I went to medical school at A.T. Still University, School of Osteopathic Medicine in Arizona. It was a brand new program, a school devoted to an innovative curriculum that gave students early clinical exposure, taught in a new inductive reasoning pattern, and valued underserved and primary care medicine.
Quite frankly, I didn't care much about any of these details. What I cared about was that this was the only school that I got an interview, and so I really wanted to be accepted there. Sure, I was fine with all the things that this school valued and taught. I think my natural bias was towards primary care to begin with, and I liked the idea of working with medically underserved people. But whatever. I would have gone to any school that wanted me, given that they were accredited and within the United States.
So, I was accepted. I started my first year with a trip with all my classmates to one of the Community Health Centers we would be rotating in during years 2-4 of school. And I was happy just to be there. The next year, our class of 100 was divided into ten groups of ten students, and we moved to our clinical sites at the community health centers. There were students in Hawaii, working primarily with homeless Hawaiians, students in suburban Seattle and Portland, urban Brooklyn, rural Ohio, South Carolina, and Alabama, Indian reservations in Arizona. My site was Central California, working with mostly Hispanic people who picked the great majority of the fruit for the nation.
I rotated through the different specialties, seeing these patients. I traveled to Hawaii's community health center, where I rotated through pyschiatry. I was exposed to different races, ages, citizenship statuses (or lack thereof), addictions, and problems, all united by poverty and limited access to health care. And I thought I understood, finally, why my school developed this new curriculum. They wanted to have us work in these settings to make us familiar with working in underserved medicine, in the hope that we might choose primary care and come back to be a doctor to people that desperately need one.
Then I graduated and started my residency, in a nice hospital that serves everyone from the very rich to people that just made it over the border. I thought more about my school, and the background it had given me with underserved medicine. And I think I understand that their vision, their goal in the grand scheme of medicine, was not to have doctors return to community health centers in primary care. Of course, this would be a wonderful bonus to their commitment to underserved medicine. However, I think they knew that by training young physicians within the lens of the underserved, we would be forever changed as doctors. Even if we chose the most sub-sub specialty in Newport Beach, California, we would always have the memory of working with those who had very little. And this, I think, is the heart of the program. Training doctors in the initial setting of underserved medicine forms a framework that affects the rest of a physician's career. I know for myself, my view of medical legislation, practice decisions and treatments are changed forever, no matter where or with whom I practice.
As I write this and think about these patients, I hum a song from my favorite musical, Wicked. As the song says, I have been changed for good.
I've heard it said
That people come into our lives
For a reason
Bringing something we must learn
And we are led to those who help us most to grow
If we let them
And we help them in return
Well, I don't know if I believe that's true
But I know I'm who I am today
Because I knew you
Who can say if I've been changed for the better?
(I do believe I have been changed for the better)
And because I knew you
I have been changed for good