Categories
General Lifestyle Opinion

Too Many Eyes Between the Thighs: Sex and Surveillance

There’s a special bond between students and their teachers. As someone who used to teach young children, I know firsthand how students can trust teachers with certain aspects of their lives that they don’t feel comfortable disclosing to other adults. But, students in the Salem-Kaiser school district in Oregon may want to think twice about what they tell their teachers. That’s because district policy stipulates that teachers are mandatory reporters of all student sexual activity. This policy means that teachers who have knowledge or suspicion of students’ sexual activities must file a formal report with the Department of Human Services, local law enforcement, or a school resource officer. What’s more, because they are mandatory reporters, a teacher could actually face disciplinary action and fines if they fail to report known student sexual activity. This law even applies to faculty members making reports on their own children if they are students in the district. The year is 2017, but this puritanical policy is straight out of the 17th century.

As a former high school student, I’m appalled by this policy. As a future doctor, I’m deeply troubled. When culture permits our libidinous drive to become an object of surveillance, sex becomes a deviant activity. In criminalizing the natural and healthy exploration of sexuality, we imbue sex with shame.

I could not help but see a link between this policy and the reports of sexual violence that have been dominating the media over the past month. My immediate reaction was that this attitude of surveillance around sex is the fertile soil from which the Harvey Weinsteins of the earth spring forth. In an article about the Harvey Weinstein scandal published in New York magazine, Rebecca Traister writes “What we keep missing, as we talk and reveal and expose, is that this conversation cannot be just about personal revelation or speaking up or being heard or even just about the banal ubiquity of abuse; it must also address the reasons why we replay this scene, over and over again.” Traister sees the perpetuation of crimes of sexual abuse as indicative of a foundational gender injustice; I see them as the result of a culture that was built upon austerity.

America is littered with vestiges of our Puritanical culture. The very fact that we can’t show the bare breast on Instagram, or that we’re still trotting out the story of Janet Jackson’s costume malfunction from Super Bowl 2004 is, to me, an indication that the body is subjected to surveillance when it’s recognized as a vessel of sexuality. Sarah Silverman’s June 2017 appearance on Jimmy Kimmel Live! illustrates this. She holds up a picture of a penis that she drew while hospitalized and correctly assumes that the picture is intentionally blurred to viewers at home, per FCC regulations. She then facetiously tells producers that what she actually drew was a stalk of asparagus, and the picture instantly becomes clear. The image is, in a way, treated as criminal, and is subject to surveillance via pixelation, and yet that surveillance is instantly removed when the association with sexuality is removed.

In a way, we’re all responsible for allowing crimes of sexual violence to occur. My intention here is not to negate the free will of an individual who chooses irresponsible, repugnant behaviors, but to suggest that we have fostered a culture which, in a way, suggests that abhorrent sexual behaviors may be the basest way to get one’s needs met. When two 16-year-olds are in a healthy, consensual sexual relationship, and this relationship gets reported to the authorities, we are sending the message that even an appropriate sexual encounter is considered an act of deviance. And it starts even at a more localized level than the school. If kids are not hearing about sex in their households and are not raised with the understanding that sexual appetite is as normal a bodily function as urination or defecation, the overwhelming message is, at the very least, that sex is something that needs to be hidden away, or more damaging still, that sex is shameful.

Sexual violence is borne from the “sex = shame” mentality. When we classify the perpetrators of these crimes as being “sex addicts,” it excuses these damaging and vile behaviors as an unfortunate error of biology rather than viewing them as a product of learned behavior. This is not to say that sex addiction isn’t a real pathology, but rather to point out that we may be confounding biology with behavior. Though sex addiction has never been classified as a diagnosis in the Diagnostic and Statistics Manual (DSM), most experts agree that the diagnosis of a sex addiction would require a higher-than-average sex drive coupled with compulsive sexual behaviors even in the face of negative consequences. Sexual drive is a difficult feature to quantitatively measure, but I suspect that a high sex drive is not the cause for most crimes of sexual violence. I strongly believe that by committing acts of sexual violence, perpetrators are primitively attempting to meet their needs. In other words, while the sexual appetite is normal, the internalization of the “sex = shame” mentality is so embedded in the psyche that the sexual act becomes a part of this narrative. When one believes that one’s sexual drive is shameful, libidinous urges cannot be openly discussed, and instead may be dealt with in a way that is clandestine and non-consensual. Larger issues of power and privilege, though out of the scope of this writing, come into play when individuals are enabled to act out these violent behaviors.

