Medical students take on a massive amount of responsibility beginning the first day of school. From passing pre-clinical tests, to perfecting the physical exam, to performing well on Step 1, we hold ourselves accountable for a high level of academic achievement to ensure successful transitions into the clinical years and residency. Most of this responsibility is personal: should we fail an exam, forget a key part of the physical diagnosis while working with a simulated patient, or underperform on Step 1, damage is done only to ourselves. Of course, this aspect of medical education is by design. After all, it would be irrational and unethical to ask under-trained students to take full responsibility for the health of patients. So we bide our time during medical school, learning as much as possible and anticipating residency when we will be held responsible for our patients’ health. But does this mean that medical students have no responsibility other than to themselves?
The medical community is deeply entwined in social and political dilemmas that have profound consequences for the patients we treat. We read about these in the news everyday, from Ohio’s “heartbeat bill” that threatens to trample the rights of pregnant women, to the supreme court case King v. Burwell whose outcome could strip eight-million Americans of their health insurance, to the controversial Trans-Pacific Partnership Agreement that may limit access to life-saving, generic medications. The majority of dilemmas facing medicine are connected to issues of social justice that are inadequately addressed.
It is easy to believe that medical students, who don’t prescribe medicine, write laws or design curricula, have no avenues to effect change. I even ascribed to this belief, until I witnessed the White Coats for Black Lives Die-In, an event orchestrated by medical students compelled to elucidate racial disparities in medicine. Soon after, I learned of a widely circulated letter to the editor that two of my colleagues wrote in support of universal health care. I also sat in on a meeting of medical students hoping to change the language of pedagogical texts to highlight inequalities experienced by marginalized groups. Yet just because we can promote social justice, are we actually responsible for doing so?
In 2002, the jointly authored Physician Charter, published in three major journals and officially adopted by the American Board of Internal Medicine, identified the promotion of social justice as one of the fundamental principles and responsibilities of medical professionals. The Charter asserts, “Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.” Though compelling, this demand explicitly pertains to physicians. Still, many medical students have also taken an oath of responsibility for advancing social justice. The UC Davis oath, for example, states, “Even as a student I have a responsibility to improve the standard of health in my community, to increase access to care for the underserved.” Nonetheless, is addressing this ideal in an oath an adequate call to action for students?
Recently, a lecturer pointed out an x-ray finding indicating the presence of pleural effusion. While the finding did not remain a part of my daily thoughts, I am certain that future clinical scenarios will reinforce this and other aspects of lecture material. A resident or attending will undoubtedly ask me to identify various lung diseases on chest x-rays. But it is hard to imagine an attending reminding me of my responsibility to advocate for improvement of the social determinants of health that affect our patients.
Issues of social justice pervade our work but rarely call for immediate attention the way an upcoming exam or an x-ray might. This can make it too easy to put activism — the kind for which many of us took responsibility in our oaths — on the backburner. Unless we make a conscious effort to address these issues on an ongoing basis, they will stay in the back of our minds while insidiously eroding the health of the patients we are learning to treat. The responsibility we vowed to take on at our white coat ceremony entails not only learning the material conveyed in lecture and on the wards, but also advocating for causes of social justice that are inextricably linked to our patients’ health and wellbeing. That is a massive amount of responsibility.
To my fellow medical students who not sure where to start, consider consulting the American Medical Student Association’s Action Center to find social and political issues relevant to your community. Attend meetings and events to gain awareness of the issues facing medicine right now. In her New England Journal publication on the importance of the Black Lives Matter movement, Mary Bassett, physician and New York City’s health commissioner, explains, “some physicians and trainees may choose to participate in peaceful demonstrations; some may write editorials or lead ‘teach-ins’; others may engage their representatives to demand change in law, policy, and practice.” There are many avenues to get involved. The only question left to answer is how you will fulfill your responsibility to advocate for social justice.