I have been involved in several circles dedicated to making systemic changes in medicine. A goal that started with optimism and hope has slowly been tainted by misaligned intentions and frustration.
Everyone has good intentions when establishing goals/priorities and starting initiatives, however, execution and implementation are very lacking. Many people have great desires and ideas, but few are willing to do the work to make the actual changes.
Many want to feel like they are doing something to relieve personal guilt, feel like they are part of something bigger, add a trendy goal to their resume…etc. However, as I witness many desires, I’m left wondering why the results aren’t matching such enthusiasm.
Why is change in medicine so difficult? Why is it that since medical school (or even since undergrad) students are not taught to put effort into the sociopolitical aspects of medicine? We are drilled to value certain accomplishments over others.
Even though the conversation is changing to say: “Yes we care about fighting equity in medicine, racism in medicine, the mental health crisis in medicine, lack of residencies for graduating physicians”; in reality, the efforts to change these things in medicine aren’t as valued as drilling out 5-10 papers about the “insert a very scientific title about a niche in medicine so you seem very smart”. We see tons of investment and recognition applied to efforts mainly dedicated to improving scientific research but not public health.
Recently, Congressman Murphy introduced a bill, the EDUCATE Act, in Congress to ban Diversity, Equity & Inclusion (DEI) in medicine. The EDUCATE Act reads as an effort to support “colorblindness” in medicine and states that DEI efforts are introducing harmful and exclusionary behavior in medicine. The Association of American Medical Colleges reports that 56% of active physicians are White (of which 65% are male), 16% Asian, 5% Hispanic, and 5% Black. So are we excluding by upholding these DEI efforts? When I look around my class, most people I see are white, and most physicians are white. When I attend programming dedicated to public health or advocacy, most attendees are women and mostly women of color. Some allies are white men (and whom we appreciate), however, there aren’t enough.
The anti-woke propaganda is spreading a false narrative that DEI efforts are meant to harm Caucasians, rather than to promote the inclusion of people of color in medicine. However, the actual truth is…POC are the ones who are mostly involved in efforts to improve the sociopolitical aspects of medicine. There is still a struggle to have allies who identify with the majority of people in medicine to be involved. Again going back to why efforts to change the “isms” in medicine are not regarded with the same value.
Are we improving medicine for a selected privileged few? Or do we want the great improvements in medicine to be accessible to the public? To be in a system that allows equitable access. In a system that appreciates well-rounded physicians and supports their physical and mental well-being.
Don’t get me wrong, I value science. The science is what started my interest in medicine. However, as I grew to understand that medicine intends to help patients, I started to expand my values to other sectors that impact patient care.
Science is imperative for medicine to move forward. For a time, it made sense for efforts to be hugely dedicated to such aspects of medicine. However, in these modern times, we are seeing how such dedication is affecting other aspects of medicine. We can see how it plays into physician burnout, physician suicide rates, low representation, and the value of people of color in medicine.
We can’t make the changes we apparently care about so much, without doing the systemic work of improving public health-related initiatives in medicine.
In my “Upstream Medicine” course at my medical school, we were given this analogy that stuck with me. Paraphrasing: there is a community whose main water source comes from a river; a huge rock blocks the stream up the hill so not much water reaches the community. Do we find a way to remove the rock or tell individual families in the community to figure out a way to bring in water?
I think right now in medicine we acknowledge we have a problem but rather than fixing the issue upstream, we are putting it onto certain individuals to make the change.
So how does addressing the issue upstream start? With changes from medical schools, residency programs, and hospital boards. With curriculums, requirements for residency, and definition of what an excellent clinician entails.
For example, instead of scheduling a wellness class for 3rd years on a Friday at 3pm, maybe we establish policies and behaviors to decrease the workload for students, residents, and physicians. Maybe we lobby and advocate for more physician hires and better pay across specialties so that doctors are not overworked and undervalued to the point of suicide.
There is this culture of: on the surface, you are to state the desire to make systemic improvements in medicine, while you are expected to not shake the table too much, and wait until you get into the room before demanding change. However also know that by the time you get to the room, you will have been broken down so much by the system that either you will be too burnt out to care or won’t have the same desire anymore because the system now finally benefits you individually.
Some individuals have a sincere desire to make changes in medicine; but, like me, when thinking about how things are and how slow change in medicine is, you are beginning to feel a bit frustrated and cynical.
Nonetheless, I’m holding on, very tightly, to some optimism and magical thinking I have regarding changing medicine. I am encouraged by mentors and peers who are in the safe spaces dedicated to making this change.
I want to encourage medical schools and hospitals to think about their mission and vision statements and reevaluate how they are upholding them, especially now as dangerous bills such as the EDUCATE Act are being introduced to our government.
I want to encourage medical students (especially our white male peers) to think back to those one or two essays submitted during the application process about vision and goals, diversity, health disparities, commitment to service, or cultural competency. Ask themselves what they have done/ could do to support those values they wrote about.
Articles to read: Murphy Introduces Bill to Ban DEI in Medicine
Tools to make change:
- Visit the American Medical Student Association Activism Toolbox to see how to write a letter to your congressman
- Find your congressperson and reach out to their office (it is within your right)
- Make a goal for yourself to select a cause, learn as much as you can about it, and support an event or organization dedicated to such a cause. One small action is better than nothing at all.