The following manuscript was submitted to the February 2017 Social Medicine Themed Writing Contest.
As we discharge another patient from the intensive care unit, we celebrate a job well done. “Can you believe how far she’s come in the past few weeks?” or “I didn’t think he would be able to go home so soon.” With the use of modern technological advancements, we are able to bypass the heart and lungs of patients, and push the limits of life to as early as 22 weeks of gestation. We do so with compassionate care and the collaboration of medical professionals from across the hospital. For every heartbreaking tragedy, there exist stories of medical miracles that surpass all expectations. Under such circumstances, we develop relationships with patients and families until the day of discharge. We cry and laugh together. We whisper on our early morning rounds and burst into song during birthday celebrations. But as quickly as they enter our lives, they leave it; in most cases, we lose touch, never to hear from them again. These are the patients I think about. These are the “triumphs” I question.
I work at a large, urban, academic medical center, and many of the patients we serve are from the surrounding community, which is disproportionately low income and comprised almost exclusively of ethnic minorities. When they leave the confines of the hospital, they are faced with a harsh, unforgiving reality, where life expectancy in two neighboring communities can vary by as much as 14 years. This difference in life expectancy is correlated with income. While the wealthiest in our city enjoy an average per capita income of nearly $90,000, the poorest live in stark contrast at an average per capita income of $8,000.
In addition to the well-studied adult health disparities that ethnic minorities in this country face, our pediatric patients, too, succumb to such differences in health outcomes. For example, children of color have disproportionately higher lead levels than their white counterparts, leading to negative short- and long-term consequences. Beyond health, the achievement gap mirrors health disparities, as neighborhood high schools in poor communities of color have graduation rates in the 40 percent range and average American College Testing (ACT) scores just above ten. Unfortunately, graduating high school is often the least of the worries for mothers and fathers in our community, as the majority of incarcerated men and women come from our area of the city with a violent crime rate to match. This is the world we joyfully discharge our patients into.
As a former middle school teacher on the south side of Chicago, these were not just facts, but realities for my students and their families. Through after school programs, weekend field trips, home visits, and daily check in with parents, I was able to get a firsthand glimpse of what life was like for my students outside of the confines of our school. While my students were able to make great strides academically, I couldn’t help but think of the added adversity they needed to overcome every day. From the dangers of walking to and from school, to providing childcare to siblings, to not having enough to eat, to coping with parents with substance abuse, my students were brave and resilient. Communicating through their daily journals, I witnessed the struggles of the community through the eyes of a middle school child. It was through this process, this overwhelming feeling that I wasn’t doing enough that made me decide that I was going to become a physician advocate. My years as a teacher made me a more compassionate physician, better able to care for and communicate with my patients. However, it is my experience as a teacher on the South Side of Chicago that revealed the necessity of standing up against injustice outside of the hospital in order to truly serve my patients and my community. These lessons have inspired my involvement in the public policy arena, advocating for more stringent gun safety laws, increased school choices, and broader services for children with elevated lead levels.
While we, as physicians, know such statistics with our minds and are empathetic to the needs of our communities, most of us do not necessarily act to change this. When our shift ends, we drive our comfortable vehicles to our comfortable neighborhoods and go on living our comfortable lives. I get it. We have trained for years and taken on a mountain of debt to become medical doctors, to care for the ailments of sick people. Furthermore, residency and fellowship are difficult enough without having to take on additional tasks. But I challenge you to ask yourself, what good is it if we are able to manage an asthma exacerbation, an episode of diabetic ketoacidosis, or even cure someone of cancer, if they have no food to eat or a pillow to rest their head on? We now know that the social determinants of health are as important, if not more important, than one’s genetic makeup, but what are we doing to alleviate the social ills of society? If we are sending our patients to fend for themselves in a world that has dealt them an unfair hand, are we making any impact at all?
Some will argue that fixing social issues is not the job of physicians but instead relegated to social workers. I wholeheartedly disagree with such sentiments, and believe that as physicians we are perfectly equipped to take on the social injustices of our communities. Who knows the most intimate details of our patients in our communities better than we do? We also are given respect and authority as medical professionals and it is this opportunity we must take advantage of to be a voice for the voiceless. Until we, as physicians, take on this struggle head on, we will have to face a dichotomous reality between our lives and the lives of our patients. And until the day comes when you are willing to fight for equality, let us think twice before celebrating our medical “triumphs.”