The UCSF Privilege

Friday, March 31, 2017

After seven weeks with my nose glued to the books learning as much as I could about the renal, endocrine, and gastrointestinal systems as well as nutrition (yes all that somehow fit into seven seemingly short weeks), I was ready for a break from the intense science content.

This break came when we started the four week long Health and Society (H&S) block.

The H&S block is designed to get us thinking about broader societal factors that influence healthcare outside of the one-on-one physician-patient interactions, which was the focus of the sister block Health and the Individual (H&I).

Discussing topics like a physician’s role in advocacy, physician leadership, healthcare systems, health insurance, and justice models in H&S has never made the uniqueness of the UCSF Bridges medical curriculum more apparent.

How often is a whole block in medical school set aside to talk about social justice issues and healthcare disparities as they relate to the larger forces that play a role in our country’s healthcare system?

Not only are the topics thought provoking, but, importantly, they are addressed with the current political and social environment in mind.

We’ve had faculty give lectures on the history of women’s health, walked through patient cases related to transgender health, and had a panel lecture titled “What is Race?”

One of the great things about UCSF is that we do not shy away from acknowledging and voicing opinions on controversial topics, which is important now more than ever.

Yet, the more time I spend at UCSF, the more it can seem as if I’m in a bubble. It’s been a privilege to study and train in San Francisco, but it also means being surrounded by mostly liberal activists with similar values and ideals.

Since the presidential election, the divisions amongst our country’s people have deepened and it’s concerning that the conversations we are having both in and out of our curriculum may be easily dismissed in other parts of the country, places we may eventually end up in for residency or fellowships or as practicing physicians.

Let’s use health insurance as an example.

It’s vital that all physicians understand the complex nature of health insurance, especially as it pertains to the patients they serve. Two weeks of H&S have been reserved to discuss both the Affordable Care Act (ACA) and the American Health Care Act (AHCA). As students who consider ourselves tech-savvy and well educated, we have been struggling to understand the health insurance system and the many delivery models.

Considering the difficulties of navigating the healthcare system in the context of the social and health disparities our patients face, it’s not hard to fathom why most of our patients are constantly confused about their coverage and bills and are charged absurd amounts that put them at risk of financial hardship. Even the average person can come face to face with a charge they had no idea was coming.

It has been enlightening to recognize these realities for ourselves, but it is also important to recognize that we learn about the ACA and AHCA with an obvious bias because of where we train.

Several times in lectures and small group discussions, classmates have pointed out that what we are learning is a skewed perspective and we should also consider other perspectives that are alive and well not only in other parts of the country, but also quite possibly in our classroom.

Drew Altman, President of the Kaiser Family Foundation, recently gave a talk at UCSF where he shared conversations that representatives from the foundation had about the AHCA with people who voted for President Trump.

The representatives explained the realities of the AHCA, including the replacement of the individual mandate with the continuous coverage penalty and the end of Medicaid expansion and income-based subsidies, all which ironically would most negatively affect the people they were talking with. Their responses were surprising in that instead of getting angry with the Trump administration and the AHCA, they were angry with the representatives who brought these realities to their attention.

This example brings to light the insight we stand to gain when we seek knowledge from those who don’t necessarily share the same opinions. The more we understand differing opinions, the more effectively we can find common ground with those outside our bubble and fight the inequalities many people face.

More of these perspectives need to be introduced as we learn about these complex and controversial healthcare issues instead of alienated and silenced .

While our curriculum administration and fellow students have acknowledged this discrepancy, the nature of San Francisco, UCSF, and the incredible physician advocates that we recruit make it hard to achieve this impartiality.

As a student in the Bridges curriculum, I know it’s a privilege to be here at UCSF in a program bold enough to broach these topics, but it is a privilege that can be both a blessing and a curse.