Sexual violence is systemic. If we don’t change our cultural attitudes toward sex, we will continue to foster an environment which is likely to create sexual criminals. Young people who are just beginning to explore their identities as sexual beings through relationships with others are most susceptible to the internalization of the “sex = shame” narrative. If we don’t learn to shed our Puritanical vestiges and celebrate the healthy, safe, and consensual sexual exploration of these young people, we will continue to support a society of people who are reduced to committing crimes of sexual violence.

References:

YThe Conversation We Should Be Having: https://www.thecut.com/2017/10/harvey-weinstein-donald-trump-sexual-assault-stories.html

Internet sex addiction: A review of empirical research: http://www.tandfonline.com/doi/abs/10.3109/16066359.2011.588351

Is Sex Addiction Curable? http://www.newsweek.com/sex-addiction-curable-kevin-spacey-seeks-rehab-condition-does-not-exist-703541

Salem-Keizer staff told to report student sexual activity, including own kids: http://www.statesmanjournal.com/story/news/education/2017/10/31/oregon-mandated-reporter-salem-keizer-staff-told-report-student-sexual-activity-including-own-kids/798865001/

Sarah Silverman on Near Death Experience: http://abc.go.com/shows/jimmy-kimmel-live/video/featured/VDKA3871414

Photo Credit: Wyatt Fisher

Categories
General Reflection

Gender Application Gap

Gender stereotypes are pervasive in medicine. Last year, JAMA reported on the gender pay gap in medicine, and I found myself wondering if other stereotypes in medicine were true. I have seen some of it and heard more of it – from Scrubs, to blogs, to my own preceptors – ortho-bros, Ob/gyn girls, etc. According to a report using 2015 data from the AAMC and a study in the Journal of the American College of Surgeons that used the same data, these stereotypes seem to fit. The top male-dominated specialties by resident in the GME class of 2013-2014 were orthopaedic surgery (87%), radiology (73%), anesthesia (63%), emergency medicine (62%), and general surgery (59%). Women made up 85% of Ob/gyn, 75% of pediatrics residents, 57% of psychiatry residents, and 58% of family medicine residents. What I was really interested in, though, was whether there is any sort of advantage or disadvantage in being a male or female applicant in a sex-dominated field.

Luckily, this must have been on the minds of the ERAS stats department beacuse one of the headline charts on their FACTS web page is a table of specialty application data broken down by sex. The table includes the total number of applications per specialty and average number of applications per specialty broken down by sex. The data included all types of applicants – IMGs, DOs, and MDs. In working with the data, I chose to focus on Family Medicine, OB/gyn, Urology, Orthopaedic Surgery, General Surgery, and Family Medicine based on the AAMC data for sex-dominance as well as the stereotype of the field. I’ll admit that the latter is not a scientific method, but I don’t think I’m going out a limb here to say that there are (rightly or wrongly) generally agreed-upon stereotypes in medical fields. The modified table can be found below:

Specialty Female Applicants Mean Number of Female Applications Male Applicants Mean Number of Male Applications
Anesthesiology 1268 28.5 2524 30.9
Family Medicine 7168 49.4 7260 51.8
Obstetrics and Gynecology 2019 47.7 758 41.1
Orthopaedic Surgery 193 79.2 1116 74.8
Pediatrics 4576 36.7 2490 33.6
Surgery-General 2606 37.2 4871 37.7
Urology 110 64.2 383 62

Nothing shocking here. Male-dominated specialties like urology and orthopaedic surgery have more male applicants, female-dominated specialties like OB/gyn and pediatrics have more female applicants, and more evenly distributed fields have about an equal number of applicants.

