I Went to Medical School to Change Lives. Now I've Lost My Faith in This Harmful System.

As a medical student, I am often a wallflower, my presence an unnoticed accessory. Or I’m a taskrabbit, completing mindless jobs that the doctors just don’t want to do. In a way, the lack of real responsibility frees me to witness, to observe and take note. But it can also mean that I feel voiceless when I am asked to participate in patient care in ways that feel inappropriate and harmful.  

A few years ago, I started at a medical school with a social mission that prides itself on centering health equity, advocacy, and person-centered care in its curriculum. My program successfully recruited a cohort of justice-oriented, energetic future leaders. I was eager to not only “save lives” but to change them. I longed to be a part of a community of healers, bringing holistic care to the people by using the voice and power that comes with my training as an MD. 

As the years began, we attempted to uncover the many layers of our healthcare system. We examined health disparities and challenged our ideas of physician’s responsibilities versus aspirations to promote change. We developed pilot projects to uplift the most marginalized voices and then redistributed healthcare resources to them. This was exactly the critical analysis and real-life exploration that I wanted to engage in. But I quickly realized how incongruent these teachings would be when I entered the clinical setting. 

I was on a surgical rotation, preparing to stand in the corner for a pelvic surgery. As I went with the surgeon beforehand to meet the patient, I nodded as he hurriedly summarized the procedure, and barely introduced me as one of the medical students, who would just be in the room to learn. He asked if she had any questions, in a tone that meant “I don’t have time for any questions.” The patient seemed anxious, as patients often are before surgery, and wanted reassurance that she was in good hands. I don’t think she ever got that reassurance.

There are countless moments in the hospital where I feel shame, disgust, and denial.

The patient was wheeled back and put under anesthesia. The OR staff quickly and mechanically stripped her down and exposed her. It was then that I was instructed by the surgeon to perform a vaginal exam.

I watched as a nurse did a vaginal exam, followed by a resident physician, followed by the surgeon, followed by the other medical student. A procession of people, inserting their hands into the vagina of this exposed, unconscious woman, lying on the table. I vocalized my discomfort in doing the vaginal exam because it wasn’t clear to me that the patient understood that I, along with many others, would put my hands inside her in this way, for the sake of learning. Everything about this routine parade felt wrong. She would never know the extent of what just happened in this room. 

I see this happen all the time. Sometimes I’m with a doctor who seeks true informed consent, by clearly and explicitly discussing with the patient what happens in the operating room. But most of the time, it is more of the same assumed consent, or “don’t ask, don't tell.”  After I objected during the pelvic surgery, I was told that I don’t respect the hierarchy in medicine and that I just need to get my hands in there more, literally. I felt small and disobedient.

There are countless other moments in the hospital where I feel shame, disgust, and denial. When a larger-bodied person goes in for surgery, the doctors often call in other doctors to “come look” at this person under anesthesia, as if taking a trip to the zoo, while making comments and jokes about how huge their body is. One time, I saw someone wake up during her surgery, writhing in pain until she was given enough meds to knock her back out. Later in the recovery room, she expressed how horrified she was from waking up during surgery, only to be told it must have been a dream. I’ve heard conversations between providers about how stupid and dangerous of a choice it is for patients to seek care outside of their system through naturopaths, acupuncturists, doulas, and herbalists. I’ve witnessed times when an unhoused person shows up to the emergency department saying there is violence on the streets where they live, only to be labeled as psychotic and violent themselves, resulting in sedation until they pass out. 

I’m watching as people are gaslit, mocked, assaulted, and ignored, not just by this abstract health care system but by the people working within it. Systems are made up of people, after all. 

And what is my role in this? As a trainee, I am often meeting patients first, before their doctor comes in the room. I’m getting their story, learning about who they are and how they’ve come before me, connecting with them. It’s an honor for people to trust in me, and I feel a responsibility to them when I’m sharing their stories. But when I hand them off to their doctor, the story falls on deaf ears, and I watch as another patient is misunderstood, frustrated, and rushed out the door. 

I’ve gotten poor grades and feedback for spending too much time with patients and inquiring about their lives outside of their presenting complaint. I’m told that questioning grandfathered-in processes and inquiring providers’ decision-making is disrespectful. But aren’t these the exact questions my so-called justice-oriented med school wants me to be asking?

I’m an aspiring healer. I feel called to connect with people and facilitate healing spaces. Now, as I’m preparing to graduate, I don’t have any faith or trust left in the system that is training me. This system neglects and punishes connection and curiosity, while operating on hierarchy and paternalism. 

I work 60 to 80 hours each week in this setting, then play out social justice-in-medicine scenarios in class. It’s disorienting to participate in a system that often lacks empathy and humanity, then go sit in a classroom that holds onto faith in the same system to change. I’ve quickly become physically and emotionally exhausted. Staying “bought in” to this system comes with a level of cognitive dissonance that literally makes me ill. I’ve had a level of anxiety and depression that mutes who I am and numbs the world around me. I’ve felt like I lost my purpose and hope in this work.

How am I to stay engaged and faithful to a system that perpetuates harm to the patients it supposedly serves and also to the trainees who are committed to undoing this harm? I’ve realized that in order to protect myself, I have to dissociate. I have to mentally separate myself and my identity from the work that I am doing, in order to get by.

I tell myself this is just a means to an end. I’ve seen the light go out in many of my peers. We all came into this energized by the potential we see in medicine, wanting to be community and family doctors for people who look like us, for people who the system acts against, using the power of our degrees to affect change on an individuaI and policy level. And now years into our training, we’re all checked out and just want to get by. I wonder, at what point do we become the means to the end?