Ideas for a cultural commentary

I want to be a doctor.  I will be applying to medical school in June.  I have shadowed a doctor extensively.  I volunteer at a county hospital in Oakland.  I have gotten my feet wet in the medical field and hope to go farther soon.

At this point in my career, it is important to begin thinking about the many ethical dilemmas that come into play in medicine.  One of the most pressing issues concerns underserved communities, and how to motivate young doctors to serve these populations, especially those of lower socio-economic status. 

The current system focuses on exposure to these populations by incorporating free clinics into the rotations for medical students.  The thought behind it is that exposure will help create a level of comfort with those types of patients.  The end goal is to foster a sense of altruism and “feeling good about yourself” for working with these patients.

However, as the paper “Learning the Moral Economy of Commodified Health Care” points out, this system has inherent faults.  Since the health care system in the US is based on profit for care, clinicians come to expect something in return for their services.  Normally this is money.  However, in a free clinic this doesn’t happen, so they come to expect something else.  They expect a moral economy, where in return for their services, they are able to “feel good” about themselves.  These student doctors feel that they are giving their time and effort out, and come to expect something from the patient in return, namely a sense of gratitude and a promise of personal responsibility in order to maintain the health provided by the clinician.  In these free clinics, the doctors become “ethical clinician-citizens” who hold the power of bestowing health upon those less fortunate, and follow their own personal moral system in order to treat all patients equally.  However, this unfair expectation leads to certain negative outcomes.  Clinicians begin to view patients as worthy of care based on how responsible they seem or how grateful they are.  They ignore any underlying factors or experiences that may affect how the patient acts in these clinics.  They view this line of work with a sense of entitlement.  It also allows for compromised care to be justified in free clinics.  Because it is seen a “you get what you pay for” system, it becomes alright to provide inadequate care in these clinics.  Students who aren’t properly trained are allowed to perform procedures they wouldn’t otherwise be allowed to do.  Patients are expected to wait exorbitant amounts of time for single use treatments with no follow up, and do it all with a smile on their face. 

The end result of all this ranting is young doctors who, although trained in underserved communities, have reinforced negative stereotypes about such populations and free clinics in general.  Not only is this an unhealthy mentality for a health care provider to have, but it actually discourages clinicians from seeing such populations in the future. 

Obviously, I didn’t express the argument as well as the actual paper did.  I suggest reading it if you are interested.  But I’ve definitely seen this issue in practice, in all of my clinical experiences.  And the solution seems to be to emphasize an education that covers the root causes that lead to poverty, and how that affects the patient experience.  This understanding shifts the focus to the patient rather than being on the clinician and what they get out of it.  The system as currently formatted isn’t working, so maybe it’s time for this kind of change.  This is what I’d like to write about for my cultural commentary.


Reflections on “Balancing Act”

This memory has always been very vivid to me, but I never thought about it much before writing this narrative.  I never understood the significance of it, or even if there was any at all.  I think I remember it so well because my emotions were so strong that day, something I’m not used to.  But I never really thought about why they were so strong. 

Maybe at the time, I was too close to the incident to properly analyze it.  And maybe I was too young to look at it objectively.  But in writing this short story, I was really forced to figure out why I was feeling the way I did.  At least for me, I usually revisit memories but never really think about finding meaning in them.  In writing this, I started out with the usual memory, trying to recall everything I saw and felt.  That led to my first draft, just a bunch of messy writing.  Once that was on the page I tried to take a step back.  I tried to look at everything on the page and organize it in some way.  And I tried to analyze it as if it were someone else’s story, and see what meaning could be extracted.  Once I found what I thought the story was about, I restructured it again to fit that theme more effectively.

I wanted to leave some things vague or unstated, because I think writing can be powerful when the reader relates in some way to the themes or characters.  And more people can relate if they are allowed to find their own meaning in a piece.  However, I was unsure that I got anything across at all, so in this aspect having others read it really helped.  Their feedback gave me clues on how they interpreted it. 

In the end, I think that the narrative itself isn’t perfect.  But I am glad that I wrote it because I worked hard on it, put in my full effort, grew personally as I analyzed that memory, and ultimately have a piece of work that I am not ashamed of.  That’s all I ever wanted out of writing this. 

Balancing Act

I slammed the door, even though no one was in the house to hear it.  Just my dad, working out in the garage like he always does.  How can a couple motorcycles need that much maintenance anyways?  What about me?

I wanted to punch a wall.  And break my hand in the process.  Then he’d feel sorry.

But the reality of that awkward age between naïve kindergartener and rebellious teenager is that you aren’t afforded many possibilities when it comes to dealing with your emotions. 

So I shut myself up in the only space I had, my corner room with the tiny latch put on the door to give an illusion of security.  And I looked around, not even knowing what for.

I saw a giant stuffed bear, weary with age, that we had gotten at a garage sale.  I saw picture frames full of a younger me, fishing or hiking or playing baseball, doing those things more for him than for me.  I saw the precariously large Lego set that I had saved up for months to buy.  And I saw a solitary juggler’s ball.

There was my target.

My dad knew how to juggle, and he had tried to teach me once.  They were a Christmas gift from Grandpa Phil, and the instant the last shred of wrapping paper was pulled off we had opened them.  All I remember was my hands being too small to do it.

This juggling ball didn’t mean anything to me before this moment.  But now it was my target, and I pounced.

 I flung it to the ground, as hard as I could.  Over and over.  The seams between the patches of blue and yellow and red began to wear.  Again, harder still.  I wanted it to break open and spill out all over the room, cover every inch.  

But it wasn’t that easy.  The ball wouldn’t just split, it was made to stay together through such torment.  So I looked around again.  There’s gotta be something I can use. 

The nearest thing I can find is a little plastic pen.  I aim for the seams and stab.  Nothing.  Again.  Again.  There! Little pink and blue beads spill out.  

I thought it would be satisfying to see that ball bleed pink and blue.  But it wasn’t.  Even though I was alone, I felt embarrassed for some reason.  This wasn’t me, I don’t do these kinds of things.  I was the calm one, the mature one, never any trouble, I remember a teacher saying once.  And now, this? Now I couldn’t even learn to juggle if I wanted to.  I wished I hadn’t done it.  I wished it would just go away.  So I swept the remains with my hand into a CD case and zipped it shut.  And didn’t open it for many years.