What is more interesting is the average number of applications submitted per applicant by sex to the different specialties. Urology and orthopaedic surgery, probably the two specialties most culturally male-dominated both have higher number of applications submitted per female applicant. This seems to fit. Perhaps female applicants, knowing that the culture is male-dominated, feel pressure to submit more applications in order to be more certain that they will secure a residency in the male-dominated field. Ob/gyn, though, is the opposite. The most female-dominated specialty (both culturally and by AAMC data) has fewer applications per male applicant than female applicant. Even though 85% of the residency class of 2013-2014 was female, and even though far more women applied to OB/gyn than men, men do not seem to feel the need to overcome any sort of cultural disadvantage like women do when applying to male-dominated specialties.

This trend of male advantage in overcoming residency stereotypes holds true among other female-dominated fields like pediatrics where there are likewise more female applicants, but men submit fewer applications per applicant. I should note that this data does not include matriculation – only applications – so it is possible that men submit fewer applications and then do not get residencies. Also, this trend is not universal. Anesthesia is a male-dominated field where women submit fewer applications per applicant, though culturally it is not stereotyped to the same level as orthopaedic surgery or OB/gyn.

The New York Times wrote about this trend in 2001, noting that while men still made up the majority of practicing OB/gyns, upwards of 80% of residency applicants were female. But, according to the article, female OBs were taking a stand. They did not want OB/gyn to become a women-only field with some even supporting the reverse sex-descrimination argument that a few male OBs had taken to the courts. What is amazing in this scenario is that in spite of patient preference being the driving factor in making OB/gyn female-dominated, residencies see this as a problem and appear to be giving male applicants an advantage for residency positions. Meanwhile, male-dominated fields do not appear to have a problem with their male to female ratio. What does it say when women physicians are advocating for more men in their field over the preference of their patients?

Photo Credit: European Parliament

Categories
Lifestyle Public Health Reflection

#BoPo: Body positivity in the age of obesity

When I was younger, I loved watching the televised broadcasts of New York Fashion Week. I grew up in the heyday of heroin chic, which meant that the runway was a seemingly endless parade of vampire-pale, stick-thin waifs. I knew I would never grow up to look like these women, no matter how hard I tried. Even though I was perfectly happy to develop my own unique sense of style, I had an awareness that no one on television looked like me.

Fast forward two decades. The landscape of beauty has changed dramatically. I can’t yet say we’re living in a whole new world, but as a society, we’re making steady progress toward diversifying our expectations of beauty. More colors, shapes, sizes, and sexual identities are being beamed over the airwaves and into our living rooms.

The strides we’ve made toward diversifying our media did not just happen overnight. They occur as part of a larger historical context that has rebelled against normative standards of beauty for decades. The Fat Acceptance Movement, started in the mid 1960’s, is considered to be an offshoot of Second Wave Feminism. In 1967, the group held a 500 person “fat-in” in Central Park, NY wherein people carried signs of pro-fat messages and burned diet books. This was followed in 1969 by the creation of the National Association to Aid Fat Americans (NAAFA) which held a yearly summer convention until 2015. More recently, in 1996, the Body Positivity Movement was started by friends Connie Sobczak and Elizabeth Scott. Their goal was to help girls and women foster positive self-images so they could lead more fulfilling lives. Today it exists as an organization known as the Body Positive. Just a few weeks ago, this organization hosted the third annual CurvyCon. This convention was organized by two self-described plus size fashion bloggers to help women “chat curvy, shop curvy and embrace curvy.” All of these organizations and movements undoubtedly have their own platforms, but what they all share is a desire for bodies of all appearances to be accepted into society.

I firmly believe that every body is worth loving, but moreover, that every body is a body worth caring for. I see care as being a balance between the emotional and physical aspects of well-being. While I am hopeful that the shifting tide of acceptance in media translates more broadly to mean that us non-Hollywood folk also find value in ourselves and others no matter our physical appearance, as a health care provider, I am concerned that the Body Positivity Movement may be construed as an acceptance of obesity. If we accept ourselves for who we are, and who we are is unhealthy, then I question whether we are really showing ourselves the love that we claim.

