To effectively practice medicine, we as medical trainees and physicians have to acknowledge the privileged position we are in and the barriers that our patients face.
This privilege exists in part because many entering the profession are advantaged in the first place: traditional medical admissions processes benefit those of higher socioeconomic status. Admissions offices across North America are beginning to create innovative solutions to bridge this gap.
The other part of the privilege has to do with the profession itself: medicine is placed on a pedestal in society, with a high amount of trust placed in us by patients. Even within health care, physicians are often viewed as the unequivocal leaders, something that is appropriately changing with more inter-professional models of care.
Recognizing privilege is important because high quality patient care depends on it. Patients sometimes struggle to be understood by physicians who mean well, but for whom issues like marginalization, poverty, or limited health literacy are simply not as real. We are trained to explore the intersection between health care and social issues, yet when it comes down to it, we may only “refer to social work.”
For example, there is a lot more physicians can do for patients in poverty, from asking patients if they’ve applied for government programs to screening for conditions that are more common among low-income populations.
Moreover, unrecognized privilege is a breeding ground for bias. Both anecdotal writing and published research have shown that health care is rife with stereotyping and microagressions that impact patient care.
This is not the explicit discrimination we are quick to denounce. Instead, it is subconscious, such as assuming patients with disabilities are not sexually active, or that their presenting issue is necessarily related to their disability. It might also mean under-treating pain in patients of certain classes or races because of subconscious assumptions about the potential for medication abuse, or a false belief that they have higher pain tolerances.
Our ability to self-reflect impacts the way we interact with other practitioners as well. While it is never malicious, medical trainees and physicians sometimes make the subconscious assumption that other professionals are not as capable. This type of hierarchical thinking can lead to more problematic issues such as verbal abuse and sexual harassment, especially towards those considered lower on the health care “ladder.”
Despite the clear importance of this, and many “calls to action,” much more can be done.
Admissions offices should continue to use outreach programs, financial aid, and widened selection criteria to build classes that are representative of the patients they will be serving.
However, there are also plenty of things we can do within the profession itself and its training.
First, quite simply, there must be a collective paradigm shift. It is not enough to stand idly by and hope that the health system will be swept up by the tide of social progress around us.
We must actively create and support initiatives to improve social justice in medicine, give back to our communities, and position medicine as a profession that does not buy into the societal hierarchy and superiority often ascribed to it. No more should the clinicians that care about social justice be considered the “advocacy types,” but instead just clinicians.
Second, we must find better ways to help medical students develop a deep understanding of privilege. Medical education has progressed, producing more socially conscious physicians than ever before, but we must not be complacent in this.
Every school has a course about the social determinants of health, but these courses are often considered the fluff that you quickly cram, or the experiences that give you a break from the real learning. On this sort of mentality, former Daily Show host Jon Stewart once said that “if you’re tired of hearing about it, imagine how exhausting it is living it.”
That said however, perhaps there is good reason that these courses are not taken seriously. Feedback and data from students must be integrated to create immersive experiences that effectively teach these concepts.
The content should also be scheduled in a way that makes it a priority, instead of being found exclusively the week before exams, when students have more pressing concerns.
It must also be dispersed throughout curricula. For example, though it is commonplace to learn about race as a disease risk factor, this is usually taught without explanation about why these risk factors exist. This is problematic, since often the cause has less to do with genetics, and more to do with socioeconomics and systemic inequities.
To supplement curriculum changes, student leaders should work to create more spaces to have open, non-judgmental discussions on topics like discrimination.
Third, we must encourage medical organizations and student societies to be bodies for bigger change. A classmate once said it best when she lamented that the most advocacy we were engaged in was for fewer mandatory seminars.
There is a worry that our place in medical school is not to be “political,” but part of acknowledging our privilege means engaging with the world around us and pushing for social change. This is slowly shifting, as was seen when student Medical Societies released statements last year standing in solidarity with Black Lives Matter.
Finally, maybe the most powerful action is reflection. It is easy to become defensive and quickly tell ourselves that we know know our patients may face barriers, or that we can rattle off the social determinants of health. It is another thing to actually believe that this privilege exists, address our personal blind spots, speak up in health care settings, and go the extra mile to actively work against inequities felt by our patients.
As medical students, perhaps sometimes we need to spend less time debating the relative incomes of various specialties, and more time remembering that no matter what, we are extremely fortunate.
Medicine is a profession commonly associated with elitism. We have to ask ourselves if that is the identity we want to have.
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Great perspective on privilege and oppression. These two exist on an individual, cultural, and institutional level as you’ve mentioned, and this is no exception for the health care industry. It’s almost impossible to completely equalize and repay back our debts for social inequality to marginalized groups, but I think that what you’re doing, advocating for a more informed perspective and getting people to think about these issues, is a step in the right direction. I hope that you’ll be the change that we need!
