Tuesday, January 20th, 2015

Power, Privilege, and Clinical Reasoning

Tehreem Rehman

“What has been your favorite part of medical school so far?”

To my surprise, I did not hesitate, swiftly responding, “The opportunity to finally learn clinical reasoning skills.”

Well, and also to engage in health advocacy work.

Reflecting back now on the reasons why I ultimately chose medicine over law as a means to pursue health justice issues, I can understand why this would be my answer. I originally started college as an engineering major. It may sound trite, but I genuinely enjoyed working through problem sets for introductory classes like physics and applied math. There was only one clear-cut “correct” answer, although getting there was what facilitated the entire learning process. I never liked memorizing things, certainly not formulas. My preference was always to derive them first from the very beginning despite knowing that I would never on earth have time to repeat such a procedure during an actual exam. And would eventually have to memorize them anyway.

Why did I then switch from Earth and Environmental Engineering to Women’s & Gender Studies? Or as my mom exclaimed when I told her about my decision to switch majors, “Why would you switch from a solid major that guarantees you a job after graduation to a major that…what does it even teach you again? Like what could you do with that other than work at some non-profit dedicated to women’s issues? What if they don’t hire you?” Her concerns were founded as low-income students are often compelled to select a major that is more practical in the short-term. I am grateful for the scholarships that afforded me the luxury to pursue an alternative, which is not feasible for most low-income students (even at top-tier institutions). A topic to explore in a later blog post.

Nevertheless, because I was on a somewhat accelerated track in engineering, most of my remaining course options were conventionally those enrolled in by sophomores; I had difficulty finding classes with seats left to fill up my freshman spring semester. Hence, I signed up for a class on a whim: Women and Gender Politics in the Muslim World.

As a young Muslim woman who had a visceral skepticism of gender roles in South Asian and Muslim cultures, I lacked the language to articulate the oppressive nature of patriarchy that I observed growing up. I honestly am not sure what I had expected to get out of that class. But what I did learn left me yearning for more. I was taught the ramifications of brutal colonialist policies in the Muslim world and the subsequent interjection of “Western” patriarchy into those regions; while problematic gender power dynamics exist in the Muslim world, they are not exclusive to that world and manifest in unique ways across the globe; the feminist struggle is global but not homogenous. Most importantly, I realized there wasn’t always a single answer to problems and there may not even be a solution. But as I found with formulas, it is still worthwhile to diligently work through such problems.

I began to crave the additional challenge of working through issues that weren’t as “black-and-white.” A myriad of factors contributed to my ultimate decision to become a Women’s & Gender Studies major, ranging from my burgeoning feminist spirit and ongoing experiences working on “women’s issues” outside of the classroom to a desire to ground myself in more historical and sociological theory that balanced the hard sciences. My concurrent volunteer work pushed me in the direction of medicine. Yet, while it may not seem intuitive at first glance, my humanities major reinforced my decision to pursue a career in medicine in the end—for the reasons we normally hear regarding a more holistic approach to individual and population health, but also for the acquired skills in solving problems that are truly complex and multi-factorial.

Now, as a medical student who hasn’t even yet finished her pre-clinical training, I am already discerning the tremendous value that the humanities major holds for those pursuing careers in medicine. Many humanities majors provide you with the knowledge and skills set to recognize larger structures in society that govern all aspects of one’s life. Such awareness is instrumental in understanding how “just as stigma in clinical encounters must be addressed structurally, so too must inequalities in health be conceptualized in relation to the institutions and social conditions that determine health related resources”, as articulated by Professors Jonathan M. Metzl and Helena Hansen in their paper, Structural competency: Theorizing a new medical engagement with stigma and inequality. Metzl and Hansen coin the term “structural competency” when describing the need to “expand medical educational approaches to social realms by infusing into medical canon scholarship on the hierarchies, economies, and networks through which health and illness are produced and maintained.”

Hansen is an alumna of my medical school and I had the great pleasure to obtain her feedback, after a talk she recently gave at Psychiatry Grand Rounds, on the pilot of the US Health Justice course I created with a classmate. She has a PhD in Medical Anthropology that influences her sophisticated analyses of the causes of health inequities and the ways that clinicians can work towards alleviating them. My own background knowledge in fields like anthropology and sociology through my interdisciplinary major in college has similarly allowed me to grasp that health disparities manifest beyond simply access to care. It is imperative for all future physicians to comprehend that in order order to truly serve their patients, they need to appreciate structural causes and advocate for structural interventions to mitigate factors of poor health outcomes that disproportionately impact under-resourced and marginalized populations in this country.

About Tehreem Rehman

Tehreem Tehreem Rehman is a first year student at Yale School of Medicine.  She recently graduated from Columbia College as a John Jay Scholar with a B.A. in Women’s & Gender Studies. As a Co-Founder of Columbia’s Public Service Initiative, Tehreem was selected to be a People for the American Way Foundation’s Young People For (YP4) Fellow for the 2012-2013 academic year in order to expand the program. Tehreem has previously served as the National Chair of the American Medical Student Association’s Race, Ethnicity, and Culture in Health committee and as a National Editorial Advisor for the New Physician Magazine. She is currently a Humanity in Action Fellow through which she intends to create a multi-school platform to address institutionalized racism and sexism in the medical school admissions process. Tehreem is interested in clinical interventions for violence, addressing gender power dynamics in the clinical setting, and the impact that health inequities have on women of color and low-income backgrounds.


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