I think what the Body Positivity Movement does well is emphasize self-value on the emotional spectrum of care. Where body positivity endeavors seem to lag, however, is in the promotion of physical health. Physical health can be just as challenging to realize as emotional health, yet it is just as important. Diabetes, hypertension, and hyperlipidemia are real diseases whose prevalence strongly correlates with obesity. They do not discriminate between people who love their bodies and those who don’t. They can affect and ultimately kill anyone whose body mass index falls into an unhealthy range. Our government makes the realization of physical health all the more difficult by setting up barriers for people to receive quality health insurance. Financial barriers are only one aspect of this problem. Any policy that allows for the proviso of health barriers, in the form of exclusions, special criteria, and added financial burden for people with pre-existing conditions, is a policy that does not believe all people to be equally worthy of care and is therefore an injustice.

Even though a key focus of the Body Positivity Movement is self-love, this does not mean people have to go it alone. As future physicians, we can partner with our patients and aim to help them strike a balance between their emotional and physical care. To me, this means helping our patients foster emotional self-love while also being conscious of physical health. While monitoring sensitive aspects of our patient’s physical health such as weight, infectious disease, and heritable conditions may be challenging, perhaps in part because they may draw on our own personal insecurities, we can discuss these topics using sensitive, collaborative approaches that are respectful of the patient’s emotional well-being. Ultimately, our goal should be to meet our patients where they’re at in terms of care and be a supportive force to propel them forward.

References:

The Body Positive: http://www.thebodypositive.org/about

Brief History: The Fat-Acceptance Movement: http://content.time.com/time/nation/article/0,8599,1913858,00.html

The Curvy Con: http://www.thecurvycon.com/about

Overweight and Obesity: Signs, Symptoms, and Complications: https://www.nhlbi.nih.gov/health/health-topics/topics/obe/signs

Photo Credit: Crystal Coleman

Categories
Clinical Lifestyle Patient-Centered Care

Running Low and No Longer Running

I recently completed a rotation in endocrinology, and I learned valuable lessons about diabetes management in both the inpatient and outpatient setting. Today, I wanted to share a clinical pearl generally not discussed in lectures: Diabetic patients often gain weight because of the fear of hypoglycemia.

That’s right. The fear of hypoglycemia drives patients to eat a little more at meals. Let’s backtrack. Patients who have persistently elevated sugars are often started on insulin in addition to oral agents. Depending on their insulin regimen, patients may not eat enough after an insulin dose to prevent a drop in blood sugar. Patients who experience a hypoglycemic event try their best to prevent it from occurring again. This is understandable—fainting is scary and should not be taken lightly (pun intended).

The problem is that patients counteract this fear of hypoglycemia by either eating more after an insulin injection, or by exercising less. This impedes diabetes management. In addition to advising our diabetic patients to monitor their carbohydrate intake, we urge them to start some form of physical activity. Physical activity enhances the body’s insulin sensitivity—it gets to the core of the problem (insulin resistance) and improves overall cardiovascular health as well. But how can we encourage these lifestyle modifications if our patients are getting lightheaded after injections?

The answer: carbohydrate counting and education.

Not the answer: increasing insulin.

My attending explained that “increasing insulin” is actually what happens in some cases. For example, let’s say a patient named Sara comes in for her follow-up appointment and unknown to us, has “fear of hypoglycemia.” Sara brings her glucose meter, and the sugars are poorly controlled. Part of the reason for this poor control is secondary to a) eating more after an injection to prevent fainting and b) decreased physical activity to prevent fainting. Now, if we just treat her numbers, we would increase her insulin.

The lesson here is that one can’t just treat the number in medicine. Talking to the patient, even for a few minutes, will provide the story. Increasing the insulin perpetuates a viscous cycle, and breaking the cycle comes from better regimen management. Validating patient concerns about hypoglycemia and educating them on injecting based on carbohydrate intake is invaluable.