Why is it that identifying yourself as ‘being privileged’, smacks of elitism. I understand what you are saying and applaud your passion and hope your senior disgruntled peers do not beat it out of you. Me being a patient with a chronic illness am very glad my children did not go into medicine or law. It seems no matter how disgruntled a practioner becomes, there is just no way out, after investing themselves. You will certainly have to steal yourself against your seniors who will warn you that your passions or compassions will do you in.
I enjoyed reading this article.
I was not privileged going into Medical school but I sure am privileged now. I think about that privilege everyday, especially on the bad days. It helps me focus on the patient.
Well done and keep up the good work
“There is a worry that our place in medical school is not to be “political,” but part of acknowledging our privilege means engaging with the world around us and pushing for social change. This is slowly shifting, as was seen when student Medical Societies released statements last year standing in solidarity with Black Lives Matter.”
Black Lives Matter Toronto is not an organization worth looking up to.
1. Black Lives Matter refused to sell a white woman a T-shirt for solidarity because she is not black.
2. Black Lives Matter Toronto leader sends out a tweet, praying to God/Allah to give her the power to not kill black people.
3. Black Lives Matter Toronto leader, Yusra Khogali, says white people have inferior genes.
I am a person of color, an immigrant, and I am a physician. But I have a lot of issues with ignorant students such as yourself trying to virtue signal to others on how much you care about social justice by latching on to the cause en vogue. When you critically look at the cause, it turns out that it’s not necessarily about justice, and the leaders who claim to care about justice are incredibly racist and bigoted themselves. You really think supporting this group will lead to positive social change?
Congratulations, in your ignorance you have spoken for hundreds of medical students in supporting a group with leaders who have said unthinkable racist comments. But anything to make yourselves feel better on how much you’re fighting against oppression right? Whatever makes you sleep at night.
Thank you so much for your thoughtful, empathetic and important article Samik.
If The College of Physicians and Surgeons were to lobby for uncontaminated water on our First Nations reserves, to the government officials responsible , I am certain we would see quicker action.
I once met some staff who had been working in war torn countries with Médecins Sans Frontiers. They all said it as more difficult to see what was happening on our reserves in terms of health care. Our First Nations people deserve top notch health care, without judgement and criticism.
Meet Dr, Nadine Caron, Canada’s first FN surgeon and listen to story.
Sorry, forgot to give you the link :(
A thoughtful and though-provoking piece. We truly are one of the more privileged groups in society and would benefit from reminding ourselves of that regularly. I have become more troubled over time with the relative lack of students from lower socioeconomic backgrounds in medical school. Deregulation of professional school tuitions in some provinces has put med school out of reach for many and I wonder how many don’t even consider it because of the cost. The University of Manitoba has started to factor socioeconomic background into their admission process- hopefully more schools will follow suit.
Thank you for this thoughtful and thought provoking article. Understanding that being a health care provider is truly a privilege and bringing change to the “elitism” in our profession must be a priority across the educational continuum. I look forward to working with Samik and the next generation of physicians to ensuring this is a priority in our MD Program
It’s kind of ironic that a medical student wrote an article taking about “checking your privilege” where they chastise their more learned colleagues for not practicing medicine properly where they are a long way from actually carrying the burden of full responsibility themselves.
Doctors are not social workers. There already aren’t enough hours, energy or funding to go around to allow the average doctor to perform their main function adequately, the practice of medicine, while maintaining their personal lives and their sanity.
By all means, be aware of poverty and tailor your approach based on individual circumstances. Learn what’s on or off your provincial formulary. Get a general sense of drug costs and pick cheaper alternatives whenever appropriate. Don’t charge people for sick notes if they can’t afford it. Help people whenever you can to fill out government documentation for additional funding. Don’t start people on expensive drug samples if they could never reasonably afford the medication out-of-pocked once the samples run dry.
But your main prerogative is to practice medicine and do it expertly. This job is hard enough. Don’t take on the worlds problems. They will sink you and you will lose.
As someone close to the end of my medical career, I must disagree with Dr. Pookay. Our students are in a position to see the medical world from the inside without having fully become insiders and I think we can benefit from the insights they give us.
You are right that our time is tight, but making assumptions can lead to missed diagnoses, prescribing meds that patients can’t afford, or blaming patients for their illnesses.
I have read some of your other comments on various blogs and know that you are concerned about getting the appropriate tests and medications covered for your patients. It doesn’t take an inordinate amount of time to take the next step and incorporate Mr. Doshi’s ideas into your approach.