For better or worse, I have always partaken in escapism in one form or another. “Escapism,” defined as the practice of avoiding a difficult reality by immersing oneself in distraction or entertainment, is a concept that rose in popularity in the 1930s as a natural reaction to the Great Depression of the previous decade. Although I did not know it at the time, I have been practicing escapism since 2000 BC (before COVID). As the eldest daughter of immigrants who were new to the continent and busy building a life from scratch, I would get lost in stories from a very young age. I had little in the way of friends and even less of an interest in being popular, so naturally I was drawn to books to fill that emotional void; novels were the way to my heart — fantasy and fiction, oh my!
My medical school career was complicated by more than just complex cardiac physiology or biochemical pathways. Little did I know that at the end of my second year I would go from knocking on a patient’s door during a clinical session, to sitting in an exam room myself.
The heart monitor beeped incessantly, and the pulse oximeter kept dropping to the 80s. I ran to get a nurse. He walked calmly into the room, straightened the patient’s finger and left without a word. The oxygen went back up to 98.
I no longer feel alone the way that I did the first few weeks of dissections, because now I recognize that my peers were sectioned off at their tables also worried that they were losing their sensitivity, that they weren’t good enough to belong, and they didn’t know how to cut into a person. I wish that I had known what my classmates were thinking and feeling during the anatomy course.
To understand the issue surrounding assessments, we must understand that it has become increasingly challenging to train physicians suited to face contemporary changes. To future physicians who have access to a repository of ever-expanding information on their smartphones, being tested on ‘high-yield’ minutia serves little purpose. Being able to think critically (and perhaps even imaginatively) in order to make sense of that information for patient care is what counts. And thus, no matter how standardized an examination is, lack of contextual reference renders it futile.
Why would someone choose to donate their body to medical education? We have a dishonorable history in medicine of illicitly sourcing cadavers for dissection: robbing corpses from graves, murdering people for their bodies and salvaging the unclaimed dead from city hospitals and morgues. Today, we call the bodies we learn from “donors” instead of “cadavers” to honor their autonomy and personhood, their choice to be in the room.
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.
It is the day before the first anatomy lab for the first-year medical students, and a single professor walks alone, up and down rows of tables laden with 26 naked, embalmed bodies. He silently shares a few minutes with the donors, a private thank-you. Soon the donors will be covered in white sheets, and the students will tentatively spill through the locked wooden doors of the labs, a rush of anticipation, teamwork, questions and learning.
Another day passed as I approached the deadline of my latest assignment. Our professor asked students rotating in the ICU to reflect and write up a patient encounter that influenced them deeply.
I believe these inadequate approaches circumvent the answer the interviewer is actually trying to provoke: are you self-aware enough to know your faults?
Every one of us is imperfect, fallible, and vulnerable to making mistakes. Being a strong physician requires self-reflection and awareness, and interviewers want to know if you are willing to be honest with yourself and others. I can’t tell you how to answer this question, but I can tell you how I did.
As we seek to understand this phenomenon, there are many subjective variables that contribute to the trust between patients and providers. Measuring trust in a reliable and consistent fashion is challenging in itself. With these limitations in mind, three salient factors are involved in the decline of patient trust in physicians: one, a commodified health care system; two, lack of quality time spent with the patient; and three, racial influences on the patient-provider relationship.
When I was 17, I went to the gynecologist for a Pap smear because my mom said, “Once you have sex you have to get one.” It felt like punishment, but it was also the only way I had a chance of getting birth control. I went to three different doctors and exam after exam, they kept saying I could have cancer. I did a ‘colpo’ — whatever that is. After that, they did three different procedures on me, three, all to take pieces of my cervix. I don’t remember what they were called or what even happened. All I remember is the pain.