A Doctor’s Role In A Community: Reflections From A Yale Med Student.
I found Michael sitting in a café on Yale’s campus early on a Saturday morning. I arrived to write up my questions before my last interview on my revisit for the Ph.D. program at the Yale School of Management and was surprised to see someone else here. The café had only been open for 20 minutes and the campus was mostly empty while most of the students were on spring break. There was room at the table beside him, so I sat down and asked him, “what are you reading?”
“A book about eye examinations and diagnosis. It’s for an Ophthalmology class I’m taking at the medical school.” He was holding a highlighter in his right hand, and had been flipping back and forth between pages with a very serious expression on his face when I interrupted him.
“Do you like the class?”
“Yes. The faculty who teach it are trying to convince us to join their specialization.” And after a pause where he looked off into the room behind me absently, he added, “It has instilled a joy of medicine in me that my other courses haven’t.” There was weariness to his tone. Maybe medical school wasn’t what he expected it to be.
“What kind of patients do you want to work with?”
Like he was apologizing to me, he said, “I want to support a patient population that doesn’t trust physicians and who has been under-served by the medical system, like undocumented workers, low-income people, people of color…”
“Does your medical school do a good job reaching out to them?”
He thought for a minute, looking down at his lap as he responded. “Yes, it’s part of our curriculum. We talk about how to take care of them.” Though, it seemed, maybe not as well as he hoped.
“What are the biggest barriers for them?”
He looked up again. “Lack of access — I mean physical and financial access. Distrust of the medical system.”
Overcome with my own curiosity, I asked, “How do people rebuild that trust?”
“Well, you have to be there and follow up, and be there for a long time. It’s about building long term relationships. It’s about outreach: going to people’s homes and providing care there, not forcing them to go to a clinic full of people who don’t look like them, not force them into filling out overly complicated forms and navigating payment systems. The offices are gross, they’re covered in Pharma ads, with Pharma pens and Pharma shit everywhere.” I felt a similar frustration towards Pharma, especially with the ACA on the chop block earlier that week.
Michael, trying to convince himself he was a happy med student.
“What kinds of doctors do a good job serving them?”
“Right now, Primary care and family medicine do this well. But we also want other kinds of doctors to do better. Ophthalmology could do better … you need your vision to help your family, lots of space for impact here. People go into poverty because they have vision issues. There are so many easy, low cost interventions that could fix their vision issues.” Maybe he really was interested in reading about eyes!
“What made you decide to become a med student?”
He crossed his legs, then his arms and leaned back in his chair. He looked down again when he said, faintly, “I want to help people. I want to be a doctor who serves these communities.”
“Do you still believe that you can do that as a doctor?”
He tilted his head and raised an eyebrow at me. “I do. I don’t know what it looks like in practice, what with all the logistical issues of being a physician. I like the idea of providing free care to people who need it. But this is a logistical nightmare… but who has time for it? And all the ethical things that go along with that… so much paperwork…” He was avoiding my eyes now. He had put his book and highlighter down on the table and was now very focused on gathering the crumbs on the table in front of him into a pile.
“Who creates all this extra paperwork?” I couldn’t help but keep poking.
“Insurance. Medicare and Medicaid do. HHS do.” He seemed to be less interested in answering my questions now, so I changed the subject.
“I don’t quite know how to ask this,” I said, “but what do you think about the physician’s God Complex? Do you notice one?”
He looked at me very seriously. “Some do go into medicine for this reason: OBGYN and Surgeons do see themselves as super humans. It exists. But I find this very off putting. I went into medicine to build relationships with patients, to help them in the long term. I think having a God Complex means building an inherent distance from the patient. This is off putting to me. I believe medicine is about empowering patients, not just doing things to them that makes their lives better. It’s a collaboration, I’m not just a service provider.” He looked at me expectantly.,
I found myself without a good response, so I asked quietly, “Is it sometimes hard to remember why you are there?”
“Yes. Especially when you’re memorizing the umpteenth fact about cranial nerve 10 or whatever, it’s hard to remember why I’m doing what I do every day and what it will ultimately lead towards.”
“So then, how do you re-center yourself?”
“I try to go have experiences in hospitals as much as I can, I shadow as much as I can because that reminds me why I am here.”
He looked at his watch, purposefully. I got the message.
“Ok I have one last question and then I’ll leave you alone. What is something you wished people would ask you?”
“I wish people would ask me why my beard is red but my hair is not red. The answer is that it’s a mutation of one gene. I discovered this in med school, when my med school friend told me.” I let out a laugh from deep in my stomach in surprise.
You can find more of my primary sources here.