With the public health emergency of COVID-19, there has been a renewed call to improve emergency preparedness among physicians. Varied proposals have arisen for how to improve medical education in anticipation of future disasters. While many of these proposals are reasonable, a problematic train of thought has also emerged: seeking to improve pandemic education at the cost of removing existing education on the social factors surrounding health.
This approach is misguided, failing to recognize that the pandemic is, by its own right, a vivid illustration of the need for a socially conscious medical education.
The impact of COVID-19 across divisions of race and ethnicity has not been equal. Our emerging knowledge of this disease paints a grim pattern, by which the existing disparities of our health care system are themselves risk factors. Within the United States, communities of color face higher mortality and increased difficulty in accessing testing or treatment.
There is no evidence that these worse outcomes are the result of a variation in biology. Rather, they are the result of structural inequities in our health care system. The United States has a long history of failing to provide adequate health care across the socioeconomic spectrum, and such failings have been laid bare in today’s circumstances. Our health is more reliant on one another than ever before.
And sadly, these inequities will become further ingrained with the economic fallout of COVID-19. From housing and food insecurity, to job loss and medical bankruptcy, the scars of this pandemic will remain on communities of color, far past the public health concerns.
The role of physicians in actively recognizing and working to compensate for these inequities has been well-acknowledged. It’s why the medical school accrediting body of the Liaison Committee on Medical Education places emphasis on a curriculum that teaches students how systemic factors influence individual health.
We expect our next generation of physicians to do more than diagnose blithely, to prescribe or operate by rote. Each patient faces unique challenges based on their identity and situation, and young physicians should be trained in recognizing these factors. Medical education should not aim to become a one-size-fits-all assembly line at the dog whistle of a false dichotomy between clinical excellence and anti-bias education.
This aspect of medical education does not imply that physicians are responsible for the inequities of society, or that they are capable of fixing these problems. Nor does it imply that health care is the root source of longstanding social and economic tensions. Rather, it is an acknowledgment that someone’s health is intrinsically tied to their position in society and the opportunities they’ve been afforded in life.
This pandemic has shed light on gaps in our current health care system. However, increased education on preparedness and response cannot replace crucial education on the social determinants of health.
Now, perhaps more than ever, the world needs doctors who understand the needs of our most vulnerable patients.
Matthew A. Crane and Sara Wallam are medical students.
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