I could do this forever! Dr. Treadway’s Intro to the Profession (ITP) course ended far too quickly! The class brought to light several interesting aspects of medical professionalism, cultural competency, and general principles of doctoring. This week we had more training with high-fidelity mannequins. We also discussed a book that dealt heavily with cultural competency in medicine, engaging in important conversations about the ways that culture, socioeconomic status, and religion affect quality of care. However, the highlight of this course was clearly the case study on an HIV-positive patient.
Over a period of two days, we studied the case of a patient who had acquired HIV in the late 1980’s, before antiretrovirals were available. In small groups, we watched vignettes of the patient who was being interviewed about his medical condition. Not yet aware of his infection, the class watched as he described his first bout with polycystic pneumonia (PCP), a kind of pneumonia that was a hallmark complication of people with HIV at the time. He described his illness in depth, including his near-death experiences, his arduous drug regimens, and physical incapacitations. He also went into great detail about his mental health, his personal life, and his social history. We, a group of nine, decided that the next course of action was to test him for HIV.
After watching the videos that followed, the class discovered the man was, in fact, HIV-positive and how that impacted his life. He talked about losing faith in his physician and being able to find another top doctor that could help him. At the end of the second day, we actually got to meet him and hear him tell his story; that “second doctor” was there with him. Oddly, it was much harder to hear his story from him in person than it was to learn about it via video clips. In fact, it moved me to tears to hear him tell his very painful story. He cried. I cried. Moving…
However, one part of the interview really stuck out to me. He was asked what percentage of people who contracted HIV when he did lived to tell the story. His response was “I don’t know, 10% or fewer.” He was right; the outlook was that grim at the time. But my question became what made him special? Why did he survive when so many others didn’t? I became preoccupied with that point of contention.
The fact is, this man was extremely privileged in virtually every way other than his disease status and his sexual preference. This was by his own admission. He stated his status of extreme privilege time and time again. I believe that because of his race, class, and socioeconomic status, he was uniquely empowered in the medical arena. I don’t think it’s a coincidence that he survived while upwards of 90% of others did not. While ITP was an absolutely amazing experience, I truly wish we could have seized the moment and talked about substantive issues regarding systems of privilege and oppression.
Talking about Issues of Race and Health Care Disparities
Two of my role models, and second year students at HMS, Kai and Garrett, helped devise a way that our class could demonstrate our desire to talk more deeply about issues of race and the health care disparities that are the results of racial biases. They are part of a coalition of Harvard medical students called the Race In Curriculum Working Group (RICWG), who share my desire to have more substantive discussions about race and oppression. There has been some apprehension by the course director because the belief is that many students may not be ready to have these very uncomfortable discussions about systems of privilege. We desire to make that a key underlying theme of the ITP course.
Eight of my class members and I joined the RICWG in a demonstration on Thursday afternoon when the course ended. Because the faculty was concerned about our class’s ability to “swim” during these conversations and that some students may “drown,” we developed the slogan, “I can swim.” Students willing to swim were supposed to write the words “I can swim” in the end-of-course critiques. We made thousands of flyers with our faces on them, informing the class that we can swim and asked them if they could too. We strongly believe our classmates can swim,; they are ready, and we are ready. We canvased the atrium of the medical education building with the posters, putting them on busts of famous doctors—literally changing the faces of medicine. Then, as the class left the auditorium for the last session of ITP, thousands of flyers rained down from the fourth floor of the TMEC atrium while we blasted the edited version of Lil Wayne’s, Make it Rain (all expletives removed). Everyone was shocked!
Afterward, we sat down and talked to course director, Dr. Kate Treadway and Dean of Students, Dr. Nancy Oriol. Much to our surprise, they were very receptive to our ideas. In fact, they were touched by our dedication to the subject matter. That reaction meant more to me than they will ever know. Today’s medical education is cultivating a different breed of doctors. We are a generation of doctors with a social conscience. Our generation will greatly mitigate the social and racial determinants of health in America and abroad. I have never been more proud of a group of people to which I belong. Thank you HMS class of 2016! I love you!