It’s easy for medical students to think about medicine as it is presented in our textbooks and PowerPoint slides: clear, defined and explained by objective data. Especially in the preclinical years, when we aren’t regularly conversing with patients, it’s easier to conceptualize disease from a pathophysiologic perspective, with less emphasis on its complex socioeconomic underpinnings.
Accordingly, after one and a half years of preclinical “textbook-based” education, I noticed that my original motivator to pursue a career in medicine – the opportunity to connect with and serve other humans – was no longer at the front of my mind; I had been afforded the privilege of focusing on my education (thanks to my own good health and financial foundation), but it came at the expense of remembering my true inspiration to become a physician.
Things changed when I started regularly volunteering at Saint Louis University’s student-run free clinic, the Health Resource Center. As a director of the SLU Sight program, I coordinated eye-related medical care for the underserved populations of Saint Louis. The SLU Sight program brought medical students, optometrists, ophthalmologists and optometry students together to offer diagnosis and management of eye-related disorders and prescription glasses free of charge.
Working at the HRC was particularly sobering as I came face-to-face with the significant health care disparities within my own community. Many patients lacked employment opportunities, lacked housing, faced language barriers or were impacted by other oppressive forces. With limited resources, these patients had to prioritize their basic human needs over other concerns, including visual health.
During one of my first patient encounters at the clinic, I remember a young and seemingly indifferent patient come in with earbuds plugged in her ears. Her hands tightly grasped the arms of the exam chair as she anxiously awaited the arrival of the clinic optometrist. As we examined her visual acuity, I understood why she felt uneasy: a dire need for corrective lenses as well as undiagnosed cataracts had reduced her to near blindness.
According to my supervising optometrists, this was typical; when individuals lack insurance, they often neglect their vision until dire intervention is needed. As we proposed a treatment plan, her quivering leg exposed her uneasiness as she raised concerns about costs, receiving time off work to attend future appointments, and finding transportation to and from the clinic.
Later, the patient returned to the clinic to try out a pair of bifocals we had measured and ordered. As she tried them on, I immediately noticed that her crossed arms and tense facial expression began to relax. I held a mirror out and saw that vision was not the only thing restored: her previously anxious demeanor melted away as she chuckled softly at the clarity of her reflection. In those relieved and tired eyes, I saw someone who had long been at the mercy of circumstances beyond her control, except now, I also saw a way I could tangibly help her situation.
I left this experience with indisputable evidence: caring for others holistically is our responsibility as medical providers. We may not be able to change the life circumstances into which people are born, but we can minimize the damage of systemic barriers to health. Addressing such significant obstacles will take a multifaceted effort, but direct service in the at-risk community is an important place to start. This is where free clinics shine: by simply providing underserved patients with access to the healthcare system, free clinics can have outsized influences on people’s quality of life.
Service is a necessary and mutually beneficial component of medical training. While volunteer work can be exhausting when combined with life’s other demands, it provides the challenges and opportunity for growth that we otherwise may miss during our preclinical years. As future physicians, we will soon have major impacts on our patients’ lives in both obvious ways – such as our major clinical decisions – as well as more subtle ways – such as the small efforts we make to address their social determinants of health. As for myself, I am no longer angry about the state of my community, but rather eager to utilize medicine to create more positive identities for its members – an outlook I never could have developed in the sterile confines of a preclinical lecture hall.