Reply to the Latino Paradox

I wanted to comment on the wonderful post by an unidentified person... the post on Feb 22, with the video and news article. I finally got around to reading those! Anyhow, I found the short film clip really interesting. The fact that the most socially marginalized of the population is the healthiest--even healthier than the wealthiest segment of the population--is rather astounding. If you think about it, however, I suppose it's not too surprising: as Dr. Grover mentioned, the Latino community has an extremely strong support network, a religious regard for the body, and (the first generation immigrants) have an extremely high work ethic. These people undergo physically strenuous labor for many hours of the week--probably more laborious than any of the likely sedentary jobs that we will have--and also haven't completely adopted the Big Macs and fries that seem to be so integral to American culture. If there was just a way to help maintain this work ethic, this pride, and this diet...! I suppose I'll mull over this a bit in the couple of weeks that we have until the ASB (and indefinitely after that too...).

Follow-up on Edgardo's post about "The Spirit Catches You"

While I have not read "The Spirit Catches You and You Fall Down" by Anne Fadiman, I thought Edgardo introduced several issues which have been recurring throughout our ASB course.
First, there is the dual nature of the doctor. The medical profession has constructed a subculture with its own esoteric medical jargon which unfortunately seems to exclude patients from grasping the treatments that they are receiving as well as the cause of their symptoms. Many of the problems that I feel come up with cultural competency involve a disconnect between "western medicine" and a patient's native cultural values or beliefs. I do not think that the clash between the two needs to be a zero-sum game with one triumphing over the other. As we read earlier (in Dr. Glover's article? I don't remember exactly), many times compliance might be enhanced if doctors encouraged patients to engage in their herbal or homeopathic remedies in addition to what we consider "medically sound" treatments. If anything a patient might begin to feel better sooner via the placebo effect. Cultural competence is and will only become more important in the coming decade as minorities comprise a larger portion of the population. Medical schools should stress cultural competence and bilingualism as tools for better serving patients, and as Edgardo put it, to reveal the "humanity" of doctors.
Second, there is the role of government in assuring proper care for patients. While I believe the government should ensure access and affordability of health care for all, I believe there are certain lines which the government should be wary of crossing. The case of Teri Schiavo certainly comes to mind, but Lia, one of the characters in the novel seems to also fit this mold. At what point does the government become too controlling of individuals' ability to make personal decisions? Although I certainly agree that cultural health remedies which exacerbate conditions or are dangerous should be frowned upon, individuals have the right to express themselves. The issue of minors and adolescents is particularly tricky. I'm not sure if removing a child from the care of his/her parents simply because the parents aren't agreeing with the child's doctors is in the best interest of the child. No parents (or at least most parents) would not knowingly make decisions that would farm their child. It is at this point that education and cultural competence play such a large role. Are the parents making an informed decision based on all the facts? Do they know the risks of choosing to not accept "western" care? The doctors and legal experts must do their best to inform individuals and caretakers, but in my opinion should not overstep their bounds.

The Spirit Catches You and You Fall Down

The Spirit Catches You and You Fall Down

After our discussion about traditional remedies and the role of religion in patient health, I thought of The Spirit Catches You and You Fall Down, as a too good of an example to let pass. First the book tells the story of Lia, a Hmong infant diagnosed with epilepsy. The collision of Lia's Hmong culture and her doctors Western biomedicine culture leads to Lia being placed under medical foster care after her parents do not comply with the doctor's requests.

At the center of the book, there are many issues. First, is the role of religious traditions and if it applies to a minor. Lia's parents did not want to comply with some of the western medicine because they preferred to try their cultural remedies first, saying they needed to restore her spirit.Plus in the Hmong culture, children with epilepsy are seen as sacred beings. The problem was deciding if religious beliefs applied to a minor, especially if that minor is not old enough to state their position. How do we know that the minor will adhere to the cultural and religious beliefs? This was a problem that the doctors faced. They were interested in the health of Lia but her parents opposed the western biomedicine approach. Currently in California, the law grants the freedom for parents to practice spiritual treatment for a child through prayer as along as it is in accordance with an accredited practitioner and it cannot allow to continue or cause any serious physical harm. If the spiritual treatment cannot be applied successfully with satisfying results and the parents refuse any other medical treatment, the law gives doctors the right to intervene and place the minor under medical foster care. The state acts in the welfare of the child because the minor is the most vulnerable since the child cannot define their religious stance.

Another issue, was the lack of a cultural barterer between the American doctors and the Hmong parents. The doctors, even though they had the best intentions were not educated to the customs of the Hmong culture. Anne Fadiman, the author, writes "Neil and Peggy were dimly aware of some of these remedies( or example when Lia had marks on her chest from coin rubbing), but they never asked them about them and they certainly never recommended them." The need of a cultural barterer was very much needed to build comprehension between the two cultures. In the book, Fadiman interviews Arthur Kleinman who suggests a return to a whole doctor. Doctors should not only concentrate on the science of their art but also on the humanity. It is essential for doctors to know more about their patients because it is the only way to offer optimal care.