Photo Credit: Melissa Johnson

Categories
Clinical Emotion Public Health

The Day I Took off my White Coat

The man in scrubs stands in the middle of the room. He has a blood-filled syringe in one hand and hand-written lab notes on the back of an envelope in another. He scans the room, looking for someone or something. I follow his gaze. A young man is curled up in a ball on the floor, rocking himself back and forth while groaning in pain (gangrenous wound on leg). A man is throwing all his weight on his wife and yelling in pain (renal colic). A woman is holding a piece of red, soaked gauze tightly on the hand of her screaming 7-year-old son (amputated finger). An older woman in a wheelchair is drooling from one side of her mouth and has a drooping shoulder (stroke). A young man, handcuffed to a police officer, has circular marks around his neck and blood dripping from his mouth (suicide attempt with hanging and ingesting barbed wire). A young woman sits limply in a wheelchair, eyes rolled back, and blood on her clothes between her legs (severe anemia – abortion days prior). In this room no bigger than my mother’s walk-in closet, the suffering is palpable and audible, but the man in scrubs does not find what he is looking for, and begins to walk out. Before he reaches the door, an unconscious man is carried in to the room (antifreeze ingestion). Without missing a step, he reaches over and gives the man a rough sternal rub to wake him up, to no avail. He exits the room.

The man in scrubs is the sole medical resident in charge of the stabilization and triage of incoming patients at this Emergency Department situated in a Low and Middle Income country. As a visiting medical student, I am wearing a white coat, and although I should fit in, my general ignorance about the majority of relevant things makes me feel like an imposter. I shouldn’t be here. I shouldn’t be wearing this white coat.

‘You! You can help me!’ exclaims a woman in a wheelchair as she reaches towards me. Her face is covered, but somehow I know that she is in pain. Reluctantly, and with as much grace as a fish on land, I walk towards her. I walk towards her knowing that the only care I can provide is a hug, a tear, or a smile; the only prescription I can write is a kind word, and the only order I can put in is a prayer to the heavens.

I came to medical school to gain the skills that I need to better care for my neighbors, to share moments of humanity, of suffering and healing with my neighbors, to be meaningfully curious – to ask and answer questions that benefit my neighbors and our community, and to use medicine as a platform to implement meaningful social change. The irony is, I see none of that now; all I can do is stand defeated as I watch my neighbors suffer. I watch because I don’t have the money to cover the 15 pounds admission fee for every patient that is turned away at the door of the ED. I watch because I don’t know whether that comatose child who was just intubated is in trouble because his stomach is inflating instead of his lungs. I watch because I don’t know if that medical student just injured that woman’s radial nerve while trying to get an arterial blood sample.

With tears in my eyes, I fumble out of my white coat and head for the exit. I’m done watching, I tell myself. I’m done watching and I’m ready to learn. I’m ready to learn how to care for the suffering. I’m ready to be a part of the change I want to see in the world. As the door of the ED closed behind me, I managed to catch a final peek of the chaotic scene, as if to tell myself, ‘I will return when I’m ready.’

Looking back, I wish I had kept my white coat on, even if just to care with a tear, heal with a kind word, and pray for the well-being of my neighbors.

Photo Credit: Alex Proimos

Categories
Emotion Empathy General Humanistic Psychology Narrative Public Health

Guter Mann

This city is so peaceful. As the bikes whiz by, I notice the absence of the cacophony and polluting fumes of traffic. I’m walking down the sidewalk in brown leather shoes and a tucked-in dress shirt while eating bougie gelato. I love gelato. I look up and notice the blue sky. It’s a deep blue and the clouds have distinct borders. I’m in Salzburg, Austria for a conference and I’m loving this city. Just as I marvel at the clean streets and begrudge the abundance of luxury vehicles, I turn the corner and see my sister on the floor asking for money. I immediately cross the street and reach in my pocket to hand her the change I received at the gelato stand. My sister is donning the flag of Islam on her head and I greet her with the anthem of Islam, a greeting of peace. She smiles and says, “Allah yijzeek al-khayr” – God reward you with the good. As I walk away, I smile at the beauty and seamlessness of our interaction.

