A lack of social education in medical schools today

I’m a second-year medical student, and quite recently, a lecture left me with serious doubts about the state of social awareness in the medical field and schools. The dermatologist lecturing described a patient with secondary syphilis, stating he felt the case was odd since, “He [the patient] didn’t look gay or anything,” as if only homosexual men could contract that disease.

I was hurt. I not only belong to a racial minority, but I am also gay. His words were utterly oppressive, and yet he uttered them nonchalantly and acted like he had committed no wrong. The worst part? A few of my classmates laughed with him. That is not to say that I am openly discriminated against, as many of my classmates came up to me afterwards expressing their disapproval at such an offhanded comment and offered support, but it is not the first time I have heard a physician say something outdated and oppressive. Hearing both MDs and DOs consistently teach in this way makes me question how prepared some of my classmates will be in an increasingly globalized world.

At my school, we are taught by both DOs and MDs, and I have noticed a general trend in this lack of social education. For example, in our lectures and handouts, men who have sex with men are automatically termed “homosexual”; actual homosexuals are deemed at high risk for most STDs and infections; sex and gender are used interchangeably; race is tossed about as a buzzword without explanation; endless cultural stereotypes are reinforced; Africa is referred to as a country; African-Americans are automatically relegated to a lower socioeconomic status.

I could even go on and on about how my Muslim friends were singled out in a class of two hundred simply because our virtual patient wore a hijab in her stock photo or how the “correct” answer on an exam was to either bow to an Asian patient or greet a Hispanic patient in Spanish.

To think, this is all at a top ten primary care institute.

What’s frustrating is that most of the administration and faculty are passive in pursuing solutions to these problems, despite student input via course evaluations and student organizations. It’s incredibly frustrating in two ways: Intolerance is still highly prevalent, which makes people of my identity feel unsafe, and this social unawareness only perpetuates its misuse, which in turn informs future physicians on how they perceive and treat their patients.

Laverne Cox recently said, “Each and every one of us has the capacity to be an oppressor.” We, too, can hurt as we heal. As medicine is constantly evolving, so are the times, and it is time medical schools properly educate their students, for this stark lack of social awareness reflects poorly on the entire profession and mitigates our capacity to act as healers.

As future physicians, one of our goals in the clinic is for the patient to feel safe — not demeaned or judged for who they are. Current physicians, too, need to brush up on what is correct and what is outdated. After all, a career in medicine means a lifetime of learning.

The author is an anonymous medical student.

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  • MDinTraining

    Awesome article. I’ve noticed this in medical school too, and no one talks about it. Thanks for articulating such an important shortcoming in medical education. I wouldn’t be surprised if you recieve a lot negative feedback about being “too sensitive” or “politically correct” but patients are much better served if we’re more open and aware of social/political identities and how they evolve – not stubbornly against adapting to them.

    • SteveCaley

      You near a critical topic in medicine that is poorly understood, and poorly taught. As language itself in its construction drives thought, even more so do labels command the flow of thought, and often arrest it.
      The language of medicine is an oral language that we have to learn; to tell a story. The technologizing of medicine assures that more is better, and extraneous normal detail adds to the comprehension of the patient. It does not.
      Properly, the medical narrative is poetry. The EMR is machine language, not poetry. The skill of diagnosis is being lost, because we are teaching the humanity out of medicine.

  • buzzkillerjsmith

    One of the most ridiculous things I heard in med school was when a young black woman with Marfan’s was in front of a bunch of us and we were asking her questions. One idiot faculty member asked her if she ever noted any extreme exertion when she was swinging an ax.

    Then he backpedaled, saying something about Abe Lincoln and Marfans and chopping wood.

    It was so absurd we had tears in our eyes from laughing.

  • http://www.amerechristian.com/ Ron Smith

    Hello, anonymous.

    Hmmmm. I am a typically southern medical doctor, trained in Arkansas, at UAMS.

    I was born and raised in rural area around Arkadelphia. My Father was born and raised down ‘across the railroad tracks’ and my Mother born and raised in the real sticks of Graysonia, no longer now a town, but which was some 30 miles deep into the backwoods beyond my Dad.They had about $20 or so when they got married. The poverty line was so high for them there was no further down they could go. I was 5 and my brother 1 when we spent a cold Christmas one winter in Hakell, Texas, where my Dad desperately moved us to get work. I am not sure if we had a Christmas tree…but I do remember the only two gifts in the house. There was a cheap plastice truck with wooden blocks, one each for my brother and me.

    I have a rural, southern drawl. I never expected to be able to completely eliminate a southern slang no matter how I tried, and as much as it might have made me look differently to city folks.

    But poverty, lack of social upbringing, and a southern drawl that I couldn’t myself perceive, didn’t stop me from making straight A’s in Chemistry for four years. It didn’t stop me using my brain and the common sense my parents gave me to prove that I could be a good resident. It hasn’t affected my ability to practice solo, or be a clinical participant is the fist neonatal surfactant trials destined to change the horrible 30% mortality of the premies I took care of doing level three care in a town of just 25,000.

    You see my identity as a good doctor has nothing to do with my southern drawl, the lack of social upbringing, the poverty in which I was raised anymore than matching colors of the clothes I wear.

    I have an identity as a good doctor for *one* reason: its what I strive for and its what I am determined to be.

    Now I’m a Christian, married to my wife Stacy now coming up on thirty-seven years, am straight, and still get a thrill out of new families after 31+ years in Pediatricis.

