Why the diversity of medical students is important

As a medical student, it’s difficult to face a situation where everything possible is done for a patient, yet due to circumstances (seemingly) beyond our control, the risk of future harm remains uncomfortably certain. The majority of our medical school learning focuses on how to cure illness; unfortunately we’re not always taught how to deal with the real world issues that face our patients and that threaten the medicine we practice.

This month I’ve been on my neurology rotation at Santa Clara Valley Medical Center, a county hospital with patient demographics quite different from those seen at Stanford Hospital. As I serve a more diverse and disadvantaged socioeconomic population, it’s often the case that the information in the patient’s “social history” section, which I usually quickly pass over, becomes a defining piece in deciding next steps. The 20-something-year-old with daily seizures because he’s so high on methamphetamine that he forgets to take his pills, the 40-year-old with left-sided paralysis who keeps checking in to the emergency department because she feels unsafe living alone in a trailer park, the 60-year-old who didn’t present to the hospital until days after suffering a stroke because he couldn’t physically get to the door to call for help: These patients demonstrate how social situations can make efforts to provide medical care at times seem futile.

In medical school, we’re taught the pathophysiology of disease and systematic approaches to medical management, but not how to deal with social contributors to health. (The latter is a not-so-glamorous aspect of medicine relegated to the hidden curriculum of clerkships.) During pre-clinical years we spend a lot of time discussing how to make empathy a part of our clinical skillset, but a pitfall to practicing medicine in a way that is sensitive to a patient’s social context is the belief that showing empathy is enough. To express concern for a patient is different from really understanding a patient’s challenges. Things like the fear that drives a patient to repeatedly present to the emergency room for “inappropriate” reasons and the thought process behind not getting an MRI done since it would mean missing work may not fit traditional logic, but they represent an important piece in delivering care.

What can’t be taught in school is an inherent understanding of the difficulties that some patients face, which is why the push for future physicians to be individuals representative of the various backgrounds that patients come from is so important. (It can be surmised that students who have endured these difficulties, themselves or through family, socioeconomic or health related, could better relate to patients they come in contact with.) While socioeconomic demographics are easily seen on paper, though, what is harder to select for and recruit is the student who has lived the real world environment characterized by social issues like multiplicity of chronic illness, housing insecurity, and financial hardship. And, of course, many students in this very position never make it to the point of training for a health profession as a result of the very hardships that make them more attune to the social issues that may contribute to poor health.

Medical school recruitment has changed in ways that will hopefully improve diversity of recruited students and contribute to a greater understanding of the background of all sorts of patients among health care providers. However, more still needs to be done to support students from less traditional and underrepresented backgrounds so they reach the point of applying in the first place.

Instead of being discouraged by their less-than-ideal journeys to medical school, students who have endured educational, financial, and social hurdles should be encouraged to use their learned experiences as a frame of reference to positively impact the delivery of health care.

Moises Gallegos is a medical student who blogs at Scope, where this article originally appeared.

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  • Eric Strong

    Moises, thanks for this thoughtful post! Underrepresented populations in medical school aren’t limited to those of a certain race or geographic location. Of course, a major challenge is identifying who those students are since there isn’t exactly a clear place on the application to note a personal history of economic or social hardship, especially when many applicants may mistakenly see this as a negative or as something to be embarrassed about, and thus, something to be downplayed as much as possible. Also, as you’ve stated, most of these students don’t even reach the application step since they’ve either given up or been forced out of the process well beforehand. I agree that we should do better.

  • Vinyl

    My problem with the whole “diversity” or “embrace diversity” in medicine is that at some point it will become a Catch 22. Medicine is not about convincing the public of the need for more diverse doctors. Nor should the discussion lead toward medical schools admitting more minorities for the sake of diversity. Medicine is about teaching each and every student that ALL patients are unique, regardless of creed, ethnicity or background. We are all individuals from unique backgrounds and cultures. How is it any different for a minority treating a privileged patient than it is for a privileged physician treating a minority? It is a two way street. I can’t tell you how many times of have listened to family, friends, and even patients complain that they feel they either can’t understand what their doctor is saying or instructing (because his or her native language is not English), but can’t relate to them. And these are “privileged” or “run-of-the-mill Americans” Yet we don’t hear about this disparity. The point I am trying to make is that for me, medicine is about treating everyone uniquely with an OPEN MIND. The latter is the most important factor approaching patients. You may not understand what the patients culture is or religious idiosyncrasies are, but as long as you approach each patient with an open mind and willingness to understand then to me that is far more important than trying to match up minority doctors with minority patients and privileged doctors with privileged patients to make things easier or more appropriate. What ever the reason is, I think the conversation should be about teaching everyone how to treat an individual. No matter what creed, ethnicity or background you come from, there will always be a discrepancy or, to phrase it this way: a moment lost in translation, where we as physicians may not understand or relate to a patient. The point is the willingness to understand them. That is the art of being a physician. Not about matching color with color or creed with creed.

