First week of med school

So I’ve gotten through the first week of med school and so far, I am still alive. I think they are easing us into it right now, no cadavers and long Anatomy labs just yet. Its interesting because I am already seeing some aspects of medical education that is indicative of the problems of health care in this country and the assumptions of scientific cultural hegemony in western medicine. So do we have a monopoly on the CORRECT way to treat patients? Is evidence-based medicine the only way to understand and measure life and well-being?

The studies that are being done in medicine are increasingly specific to treating certain diseases and understanding the pathways for those diseases that are affecting mainly the rich in this country (heart disease, cancer). The goal is to get patients to the point where they can live with the disease, not cure it completely. As Chris Rock says “they don’t cure shit! Cuz there ain’t no money in the cure, its the medicine”. Meanwhile, the rest of the world is suffering from completely curable illnesses that get little or no attention in the “first world”. Take TB for example, tuberculosis is a disease that is 95% curable with a triple drug therapy yet there are over 1.5 billion
people with the bacterium in the world. The allocation of resources to managing this epidemic have declined both in dollars contributed to research and perceived importance of the disease in popular media largely in step with the decline in prevalence of TB among rich white people in this country. In South Africa, patients with CLEAR signs of active TB, coughing, bloody sputum, night sweats, loss of weight cannot be put on treatment until they are “properly diagnosed”. Even when there IS an X-ray machine at the clinic, sputum samples must be taken and cultured (a 3-5 day process) before a positive diagnosis can be registered. This means 3-5 days where the patient can spread the disease, often it is longer because the patients must come back to the clinic (some never do in fact come back).

As Paul Farmer puts it “We live in a world where infections pass easily across borders – social and geographic – while resources, including cumulative scientific knowledge, are blocked at customs”

While we learn important aspects about the molecular basis of medicine, physiology, histology, anatomy in our curriculum, little or no attention will be given to studying the institution of medicine itself. Meanwhile, the health care system in America is perhaps the most inefficient yet institutionalized system around. We as a nation put the most $$$ into health care and yet rank embarrassingly low in terms of primary health indicators like infant mortality. It is increasingly clear even in popular media these days that the health care system in this country is broken yet as physicians-to-be we learn nothing about how to fix it, or even how to understand the problem.

Anyway, I guess I meant to describe my first week of med school, but somehow I stumbled onto this tirade against my chosen profession. But I suppose that is why I am here, as a physician, it will be my responsibility to understand the problems in my profession and try to change it for the better.