As a premedical student, I cannot count the number of science and math classes I have taken. I have dreams where I have to build spaceships with nothing more than solved integrals and ones where I must open doors — and escape monsters — with the solution to organic synthesis problems. I can tell you the pH of different organelles in your cells and the “behavior” of a carbon atom double-bonded to an oxygen. I can explain why HIV is so difficult to cure and prove why the area of the sphere is always equal to 4(pi)r^2.
And that’s fantastic. But there are things that I can tell you that have nothing to do with my premedical education but everything to do with medicine, knowledge that I had to actively seek out on top of — and often, at the expense of — the time I needed to study for my classes. This knowledge includes the ways that biases play out in the waiting and exam rooms and how too many patients — patients of color, female patients, trans patients, fat patients, mentally ill patients, disabled patients* — don’t get the quality healthcare that they deserve.
Now, there’s a certain level of sociological knowledge needed for a premedical student, which you can obtain with a single, first-year sociology class. It’s tested on the MCAT, after all. Unfortunately, though, the knowledge we’re supposed to know reads like bullet points:
What factors affect access to quality healthcare?
- Stereotype threat
- Environmental injustice
It might be a start, but it’s nowhere near enough. At no point are we looking at studies where medical residents almost universally rate Black patients’ pain as lower than that of white patients, or studies that show Black patients are often over-diagnosed with stigmatized, ‘out of touch with reality’ mental illnesses when their symptoms in fact indicate a more typical course of anxiety or depression. We don’t read accounts of fat patients who go to the doctors complaining of severe pain and are told to just lose weight, only to find out — often too late — that it was pancreatic cancer.
We don’t read about how Latina or immigrant women are assumed to be incompetent because their accents, or how patients experiencing psychosis are dismissed as drug users and treated poorly by emergency staff (or how drug users deserve quality care, too). We don’t talk about women who are deemed unable to make choices about their own bodies or children with autism who are subjected to multiple, sometimes dangerous, ordeals to cure them of something that can’t — and many Autistic activists and allies agree shouldn’t — be cured.
The bullet-point knowledge we’re required to know paints bias as a cloud that hangs over the houses and communities of those affected, depressing the mind, the body, and the desire to seek care. While this might be true, this kind of bias is something that no individual can do anything about. It’s the distant sort of bias that we can feel good about combating if we offer some pro bono services or donate to related nonprofits.
The bias that we don’t learn about is that kind that we are directly responsible for and we can directly, as individuals, combat. It is the kind of bias that doesn’t affect others “Somewhere Else” — it will affect the very patients that will sit in our exam rooms in the future. Isn’t it, therefore, precisely the kind of bias that we should be learning about?
My original intention for this blog was to write about issues in the mental health care system, especially pertaining to factors that bar access — I came from a medically underserved community, so, naturally, that’s where my interests lie. But my posts have been haphazard, my theme unclear. As a premedical student, I haven’t been able to post much at all. I have 50 unfinished drafts.
So, as I am approaching the end of my last semester as a premedical undergrad, I think it’s the perfect time to readdress and expand my intentions. Patients of all walks of life are not receiving the healthcare — physical, mental, reproductive, anything — they deserve. We talk about the problem as if we cannot do anything about it when, actually, we have direct control over how our biases and our actions affect those around us. We need to refocus the conversation. We cannot afford to keep having the conversations we’ve been having over and over again, not if we want the next generation to live in a world where everyone has the same opportunity to pursue a happy, healthy life. And don’t we owe them that, at least?
*If you noticed the lack of person-first language — I am many of these things. There is also nothing inherently wrong with any of these things; many people for whom these labels apply to consider person-first language to be treating the “thing” as something inherently wrong, hence the desire to separate the “thing” from the person. As a disabled, (temporarily) fat, (previously) mentally ill female, I am one of these people. That being said, if one of these labels apply to you and you prefer person-first language, that is entirely your right to decide and I will fully respect how you wish to be identified.