    To me those are good things, but they are not what makes me a good doctor. Sure I probably have been snickered at or looked down on, and didn’t even know. Some reading this might be snickering even now. But I’m not bellyaching about it.

    The proof of the book is in the reading where it says ‘THE END.’ Now if you want to be a good doctor, focus on that. You and I may be different in every other way, but perseverating on those things that ‘hurt your feelings’ or aren’t’ politically correct won’t help you and it won’t change anyone.

    People are going to do what they want to do regardless of what you say.

    Now I’m not being condescending in this advice. You’ll take it or leave it, scolding me in the process or maybe considering the wisdom of my words.

    Get over what isn’t right with your little part of the world, and be the best doctor you can be.

    Respectfully,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • Felix Oyoung

      Dr. Smith, I believe you’ve missed the point of this op-ed entirely. Your last statement is proof of that.

      Let me go back in time and simply tell Civil Rights Leaders and activists to “get over” segregation. Let me go and tell LGBTPQIA and allies to “get over” their issues. Let me go back in time and tell the slaves to “get over” it. Let me tell that to everyone who was and is discriminated against to “get over” it.

      This is a classic “You’re being overly sensitive” response.

      The author here is talking about the fact that the medical profession is perpetuating oppression and ignorance. He never stated that he was not striving to be the best doctor he could be. Clearly, you have striven for much, but you miss the fact that the author is a part of both a racial and sexual minority, and you are a white, cis-heterosexual male practicing in the south (hello, white male privilege). You are literally telling this med student that because he is not any of those things, they are not good.

      What this author has written about is a very real issue, and it’s not about being overly sensitive. This plays into a much larger issue around this nation, and you, Dr. Smith, are guilty of perpetuating it.

      I’ll leave the “advice” alone, and I believe the author will too. You aren’t being condescending in anyway, it’s just that you’ve proven this doctor-in-training’s point with your “wisdom.”

  • PoliticallyIncorrectMD

    It appears the author has learned everethyng there is to learn about Medicine, so now it is time for social education : )

  • querywoman

    Venereal disease is a fact of life, not limited to a certain racial or sexual group.

  • Eric Strong

    What you’ve described is the an example of so called hidden curriculum of medical school. And you will see even more of it on the wards. Whether or not you challenge it directly when you encounter it is a personal decision, but for students, I usually advise against it. Sadly, openly pointing out a professor or attending’s inappropriate comments/behavior may harm your grade, reputation, and/or personal relationship with that individual (who you may encounter again further in training). The best thing to do is usually to describe your concerns in an anonymous evaluation of the course. It’s unfortunate that this apparently hasn’t had any impact in your own institution from what you’ve described. An action to also consider which will almost certainly require the school to make changes is for a group of students to all describe your concerns in surveys distributed by LCME during the school’s reaccreditation evaluation.

    All students learn from the hidden curriculum. The ones who don’t recognize it as such will learn a reinforcement of prejudices. The ones who do recognize it as such can better understand how prejudices persist in health care, and thus will become better prepared to fight against them.

  • SteveCaley

    Benson Snyder may well have launched the concept forty years ago. I recommend “The Hidden Curriculum” by Benson Snyder, MIT Press 1973

  • Duncan Cross

    Clinical education is the opposite of social education. It’s a bigger problem than intolerance or cultural ignorance: the approach to disease taught in medical schools focuses on disease as a clinical problem, encouraging physicians to ignore illness as a social problem. What patients too often get is treatment that does not connect to the social aspects of their lives: medicine that prevents them from living their lives, rather than helping. This won’t change until schools teach physicians to see those social aspects as important to the patient’s overall well-being, and help them find ways to work with the patient’s social context.

    • PoliticallyIncorrectMD

      Agee, but don’t you think it is the patient’s responsibility to clarify for their physicians what their particular social context is. After all no treatment is offered without patient’s consent. If you feel certain treatment does not fit your specific life goals, why don’t you say so?

      • Duncan Cross

        Yes — it’s is the patient’s responsibility to explain their social context, if only by default. Most physicians won’t ask. But even still, it’s hard to convince physicians that it matters.

      • rbthe4th2

        Actually I’ve have had treatment by a doctor that was given without my consent and forced consent.

  • Karen Ronk

    The fact that this author needs to be anonymous tells us all we need to know. One wonders if the education of doctors is so flawed as to social realities, what else are they missing?

  • A Banterings

    In response to what Eric Strong said:

    Sadly, openly pointing out a professor or attending’s inappropriate comments/behavior may harm your grade, reputation, and/or personal relationship with that individual (who you may encounter again further in training). The best thing to do is usually to describe your concerns in an anonymous evaluation of the course.

    Two wrongs DON’T make a right. SPEAK UP! All that you are doing by NOT speaking up is learning that you can do whatever you want as a physician and get away with it!

    This is only reenforcing what we have seen in the Milgram Experiment AND the Stanford Prison Experiment.

    As to homosexuality, there is such stigma with the fear brought by the 1980′s AIDS spread. This fear was perpetuated by healthcare really dropping the ball on this disease at first. They simply blamed it on “gay men.”

    I personally know some gay physicians, I think that they are much better practitioners of the healing arts than “straight doctors.”

    Allowing medical schools to teach on incorrect material is paramount to “snake oil.”

    Furthermore, we are all (essentially) bisexual. It is just a matter of preference and opportunity. I proved this fact in my senior thesis. Kinsey scale demonstrated this with his “Kinsey scale,” also called the “Heterosexual–Homosexual Rating Scale.”

    Perhaps these “teaching physicians” need to be reminded that they are (essentially) gay too, although they may not look it…..

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