The Same City, a Different Perspective

It was my second week of medical school at UC Riverside School of Medicine. I was drawn to UCR for its mission to supply the Inland Empire with physicians to address its shortage, and especially for the Longitudinal Ambulatory Care Experience (LACE) program that allows first-year students to work with a physician biweekly at a local clinic.  I was excited for the opportunity to gain direct patient experience during my preclinical education, as not every medical school offers this. I was even more elated when I was assigned to a clinic I used to attend as a child. It felt comforting walking in to a place I was so familiar with. However, that did not shake the feelings of unease and ineptitude I had. While I would be here as a provider, I had no clue what I would do or what I would be responsible for.

Clad in my freshly-pressed white coat, I couldn’t shake off the feeling that I was an impostor who didn’t deserve to set foot in a clinic to treat patients. I had limited medical knowledge- only the basics from my undergraduate classes and community experience. Upon meeting my mentoring physician, Dr. J, I stammered a hello and nervously took a seat in the corner. I had barely learned to take a patient history the week before — why would the school thrust me into this great unknown? The nurse dropped off the vitals and said that a patient was waiting in room 3. I scrunched up in my seat upon hearing those words. I thought about all my prior experiences that should have prepared me for this — was I truly ready? Dr. J asked me if I was comfortable enough to take a patient history, but I answered with honesty and said I preferred to observe. I accompanied him and readied myself for my first patient interaction as a medical student.

I walked into the room, and the overbearing stench was the first thing to hit my senses. It was dank and heavy, as if the room was full of air that weighed twice as much as the outside. The patient sat, slouched over the bed, roughly scratching his arms. “John” was a young adult African American man, suffering from atopic dermatitis (a skin condition most commonly found in children, but that can occur at any age, that causes the skin to be red and itchy). It was incredibly apparent – because his blisters were spangled across his body. I noted lesions on his sideburns, left neck, forearms, and ankles. John removed his shoes to demonstrate that they were all over his feet as well. Pus seeped over his most grievous wounds, as he stated he was unable to stop scratching. Some pus droplets spread onto the floor, alongside some skin flakes. Every time he scratched, I saw more was added to the floor. Simply put, I was not mentally ready for this situation. I was prepared for someone with a cold, or someone who wanted to discuss medications – not atopic dermatitis. I barely even knew how to pronounce eczema.

Fittingly, John did come see us that day for medications. He had been unemployed for years, but finally got a job at a large company doing order fulfillment (a common way people in my community gained access to healthcare). Finally, now that he was able to see a physician, John immediately sought access to a steroid cream to stop his unbearable itching. John told us he’d had atopic dermatitis since childhood. Despite this urgent need to see us, he still had to wait two weeks for his appointment. Transportation was also a barrier for John. Because he did not have sufficient access to transportation, it took him 3 hours via bus to arrive at the clinic on time. I was astounded that he made it to his appointment, despite all the barriers he faced. How many other people were in a similar situation, but were unable to get to the clinic?

Dr. J prescribed John a steroid cream to provide immediate relief from his symptoms. However, John needed a consultation with a dermatologist to address his greater underlying skin conditions and other health issues. His seeping wounds, potential dermatological infections, and loss of his outer protective epidermis were beyond the scope of care we could provide at the clinic. We sent him off with several referrals hoping he could make it to these appointments despite his limited access to transportation. He thanked us from the bottom of his heart, stating his gratitude for not having to scratch anymore. I saw several patients that day, even obtaining a patient’s history on my own after shaking off the nerves, but John’s story remained in my head. Was there more I could do?

John represents the type of patients I want to fight for as a physician: disenfranchised people of color who have lost their trust and faith in a system that limits healthcare to those who have access through an employer. If John wasn’t able to find work, his lack of access to steroid creams would remain an issue. John’s care was also limited by his lack of reliable transportation, an issue common to many patients I have seen.

I wouldn’t have been surprised if John distrusted medical professionals considering the systemic inequities that led to our office encounter. In fact, he was actually one of the “lucky” ones because of his access to health insurance. Even then, he was still in a rough position because of chronic under-treatment of his myriad health conditions. What could I possibly do? I wondered and repeatedly ran through scenarios in my head.

In the face of stalled progress towards health inequity, as both educational and wealth gaps increase, it truly was fitting that my medical journey started with John. He represents the type of patients I want to fight for once I gain the necessary experience. I hope to provide compassionate holistic care that marginalized communities need. I don’t want patients to have to ride buses for 3 hours to get an appointment that they’d been waiting to attend for weeks. I don’t want patients to endure destructive cycles to their body or wait years without medications because they don’t have access to healthcare, or jobs, or are unable to hold jobs because of lack of access to treatment. I want patients to have equitable access to care. I want patients to avoid complications from preventable diseases. I want patients to be able to afford healthcare. And for that, and for them, I will fight.