5.1: Understand the institutions and individuals that participate in healthcare delivery and the role of the physician in the health care system.
During my time in medical school, the US has been at a watershed moment politically, and that has led me to seek opportunities to get involved and seek to promote positive change in our politics. In the summer of 2017, just when I started medical school, “repeal and replace” was the talk of the town. The newly elected Congress and President were putting the Affordable Care Act on the chopping block. As the process went on, it became apparent that Congress had a lot of appetite for “repeal”, but less ideas for “replace”, and I worried that we would return to the bad old days of high risk pools and no protection for preexisting conditions, and that millions of people would lose their health insurance. I wrote letters to my congress people and called them, but I felt a mounting sense of helplessness as the process seemed to barrel to an inevitable conclusion. Ultimately my worst fears did not come to pass and the law was saved, for the moment at least, in part thanks to a deluge of activism and opposition from across the country. This early experience pushed me to think about the role of physicians in the healthcare system.
As physicians, we are large stakeholders in the health system and perhaps its most visible face, but we do not possess all or even most of the power within it. This power rests in the world of politics, which exists to answer the question of “who gets what?” in a world of limited resources. The health outcomes of our patients often stem not from the quality of patient care that we rightfully spend most of our time thinking about, but from systemic factors such as insurance availability and affordability, food systems that promotes unhealthy behaviors, the safety of consumer goods and the built environment, and numerous other factors. As advocates for our patients and the face of the healthcare system despite our limited power in it, it is therefore our responsibility to push for positive political change to secure broadly equitable and improved health and safety outcomes throughout our society. I slowly realized the importance of the political side of medicine over the course of medical school, and how it threads in to every portion of our profession. There was no discreet moment, just a long series of patients and situations that were impossible to resolve in the way I would want by the time they arrived in front of me. One that sticks out to me was a patient at the VA who had lung cancer, likely as a result of being stationed at Camp Lejune, a Marine base in North Carolina at the center of a massive waterborne carcinogen scandal. I wrote about this scandal in a college class years ago using a piece in Newsweek and other sources.
The cover of the Newsweek article I wrote about in college
And there in front of me was a victim of this environmental irresponsibility of the government and military. After reading so much about systemic failures leading to death and disability, here was someone in front of me living it in a way that was so much clearer than the typical shadowy relationships between exposures and chronic disease. Since then, I’ve seen others; a homeless person with frostbite from the cold Columbus winter, a chemical worker with bladder cancer, uncountable numbers with metabolic syndrome or coronary disease; but this patient sticks with me as the first time in medical school that a whole towering unseen chain of causality and callousness coalesced into its end product, a middle-aged guy with kids and a beloved German Shepard dying before his time.
White Coats 4 Black Lives event I attended in 2020
The frustration I felt from that visit has grown the last few years, driving me to volunteer my time and money for various for pro-health care access candidates in the 2018 and 2020 elections, and to participate in various events surrounding the 2020 Black Lives Matter protests. I want to continue to make these causes part of my career and advocacy. I will continue to work on these causes during residency and as an attending, and I will always look for ways to use my talents to do what I can.
- Become a regularly contributing member (attend >75% of meetings/events) of a racial or economic justice focused group during residency.