Writer-in-Training
University of Chicago Pritzker School of Medicine
My name is Frank, and I am a student at University of Chicago Pritzker School of Medicine. As a new medical education intern, I aim to write about potential opportunities for improving our medical education system. In particular, I am interested in exploring ways to incorporate lifestyle medicine into our medical curriculum in order to maximize the achievement of health maintenance and primary prevention of chronic diseases. My future goal is to go into internal medicine with a key focus on preventive medicine and public health.
Thank you in advance for reading my work! I welcome any potential comments and criticisms.
The epidemics of diabetes, cardiovascular disease, cancer and dementia roll through the US and across much of the world, eerily reminiscent to the sweeping cholera outbreaks of Snow’s era. Even in the majority of low- and middle-income countries, these chronic illnesses have already displaced infectious diseases to become the leading causes of death and disability. Yet, the majority of these are potentially preventable.
In December of 2014, one week after the non-indictment of Michael Brown, in-Training published an article entitled “A Lack of Care: Why Medical Students Should Focus on Ferguson.” In it, Jennifer Tsai argued that the systemic racism rampant in our law enforcement and criminal justice systems also permeates our health care system, affecting both access to care for black patients and the quality of care black patients receive. Lamenting that the medical community was largely absent from the Ferguson controversy, she cited startling statistics of disparities in health and health care as part of her call to action. In light of the events last week in Louisiana, Minnesota, and Texas, it’s time to revisit this message.
I walk down Summit Avenue in St. Paul, Minnesota this evening, and it is packed with people. People grieving, people chatting, people holding one another, people holding banners and people giving speeches. July 7, 2016: a black man named Philandro Castile had been killed barely twenty-four hours ago by a police officer.
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.
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 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.
During our many years of medical training, we study complex physiological processes running the gamut from acute sepsis to the equally devastating progression of chronic diseases. We spend countless hours in lectures and on the wards, attempting to gain exposure to proper medical management of bread-and-butter medical problems as well as more obscure diseases which may only affect a handful of patients annually. However, most medical schools neglect to teach one crucial area of expertise — training in advocacy skills to address social determinants of health.
I recently finished reading Tracy Kidder’s Strength in What Remains, which highlights one man’s journey from the genocide in Burundi and Rwanda to becoming a refugee in New York City. Some chapters are quite graphic in their descriptions of the slaughtering of Hutus and Tutsis — the pain, suffering and atrocities he witnessed. These deaths seemed nothing like being on a morphine drip in an ICU bed or falling into a final deep sleep as your family surrounds you with tears and prayers. Instead they seemed gruesome and inhumane.
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?”
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.
