By Lawrence G. Smith May 1, 2020
When I graduated from medical school more years ago than I care to remember, my training as an intern and a resident followed an unrushed, traditional path. Medical students at the time were introduced to patients gradually, and we took our time engaging with the trying challenges that make up the bulk of a physician’s career.
This year, students graduating from the medical school where I am dean and from other schools are facing a very different time line: Due to the Covid-19 pandemic, many of them have been called upon to volunteer or work in hospitals before their time in medical school was over.
That’s not unprecedented. In 1918, some medical students were graduated early to help fight the raging Spanish flu. In 1952, medical students in Denmark helped provide polio patients with round-the-clock manual ventilation. in the 1980s, doctors in training were thrust into the burgeoning AIDS epidemic.
But none of these match the global shutdown we’re experiencing now, and the young men and women officially donning their white coats as new doctors will soon realize that the world they’re entering is one profoundly altered by the pandemic.
They will be changed by it, as will medicine.
As they work at the bedsides of those with Covid-19, new doctors will discover a skill too long ignored by most medical schools: empathy. From my days as a trainee until quite recently, medical education focused almost entirely on increasingly specific specialization. Medical students were encouraged and rewarded for how well they mastered their chosen field, not how kindly they spoke to the frightened person looking them in the eye, eager for a glimmer of good news.
This massive outbreak changes all that, making clear that no matter how great physicians’ technical skills are, they may not be considered healers until they’ve learned how to soothe and inspire, to comfort patients and family members alike (even when it’s compassionately delivering bad news), to deliver not only treatment but also hope. Working in hospitals packed with patients of all ages and demographics, and tending to those who, due to isolation, can’t be with their loved ones, will teach new doctors skills their older peers all too often had to pick up on their own.
As my students and others all across the country make their rounds, they will likely notice that while an infectious disease like Covid-19 afflicts people regardless of race or wealth or education, its impact varies widely based on socioeconomic status. Walking the hospital corridors, physicians in training will notice that patients who exist paycheck to paycheck, or who live in one of the many food deserts that blight even America’s wealthiest cities, are more likely to suffer from heart disease or diabetes and, as a result, are more likely to be harder hit by the virus. They will also notice that many of these are people of color.
Such a realization can and must change everything about the way medical students perceive their profession, as well as everything about the way future generations of physicians are trained. Social determinants, we now know–a person’s income, say, or ZIP code–have a tremendous impact on his or her well-being, which is why death and disease rates can vary wildly even among residents of the same city who live in different neighborhoods.
These data points should no longer be considered incidental, the sort of soft stuff a physician can easily ignore and something that once wasn’t taught in medical school. Instead, we should make it a point to ask questions about a patient’s socioeconomic condition as part of the intake process so we can better understand the fuller picture of her or his life and better help him or her recover.