Medicine in Society? Check.

As of Wednesday, April 21st, I have officially completed (and passed!) my first class in medical school. Next to the course Medicine in Society, on my transcript, there will be a fat ole "P" for passed. For some (cough, cough, Kelly), this is a cause for celebration, perhaps warranting an upcoming weekday excursion to Teavana, Inc. I, however, will miss a class that actually catered to my favorite learning style. When I look back at my most memorable classes in undergrad, Modern Democratic Theory, and Ethics, Morality, Liberty and the Law (both political science classes - hmmm, figures), they involved large amounts of group discussion and debate. They also questioned, and often changed, many of my views about different issues. Learning from people my own age, each with very different experiences and backgrounds, gives my own life perspective, and lends insight into the lives of others. Apparently not everyone went to The Georgetown Preparatory School for high school.

It would be unfair to say that every class had the same experience as ours. Many preceptors lectured to the class or made sure the discussion never deviated from the curriculum. I think we were lucky in that many of us got to hear background stories and other insights. Our class promoted political views from the hard right to the bleeding left (although it would also be unfair to omit the fact that the majority of the players sat contently in Obama's camp). Members of our section have worked in refugee camps, HIV/AIDS clinics, and have spent significant time abroad in third world countries. We represented different family identities and levels of socioeconomic status. There were at least two athletes that I know of, and two people who have obtained permits for concealed weapons. The age range was from 22 to about 30, and included a mixture of ethnicities. All these individuals questioned my beliefs concerning patient autonomy, the boundaries of a physician in her practice, medical ethics, and the legislation of morality.

If I were to take away one little golden nugget of insight, one gem, it would be this: the more I know, the more I know I don't know. Cliché as that statement might be, so many readings and statistics that we went over didn't really help to clarify the "right" or "wrong" way to look at things. And, the ensuing discussion seemed to only make the waters murkier. One discussion that stands out in my mind involved the ethical implications of students doing medical work abroad. I apologize; I won't be able to do the debate justice, but I will attempt to reiterate some of the key points. In my prior mind, this wasn't even an issue. Medical students often have an opportunity to go to third world countries, assist with many procedures, care for patients, and learn skills that they would not have yet learned here in the United States. For example, some students return in August with basic knowledge of how to sew and close incisions. They get real world knowledge years before it is legal to do in so the U.S. I had never thought twice about this practice. It seemed like a fantastic experience: helping others who desperately need medical attention, and who, perhaps, would never have received care.

Some members in our group, however, voiced their concern that this is much like the practice of medicine in this country years before many of the laws that now protect patients. The history of medicine is rife with examples of "using" the poor and disadvantaged for medical education and advancement. By leaving our borders to escape these laws that are meant for the patients' benefit, we educate ourselves on those who do not have those same rights and protections, performing procedures and learning technical skills that would not be allowed here in the U.S. There is a reason medical students don't spend significant time with patient care until their third year of school. But we, as barely educated first-years, can provide that care in the third world?

The conclusion that I came to was that any medical trip I might participate in deserves a high level of scrutiny. Who am I working with? Is this legal in the U.S.? What will be the consequences? What are my intentions? Is what I am doing the best for the people I am serving? I think (and hope) that for almost all the programs sponsored by UNC for medical students, the answer these questions would be, "Yes, I am doing good." But until now, I haven't even questioned the consequences of these opportunities.

And then we got into the ethical implications of medical mission trips. This blog isn't long enough for that debate.

We have one elective next year, so yesterday we listed our top eight choices (whether I get any of those preferred eight is to be seen; I am skeptical, to say the least). My top two were Health Policy with Dr. Jon Oberlander (of course), and The Medical Narrative (how to become a better medical writer). I would be extremely happy with either.

I am now nine lectures behind, and we have Exam #2 on Monday at 8 AM. Typical. Looks like it's time to get crackin'.