Don’t Be Afraid to Think Big: A Medical Textbook on Health Equity

As undergraduates at the University of California, Los Angeles, we (Matt and Jamie) both served on the student board of the UCLA Volunteer Center. We shared a passion for social entrepreneurship-driven community health, as Jamie served as Community Service Commissioner on UCLA’s student government and Matt created the Three Pillars, One University Initiative. We both saw the duty of every physician to society as far more than that of a professional wearing a stethoscope and demonstrating their clinical acumen. The clinician-leaders we admired served additional roles as promoters of health equity. Yet we admired more than their boundless clinical commitment and pursuit of health equity.

Put simply, we admired who they were as people. From UCLA AMSA Faculty Mentor Dr. Isaac Yang, to Partners in Health Co-Founder Dr. Paul Farmer–there was a deeply engrained passion for humanity beneath their white coats. Coupled with our observations of physicians at free clinics, we began to believe that effectively pursuing health equity requires more than an intervention.

We asked ourselves, how do we introduce our nation’s pre-medical and medical students to our nation’s healthcare leaders? We thought that the meeting of these worlds, sharing these physician-leaders’empathy and audacity in action, could be impactful for future healthcare leaders. We imagined what it would be like for the most driven physicians in the world to conduct Grand Rounds in every lecture hall. We began by reviewing the work of several of the most prominent authors in the humanism-in-medicine arena. Combing through the work of Kitchen Table Wisdom author Dr. Rachel Remen, Mountains Beyond Mountains author Tracy Kidder, and Body of Work author Dr. Christine Montross, it became apparent that simple and direct language was a core tenet of an effective and meaningful inquiry into personal belief in this field. The use of short quintessential phrases to elicit unabridged narrative was common.

We thus decided to pose U.S. physician-leaders a series of simple, themed phrase-question pairs. We created our interview template with core phrases embodying humanistic values rooted in the Hippocratic Oath, and the Clinton Foundation’s efforts in global health equity. We knew this effort would require a dedicated team, and we admittedly doubted at first that leaders would work with us. We learned to never underestimate the power of sharing one’s genuine passions to support change in other people’s lives, with colleagues and the people you admire. It is also important to be humble in doing so. We were very fortunate to have many medical student leaders express a willingness to join in our effort to better understand physician-leader’s underlying passions for social equity in medicine. Our team included UCLA medical students Christina Fong, Winward Choy, Marko Spasic, Christine Thang, and Ariel Moradzadeh; Kristy Hamilton (Student Body President, Baylor College of Medicine); Amol Agarwal (Student Body President, University of Pennsylvania); and our team mentors, UCLA neurosurgery resident Dr. Daniel Nagasawa and UCLA neurosurgeon Dr. Isaac Yang.

We began by interviewing our physician-leader mentors and soon uncovered an equitable, humanistic passion that stretches from UCSF School of Medicine in San Francisco, to Miller School of Medicine in Miami.   Ultimately, with the participation of over 25 AAMC Medical School Deans, we founded the United States Service Minded Physician Project. We presented physician-leaders with seven themed phrases: our white coat, a story, attending to the world, uplifting the medically underserved, a life apart, a loving smile, and a lens into your life. Clarifying questions were presented alongside the themes. For example, the accompanying questions for “a life apart”were: As a physician-leader, when is it appropriate to feel saddened, and what are your tools for moving forward professionally in your practice? Is it appropriate to show emotion in front of your medical team and trainees?”; In a “a story” we asked: What is your favorite story from your life in medicine, which if someone had read it to you on your first day of medical school, it would have inspired you? The interview template was ordered to mirror a medical student’s journey from white coat ceremony to residency.

We were shocked by the numbers of people willing to take part. Our project uncovered a unanimity which we believe is important. We were the first to ask the Presidents or Directors of the National Institutes of Health, Centers for Disease Control and Prevention, U.S. Institute of Medicine, American Medical Association, Association of American Medical Colleges, and American College of Physicians the themed phrase-question pair: “uplifting the medically underserved: Is access to a physician a fundamental human right?”They all said “Yes.”Notably, some suggested that the question should include other primary-care givers such as nurse practitioners and physician assistants. We repeatedly emphasized to interviewees that our intention was to share their thoughts specifically for a U.S. medical student audience. This shared idea amongst physician-leaders that U.S. medical students should know that health care is a fundamental human right demonstrates a commonality amongst the leaders of our nation’s core medical education, medical policy, medical research, and medical care institutions.

It highlights a shared responsibility among the next generation of U.S. physicians to the health of the American citizen, apart from any discussion of finances. We believe this unanimous characterization of physician as public servant, on a national scale, must transform discussions of Medicaid and Medicare reimbursements across our nation into conversations on meeting the needs of those in our community who suffer from chronic illness and lack a primary care physician. And yes, this might equal pay cuts.

But why did you or are you applying to medical school in the first place? To serve the patient-customer? Or because life itself mattered in the patients you volunteered to serve? Because life itself matters to us. It’s not about waiting until the system is fixed politically and financially amenable. We can and should begin to fix it right now. Every undergraduate, medical student and physician has a potential role to play, whether it be volunteering at a Federally Qualified Health Center or advocacy work to champion greater access to health care. This is our generation’s civil rights movement. Businessmen and women took time to stand up for their beliefs in the 1960’s. It is time to march with your organic chemistry textbook and stethoscope.

U.S. Institute of Medicine President Dr. Harvey Fineberg highlighted the importance of the idea that physician and patient are partners in care. In response to the themed phrase-question pair, “our white coat: As a physician engaged in public service, and in a leadership role, how do you believe that the white coat metaphorically belongs to both patient and doctor?”; he shared a holistic care approach. He noted, “Our responsibility is caring not just for the whole patient, but caring for the whole person as well. That means understanding their life, and their circumstances at home and in the community. You have to take responsibility for your role in their life and responsibility to understand their needs at each stage of their illness. The key idea I would say is to treat the patient as a whole person. Additionally, it is important to understand your role at that moment in time, for that particular individual in front of you.”If health equity and humanism are inextricably linked: access can only be part of the solution. Health care cannot be a human right, if it is not patient-accepted. Every U.S. premedical and medical student must learn to understand patients as people, by understanding their relationships to the regionally, socio-economically, and ethnically diverse American communities. This seems a quintessential parallel step in eliminating health disparities on the doorstep of access.

We recently published our collection of interviews with U.S. physician-leaders in a book entitled The Service Minded Physician, available on Amazon in color, and black and white editions. The book is being sold as close to cost of printing as possible, and any proceeds will support organizations committed to pursuing global health equity.

About the authors

Jamie L. Yao is completing her first year of medical school at the University of California, San Francisco School of Medicine. After serving as a Fellow in the Americorps Community Health Program between college and medical school, she is currently an Albert Schweitzer Fellow, and very passionate about eliminating health disparities through health education.

Matthew A. Rosenstein is entering his first year of medical school at the Duke University School of Medicine. He is very passionate about increasing access to care for the urban underserved youth population, and previously served as a U.S. Senate Intern to Senator Dianne Feinstein, and a live-in assistant at a group home for young adults with developmental disabilities.

Isaac Yang M.D. is Assistant Professor of Neurosurgery at the University of California, Los Angeles. Dr. Yang is a dedicated mentor and teacher, serving as UCLA Faculty Advisor to both the undergraduate and medical school chapters of the American Medical Students Association – which he founded as a medical student – and was the invited faculty keynote speaker at the 2013 AMSA National Conference at UC Davis. Dr. Yang specializes in using nano particles to treat malignant brain cancer, directing the UCLA Neurosurgery Nanotechnology Laboratory.