I continue walking back to the conference hall. I review my rehearsed words as I finish my gelato. My presentation is on the data I generated regarding the controversial use of bisphosphonate anti-resorptives in the setting of chronic kidney disease mineral bone disorder. The nephrologists in the crowd won’t be too thrilled. In my head, I am considering all the different questions I could be asked, when I see another of my friends on the corner of an intersection. As I approach him, he brings his hands together and bows his head. When he raises his head again, I smile at him. I don’t have any more change so I reach into my pocket and hand him 5 euros. He has a cup in front of him, but I decide to hand him the money. I think this might make the money more of a gift than a charity. I can see hurt in his eyes as he tries to find a way to thank me. Reaching out I put my hand on his shoulder and squeeze, pointing up with my other hand, trying to tell him that I will pray for him. While my hand is on his shoulder, he turns his neck and kisses my hand. I say, “No, no!” and withdraw my hand. I feel ashamed. I know I should be the one kissing his hand for accepting my miserly gift of 5 euros while knowing full-well that I have another 10 laying comfortably in my pocket. Ten euros that I will, over the next couple hours, undoubtedly spend on a sacherwurfel from the bakery next to my fancy hotel and then on another helping of overpriced gelato.

Lost in my thoughts of embarrassment, I begin to walk away, and as I do, he yells in German, “Guter mann!” – good man. Halfway across the street, I think to myself, I may not be a good man, but I have the opportunity to try, and so I turn back around.

Ten euros was all the money that I had left on me. But 10 euros was all it cost to earn the respect and love of a man I had only met minutes ago. Excitedly, the man begins to talk to me in German. His name is Damien. (We spend a good 5 minutes on my name. I would say, ‘Mo-ham-mad’, and he would then repeat after me, ‘No-han-nam’). Damien is a father of 3 kids. He was doing well for his family until his wife lost her vision. He said, “Now my heart is still good, but children’s stomachs are empty, so my hand is outstretched.”

I notice the tears in my eyes. I had never heard German spoken before, and I shouldn’t know what he’s saying to me, but I understood every word. Home is where the heart is, and this man is my neighbor. As I leave Damien for the second time, I point up again and then turn my palms up to the Heavens in prayer. He says, “Allah.” And I repeat, “Allah.”

On my second day in Salzburg, I take the long way to the conference center, hoping to run into my friend Damien. I turn the corner and there he is, sitting at the end of the block. My stride lengthens and my steps quicken. As I approach him, I see him leaning left and right, squinting his eyes; he’s trying to see if it’s me. He leaves his corner and yells, “Nohannam!!” while jogging towards me and we embrace each other as brothers and lifelong friends. And as my neighbor and friend embraces me, I realize I may not be a good man, but Damien is willing to show me how to become one.

Photo Credit: Sam Rodgers

Categories
General Reflection

Meaningful Community Involvement

The second semester of the first year of medical school, here and at schools across the country, represents a time when first-year students take charge of interest groups and community projects. Not long ago, we were all inexperienced newcomers to our respective schools. But now, we have since taken over the reins of all of the pre-clinical year activities from the second-year students, as they each burrow away to prepare for the ominous Step 1 exam.

Sandwiched neatly between loading up my resumé for medical school applications, and loading up my resumé for residency applications, the outright requirement to have a curriculum vitae that is robust and full of interesting community service activities weighs heavily on my extra-curricular activity decision-making. Burned into my psyche from the competitive nature of the pre-med undergraduate lifestyle is the relentless worry of “Am I doing enough?”, subsequently followed by a persistent voice inside my head insisting “More! More! More!”

The most logical course of action appears to be for every student to: ace every class, have your name in several publications, and participate in as many interesting-sounding community service projects as possible in your time as a medical student. With the latter segment of this strategy, we accomplish the double-sided advantage over our competing residency applicants by demonstrating our efficacy as providers, in addition to proving that we aren’t self-centered egomaniacs. Maybe an application officer will find one of our activities particularly interesting, which then might lead to an extended and hopefully memorable conversation.

For most of us students, medical school is the first position of real responsibility that we have over the wellbeing of others in our local communities. We certainly don’t expect this time to be our last; as future physicians we all have at some point demonstrated a desire to perform acts of altruism for those in need. The shocking turn of events is that the general public endows a great deal of trust in us once we don our white coats, even coats that clearly state our amateur, student status.

