Everyone says that medical school gets better, especially third year. The traditional four-year curriculum covers basic science in the classroom for the first two years. Then suddenly, third year plunges us into clinical rotations in the hospital, where we’ve all dreamed of working for so long. Third year is when we transition from learning how to be scientists; we finally learn how to become doctors — except for one critical, necessary piece.
Like my non-medical friends who’ve really been living life, third year should finally have allowed me to say the same. After all, I’ve delivered babies, consoled surgical patients before going under anesthesia, successfully convinced people to quit smoking … I’ve even had the chance to tell a man he had brain cancer — and then be there to help him process that for hours. For most people, these probably sound like experiences of a lifetime.
Don’t get me wrong. I’ve felt deeply humbled and privileged to share these vulnerable moments with people who trusted me, a complete stranger. Regardless, these experiences simply could not make up my despair at all the things I couldn’t do. My patients’ medical problems were inextricably intertwined with preventable social problems, which my superiors all too often dismissed as “beyond our scope.” This drove me up the wall because, in my previous career, seeing every problem as within my locus of control was the key to success.
For context, before medical school, I was first a Detroit public school teacher. I taught ninth-grade biology in a low-income neighborhood school, where the average ACT score was twelve (fifth percentile). Perhaps fueled by a then-naïve vision for a better society, I trained for this role through Teach For America. While nothing could’ve prepared me for this challenge, my amazing kiddos and I connected and taught each other more than we thought possible. My strongest relationships formed outside the classroom with students whom I helped to overcome social barriers — like lack of transportation, imminent homelessness, and functional illiteracy — which were precisely the same social determinants of health deemed “out of scope” in third year of medical school.
I entered medicine with a specific calling: to do my part to reverse the trajectory of America’s decreasing life span. After a year on the wards, I still hold myself firmly to this mission. But instead of adding productive years to life, my third year focused almost entirely on suffering patients who narrowly escaped death: heart attacks caused by unsustainable food systems, combative psychiatric patients medicated to mask failing social welfare, and diabetic amputations that unacceptably should have been prevented decades ago by public education.
During my entire third year, I repeated to myself, “This just isn’t good enough. We can do better.” At some point, I realized that medical training in its current form will never be enough.
To bridge this gap, I count myself fortunate for the opportunity to pursue a master of public health (MPH) degree between my third and fourth years. This additional training will provide missing skills I’ve needed to advocate for my patients by addressing their social barriers at the intersection of public policy, community development, and education — the upstream “cures” to nearly all of their disease.
But I shouldn’t have to get “extra” training; every medical student should be taught this by default. Just as our Hippocratic Oath obligated us to learn diagnosis and management of disease, it also bestowed a social responsibility upon us to prevent disease through evidence-based policy reforms that “do no harm.”
As many medical schools experiment with new curricula, I challenge them to graduate physicians capable of seeing the bigger picture, beyond the scope of our individual hospitals and private offices. We need community-engaged physicians proficient at collaborating on legislative bills, at conducting targeted health interventions, and at protecting each of our unique patient populations through large-scale health promotion.
If we simultaneously pay for the most expensive care and the worst health outcomes in the developed world, then we are clearly “doing [a lot of] harm.” Now more than ever, it is imperative that our medical schools teach us concrete skills to stand up for what we already know is right, inside and outside the hospital. Only then can we shift toward a reality where everyone has access to excellent health — regardless of their zip code.
Rohit Abraham is a medical student.
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