justify its adoption of a pass-fail grading system. However, many medical students are met with more trepidation about their future as this major anticipated change in Step 1 takes effect.
Presenteeism does not simply exist for seasoned providers; it seeps down the medical training pipeline and perhaps poses the greatest threat to trainees at the start of their careers. The fear of missing out as the “beginner on the team” can be paralyzing when there is so much important knowledge beyond us. Such pressure persists longitudinally, too, as trainees at every level fear that taking time off will appear as a lack of dedication to clinical education or will result in lower performance evaluations.
Our illness narrative, the COVID narrative, is about so much more than regaining health (though I acknowledge that for those afflicted by the disease, overcoming the debilitating circumstances may be more than can even be hoped for). Returning to Frank’s ideas, our narrative is about rediscovering the voice that was stolen by forces beyond our control.
When the start of M3 year came along, I was ready: ready to put my First Aid book to rest, ready to be involved with patient care, ready to observe physicians in their realm of expertise and ready to find my place in the broad field of medicine. Now, halfway through the twelve months of clerkships, I ask myself, was it all I imagined it would be as an inexperienced first-year student?
I was patiently sitting in the lobby at Quest Diagnostics, waiting for the staff to slowly let people inside in adherence with the new social distancing guidelines. I waited for about ten minutes before a man in his mid-50s called my name and led me into a patient room.
“We are taking him to rehab,” she said. I could hear a faint sigh of relief and happiness permeating her voice, which had been distinctly absent for the last few months. I could also hear wind whooshing in the background and a distant trail of her voice, which meant they were already on the road.
The Iranian Consultative Assembly, the equivalent of a parliament, legalized living non-related donations in 1988 and set up a new government-run transplant matching system. Within this novel framework, living donors could choose to have their organs typed and registered in advance. If they are needed, a third-party independent organization, the Dialysis and Transplant Patients Association (DTPA), would set up contact between the donors and recipients. The donors would be compensated by a payment from the government, free health insurance, and sometimes additional payment from the recipient. The payment from the government is said to be in the range of $2,000-$4,000.
As physicians, we must work to lift patients up when they are struggling, rather than shaming them into well-being. As Dr. Donald Berwick once noted, it is not always patients’ diagnoses, but their helplessness that kills them. Indeed, the helplessness we instill through our focus on individualism and molecular pathology in the clinical setting will ensure that this epidemic kills millions prematurely and costs billions of dollars. If obesity is a disease caused by society — its inequities, trauma, and expectations — then the solution for obesity should address more than just the patient sitting in front of us.
In 2018, a patient filed a complaint against a medical student for wearing a “Black Lives Matter” pin on her white coat. When the student reached out to her school’s administration, she received this response: “It is best to not raise barriers in the way we present ourselves…Some of your political pins may offend some people, and it is probably best not to wear them on your white coat or while you are working in a professional role.”
The notion that a person’s health is only impacted by the clinical care they receive is not a reasonable one. Currently, as a first-year medical student, I have had the privilege to learn from a variety of professionals that have once again reminded me why I am on this path and why I want to serve underserved populations.
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.”