  • understandnatives

    In our experience, concepts like “diversity,” “affirmative action,” and others are actually extremely harmful to minorities. (1) They polarize communities and cause the mainstream community to hate and resent minorities. (2) Sure a very small % of minorities benefit from affirmative action but a VERY large proportion of minorities are hurt by it because of majority resentment. (3) The wrong minorities benefit from affirmative action – two Harvard professors have shown that blacks who benefit are almost always wealthy, recently-arrived immigrants from Africa or their children – and not descendants of slaves; in our experience, Native Americans who benefit tend to be white Indians who have near-zero Indian culture in them and who have lived as whites all their lives. (4) Concepts like diversity are also misused when medical schools look at “other factors.” Which basically means they overlook quantitative indicators like MCAT/GPA – which is very convenient when it comes to selecting friends of politicians, relatives of deans of medical schools, legacy applicants, children of donors, etc etc etc. (5) Finally if affirmative action was REALLY beneficial to minorities, the established elite would have never approved of such a system. Affirmative action hurts and harms minorities. Severely.

    • Eric Strong

      Did you even read the post? The author doesn’t discuss affirmative action or racial minorities at all. He’s talking about diversity inclusive of those with nontraditional backgrounds and/or those with a background of social hardship. These problems transcend race. The pros and cons of affirmative action are irrelevant to his point.

      • understandnatives

        All that diversity talk is pretty much the same thing – sacrificing quantitative, standardized indicators like the MCAT in favor of subjective decisions made by vested interests, prejudiced decision makers, deans interested in selecting children of donors, legacy admissions, etc. Just adopt the standarized systems adopted in European countries and forget about all that diversity talk.

        • Eric Strong

          1. Are you actually suggesting that an admissions policy which places positive weight on a history of socioeconomic or other personal hardship can be used as a backdoor into a school for children of wealthy donors? That is absurd.

          2. As Dr. O’Brien has already described above, as med school faculty, I am way more impressed with a disadvantaged, public university student who scores a 36 on the MCAT than I am with the wealthy, Ivy-Leaguer who scores a 36, as the former almost certainly has more innate talent. Actively seeking diversity among medical school applicants actually leads to a stronger and harder working class.

  • SteveCaley

    Be very wary, too – “diversity” has often been used as the cover for things that don’t merit praise.
    Many people are cheering the feminization of medicine, where primary care may be pushed into the category of a pink-collar profession. It’s not that society has wised up and decided to be fair – it’s sometimes used to unload something going sour onto the unsuspecting – and in bigoted ways, too.
    Anything that ranks, segregates or divides humans on the basis of worth or labels should be viewed with suspicion. Commonalities are coincidences; we are each at heart individual, ourselves – and more in common existentially than by merit of different labels.
    Our passion for conformity makes for cultural mediocrity. THAT is something that lies at the roots of prejudice.

  • James O’Brien, M.D.

    Dennis Rodman went to SE Oklahama St., not exactly a BB powerhouse. If he shows up to camp with the same skills as another player who went to Duke or North Carolina who had exposure to the best coaching, you would probably be correct in assessing he has more upside.

    Therefore it is probably correct to conclude that someone raised in a trailer park from a bad school who has an equal MCAT score to an Ivy Leaguer who went to the best prep schools has more upside potential. They did the same with a lot less. So this isn’t just ideological, it is somewhat rational.

  • Eric W Thompson

    You have a persuasive arguement. But the same reasoning could be used to say that women are better at treating women, whites for whites, asians for asians and Muslims for Muslims. Where does it end? If you state it is better to have the same background, it opens the door to significant discrimination.

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