We find ourselves at risk of a costly combination of a position of real power and responsibility matched with misguided effort and enthusiasm. If one’s goal is simply to maximize their free time with an array of activities they only half-heartedly care about, then there is a more than likely chance of some level of harm being done. Even if no actual clinical mistakes are made, or no false information is distributed, there likely exists a missed opportunity. Rather than take the time and effort to create significantly improved health outcomes for a community in need, which requires full engagement and innovation, a tepid enthusiasm for the project at hand is more probable to leave a population at its status quo.

Let’s all pledge to choose quality over quantity. Let’s create and collaborate on projects that will actually matter. If chosen correctly, these opportunities for us as students will be the first steps towards making the remarkable impacts on the lives around us that we all aim to achieve. Collectively, let’s worry less about how we appear on paper and more about the people we intend to serve.

Featured image:
Theory and Practice by Carl Mueller

Categories
General Public Health Reflection

Are you listening? Using the doctor-patient relationship to curb community violence.

If you’ve paid attention to the news recently, you might share my concern that mass shootings are becoming a normalized part of American culture. According to data collected by the United Nations, America leads the developed world in firearm homicides.[1] As a college student in Washington, DC, social justice was an inextricable part of my education. I volunteered, protested, and campaigned for issues I felt strongly about. Assuming you weren’t a student in our nation’s capital, let me tell you that these are all pretty typical parts of the DC college experience. In fact, my zeal for progressivism in the arenas of health and wellness contributed to my desire to become a physician. Unfortunately, it wasn’t until two of my friends were murdered within six weeks of each other this summer that I felt compelled to take a closer look at how, as a medical student, I could better integrate my passion for social justice into my education and clinical practice.

As medical students, our education becomes our lifestyle. It’s demanding, consuming, and vigorous. My support system likes to remind me that I’m not Atlas and that I can’t hold the weight of the world on my shoulders. They tell me to keep my nose in a book and stay focused on my studies. It’s difficult for me to comply with these directives when I feel like I’m neglecting the part of myself that is aware of the world beyond medical school. It took this summer’s tragedies to remind me that even as a student doctor, I need to hold myself accountable for working to reduce social injustice, particularly community violence. What I’ve realized is that while my activism efforts may not reflect those I experienced as a college student, I can still make simple adjustments in my current practice to potentiate positive change.

Since this summer, one of the modifications I made, in an effort to merge my medical and activist identities, is to ask my patients to rate their stress on a scale of one to ten when I take their social history. On the surface, this might not seem like a significant exercise. After all, I’ve been asking my patients about their life stressors since I started school last year. What I realized is that while most people can easily spout off a list of things that make them feel strained (bills, student loans, family responsibilities, looming deadlines, etc.), it’s an entirely different exercise to ask patients to evaluate their stress from a holistic perspective. Though this practice correlates stress level to a numerical value, I have found that I can actually get a better qualitative picture of a patient’s mental and emotional wellbeing and self-awareness by using the one-to-ten stress scale. Perhaps by using this scale, we will be able to gain awareness of and provide support for struggling patients before they feel compelled to turn towards violence.

I encourage you to employ the one-to-ten stress scale into your history taking routine in the hope that it can open the door to bigger, more important conversations about wellness and lifestyle with our patients. Please feel free to let me know how the scale works for you. I look forward to spending the rest of my medical career advocating for those who are underserved by the medical community, but for now, I hope that having these conversations can be a first step in helping patients deal with problems before they resort to violence. In the weeks and months that have followed the deaths of my friends, I find myself thinking a lot about the people who committed the violent acts that claimed their lives. I wonder if they had medical professionals in their lives who they felt comfortable talking to, and I wonder what they would have said if we, the medical community, had been listening.

References:

  1.  Global Study on Homicide. (2011). United Nations Office on Drugs and Crime. https://www.unodc.org/documents/congress/background-information/Crime_Statistics/Global_Study_on_Homicide_2011.pdf

Featured image:
Brother by Fabrizio Rinaldi