Another response to "On Racial Profiling" - Anand

Like Tara, I too, am going to give my take on the article "On Racial Profiling" by Sally Satel. This is a really thought-provoking article, especially for those considering a career in the health professions. It caused me to reevaluate my own perspective on the role of race in medicine.

While I am in no way an advocate of racial profiling in the strictest sense (I am ardently against it), I believe that including race in any patient's history/physical as part of making an educated diagnosis is critical. Based on the article I think it's rather clear that race isn't being used as the only factor in diagnoses. Doctors still take into account the symptoms presented by patients (proximate causes) and couple these symptoms with overarching correlates - like race, gender, ethnicity. Nobody (or very few at that) is saying that because of a person's race he/she has certain conditions. The science available to say that is speculative at best. Empirical evidence, however, does show that certain conditions do cluster and occur more frequently among certain populations - i.e. sickle cell anemia in African Americans, Tay-Sachs in Ashkenazi Jews - and thus one could make an educated argument establishing a strong correlation between conditions (many of which have a genetic component) and a person's race.

As Tara points out, to adopt a race-blind or gender-blind approach would be ill-conceived. Doctors are looking for all available puzzle pieces, and if race happens to narrow down the number of possible diagnoses and thus means the patient is subject to fewer unnecessary tests then I believe that race-consciousness is beneficial in medicine. Dr. Satel and others like her are not saying that a person's race should affect the quality of care that doctors afford to their patients; rather she is contending that race may play a role in the effectiveness of certain treatments.

"Racial profiling" in the context of medicine does not imply the creation of two-classes of patients - one receiving better care than the care - it simply points towards more specialized medicine. To understand this better, consider: If a doctor sees an African American patient with heart problems and is choosing between prescribing BiDil and Enalapril, wouldn't the doctor be remiss to take into account the preponderance of studies that shows the relative efficacy of BiDil vs. Enalapril (which by the way might lead to serious complications)? I know I would certainly hope my doctor would. Likewise, when it comes to dosing, isn't it wiser for a doctor to begin with a lower dose of anesthetics for an Asian American patient undergoing surgery due to the increased risk of apnea than to be negligetn and ignorant and simply treat the patient like everyone one? While discrimination and prejudice are significant problems throughout society today, we should not blindly shut the door on racial-consciousness especially when it might save a person's life.

By Tara Gu, Fervent "House" Fanatic

I'm going to blog about the Sally Satel article, "I am a Racially Profiling Doctor," because it was a much more interesting article to read than the one we were actually assigned (although, like Amy said, some of the folk remedies in Welch were eclectic enough to raise a few eyebrows and arouse my interest).

Satel begins with a bold statement: "In practicing medicine, I am not colorblind. I always take note of my patient's race. So do many of my colleagues. We do it because certain disease and treatment responses cluster by ethnicity."

To give an example -- "Kassirer, the former editor of The New England Journal of Medicine, is a renowned diagnostician. He is legendary among trainees for what he can tell about a case from just a few facts. He gave an example from a recent morning report, the daily session in which young doctors describe to senior physicians the most vexing cases admitted to the hospital the previous night. During one report, the resident began: "The patient is a 45-year-old Asian male who came to the emergency room complaining of 'feeling weak and wobbly in my legs' after drinking two bottles of beer." Kassirer stopped her right there. "Here's what I infer from that information," he said. "First, we know that sudden weakness can be caused by a low concentration of potassium in the blood, and we know that Asian males have an unusual propensity for a rare condition in which low potassium causes temporary paralysis. We know that these paralytic attacks are sometimes brought on by alcohol." Of course, the patient could have been suffering from some other muscular or neurological disease, and Kassirer instructed the trainees to consider those as well. But in this case the patient's potassium was low, and the diagnosis was correct -- and confirmed within 24 hours by simply observing the patient. Thanks to racial profiling, the Asian patient was spared an uncomfortable and costly work-up -- not to mention the worry that he might have something like Lou Gehrig's disease."

Now before all those PC activists out there get all ants-in-the-pants to make a tirade about racial equality, let's consider the purpose of a physician. A doctor, like a good detective, tries to solve a mystery based on the clues that they can gather from the symptomps of the illness. However, they consider both the obvious physical signs of disease as well as other potential clues by deduction. To me, Dr. Kassirer's diagnosis sounds a lot like those of Dr. Gregory House, who is named after Sherlock Holmes.

What is the difference between using racial data and other factors of a patient, such as his history or genetics? If racial profiling, in this case, is a form of discrimination, then isn't patient history also a form of discrimination? Can we execute any type of "judgment" or dicernment of the illness without discrimination? When we infer that something is caused by one disease, we are discriminating against all other illnesses that could have caused the same symptoms.

We split medical research into women-only and men-only studies because some treatments respond differently to gender. Current research centers on finding more female-friendly approaches to treating heart attacks. Are we now all sexist doctors as well, because we treat men and women differently?

