Contributing Writer
Creighton School of Medicine
Jocelyn is a fast-talking swing dancer from Tacoma, Washington. She appreciates short lines at the post-office and fine point pens. She is 26 years old and a third year medical student at Creighton School of Medicine in Omaha, Nebraska.
Among my professor’s stories from Lima, the chicken dinner story haunts me most. It features two students from his time as a middle school teacher in one of Lima’s most dangerous outskirt neighborhoods. A young teacher working at a Fe y Alegria school in North Lima, my professor, Kyle, had promised to take them anywhere they desired for dinner in exchange for exam success. The students requested chicken, standard Peruvian celebratory fare.
Though they make up 5.6 percent of the US population, discussions about Asian-American health appear to be few and far between. According to the Asian-American Health Initiative, a variety of medical and public health scourges disproportionately affect the Asian-American community. Some of these disparities entail disease incidence, while others describe a paucity of certain preventive health measures being delivered to this group.
Coming from an Indian-American background, yoga and Ayurveda were a part of my life even before yoga pants and juice cleanses became popular. As a child, my parents had all kinds of alternative remedies for common childhood afflictions. Instead of taking Tums for an upset stomach, I drank a concoction of ginger, cumin and lemon to relieve my discomfort. And I still do.
In 2015, the Institute for Women’s Policy Research published an alarming statistic: on average, women made only 79 cents for every dollar earned by men. Even more alarming was the fact that when the study controlled for qualification or stratified by job title, the gender wage gap persisted. Unfortunately, medicine is not immune to the gender wage gap phenomenon. According to data from the US Census Bureau, women make up one-third of US physicians, but on average make only 69 cents for every dollar earned by their male colleagues. This results in over $56,000 in potential wages lost for women in medicine each year.
In today’s America, it is well documented that each year, more of our GDP is being devoted to healthcare spending, and a disproportionate amount of that healthcare spending is towards end-of-life care. According to a 2013 report from The Medicare NewsGroup, Medicare spending reached about $554 billion in 2011. This was 21 percent of the total spent on health care in the US that year. About 28 percent of that $554 billion — $170 billion — was spent on patients’ last six months of life.
In El Salvador, 17 women imprisoned after experiencing miscarriages or stillbirths began a campaign against reproductive injustice. “The 17” were sentenced for up to 40 years in prison for miscarriages or complications during delivery, after being convicted of attempted or aggravated homicide. This was the outcome of a total ban on abortion: young, often unmarried, women of lower socioeconomic status are suspected of inducing illegal abortion when experiencing emergent obstetric complications. Stigma and misogyny play into the result, in which a woman’s health during pregnancy is viewed with distrust.
Gun violence is a public health crisis. On your average day in America, 297 people are victims of gun violence. They are shot in murders, assaults, suicide attempts and completions and police interventions. 89 of these victims died — seven of which were children. In the first 90 days of 2016, there have been 57 mass shootings. Your average American is now equally as likely to die via firearms as in a car crash.
Each time we came in for our Islamic Medical Association of North America (IMANA) Medical Clinic, we never knew what to expect. IMANA clinic is a community-based project led by the Albany Medical College Family Medicine Office that connects medical students to the local Muslim population through screening and education clinics at Masjid As-Salaam. This masjid is the central prayer space and community support for many of Albany’s Muslims. The unique quality of this service-learning program is its emphasis on cultural competency and understanding the role of spirituality in medical care.
“I could never be a primary care doctor,” my friend and fellow medical student says as she pops a french fry into her mouth. There are five or six of us sitting around a hospital cafeteria table, grabbing a quick lunch between our morning and afternoon lectures. “I mean, seeing fat people with diabetes and heart disease all day. It would just be so frustrating, because they did it to themselves, you know?”
One of the major expenses that future doctors face is the cost of the United States Medical Licensing Exam (USMLE). This test is given in three parts, spread out across a student’s training, in total costing over $3,000. The most expensive item by far is the Step 2 Clinical Skills test, whose registration fee comes in at a whopping $1,275.
Too often medical students lose their motivation because of emotional exhaustion, depersonalization and a diminished sense of personal accomplishment. Medical students should no longer see their education as a challenge to overcome. They should see it as a game that can be won.
As medical students, we recognize that bias in medicine is doubly damaging: it burdens our peers and it harms our patients. In the opening narratives we see both of these at play: in Micaela’s self-doubt and frustration, and in the intern’s judgment of their older, Latina patient. Such clinician bias has been increasingly shown to contribute to widespread health inequities.
Contributing Writer
Yale School of Medicine
Tehreem Rehman is an MD/MPH candidate at Yale/Johns Hopkins. She is invested in addressing the impact of adversity and trauma on psychopathology, clinical and community interventions for violence, and the relationship between healthcare provider biases and health inequity. Tehreem blogs at www.tehreemrehman.wordpress.com and can be reached on Twitter @tehreem_rehman.