A friend sent me this story about Lloyd Carter, an environmental activist in Fresno. I think it is good information to share, especially since it is occurring in the area we will be visiting. As a quick summary, Lloyd Carter is a the deputy attorney general is being pressured to resign from his post in the California Save Our Streams Council after commenting on farmworker's social position in a local tv interview.

It is reported that Carter said the children of farmworkers "are the least educated people who turn to lives of crime. They go on welfare. They get into drug trafficking and they join gangs."

Farmworkers and other groups are advocating for Carter to resign from his position in the Attorney General's Office in Sacramento. The farm workers have organized themselves to meet with lawmakers. Attorney General has condemned Carter's remarks but has not acted towards any action.

The full story can be read by clicking on this link:
http://www.fresnobee.com/local/story/1191212.html

Plus. found this really cool site titled "Unnatural Causes". It was series on PBS exploring health inequalities in the United States. This video is about the Latino Paradox. I recommend visiting the site it has a lot of information and videos.

Health Care in Shadows

http://www.nytimes.com/2008/05/10/us/10migrant.html?_r=1&ex=1211256000&en=a8a08ef786055855&ei=5070&emc=eta1

 

           

            As already mentioned repeatedly, farmers have one of the most dangerous occupations. At the same time, most of the migrant farmers are working illegally and more importantly, they do not have access to conventional healthcare since they cannot obtain health insurance nor have enough money to go see a doctor. Furthermore, they are anxious to go see a doctor because of the fear that they will be deported from the United States. The traditional healers, curanderas, provide much hope for these farmers who cannot afford conventional healthcare. No matter how absurd these remedies may seem, as long as they provide the placebo effect at the least, they should be continued to be practiced.

 

            Nonetheless, one must note that some of the traditional methods of healing may be harmful. It is extremely important that we inform these curanderas of the detrimental ways of healing. Additionally, we must convince the local doctors to work together with these traditional healers to effectively maintain good health in these farmers.

Some More Thoughts on Competency, by Amy

One thing I appreciated from the article this week was that Welch stresses the importance of accepting and working with traditionally held beliefs, such as folk remedies. Heaven knows that I've had to gargle salt water for a sore throat, eat tons of oranges during the onset of an illness, drink ginger tea with lemon and honey for a cold, eat ginseng because it's shaped like the human body (and therefore is good for the body)... and I know that these are not clinically proven to work. But my mother swears by them, and I'm happy to oblige. Granted, the folk remedies mentioned in the article can range from innocuous to potentially harmful, but as long as the doctor is aware of the dangers and can somehow get the patients to avoid the potentially harmful ones, it's better for all parties to work with the remedies rather than declare them ludicrous and ban them. I liked especially how the article suggesting altering rather than banning even the dangerous remedies, in order to better accomodate the patient's beliefs. After all, I don't think the home remedies I use are ludicrous, but who's to say that people of another culture would think that of them?

Actually, this is somewhat of an inspiration to me as we begin thinking seriously about our health presentations. How can we most effectively present the material and make it immediately applicable and feasible to implement for our audience?

Cultural Competency

I just finished reading the article we had for this week on "cultural competency." Here are some random thoughts and ideas to incorporate into our ASB week.

1. I thought that much of the advice that the article gave to health care professionals was painfully obvious. I mean, it's not too hard to realize that doctors should treat their patients with kindness, friendliness, and respect. I would hope that patients don't have to be Latino to merit this sort of considerate care!

2. That being said, I see the point that the article is making. Many people coming from Latin American cultures expect more of a personal relationship with their doctors. As I'm sure many of you who have spent time outside of the US know, not everywhere has the rushed, "efficient" approach to doing business that we do.

3. I think we should keep this article in mind when we're presenting our health projects. It's important to establish a connection with the people we hope to serve. Throwing information in their faces isn't going to accomplish anything, so we should make sure to approach each interaction with a friendly, approachable, respectful attitude. That sounds easy, but I think we will find it hard to keep up sometimes, especially after a series of long days and travel.

4. And, maybe most importantly, we should make sure not to be judgmental. Not only would a judgmental mindset limit our interaction with others and thus the service we can give, it would be a serious detriment to the learning we can gain from this trip! I hope to approach the whole week with a very open, observant mind.

Ideas for Health Education Project - Anand

After reading the articles by Minkler and the one entitled "Suffering in Silence," I've come up with a few ideas and things to keep in mind when we generate our health education project. These ideas are geared mostly towards the children's health education program but could be applicable to the adults' one as well.

Presentation:
1) Overall, based on the Minkler article, I feel that it is important to stress that health promotion is only successful if an individual is committed to it. While certain "ecological" factors are outside of our control, we do make conscious choices with regards to smoking/drug use, exercise, and diet (to some extent at least). If we can stress personal empowerment, then I feel that kids are more likely to respond rather than if we tell them this is what you need to do to be healthy.
2) Exercise: The Minkler article pointed out that a strategy of "Active Living" has been successful in Canada. Basically, rather than trying to coerce people into setting time aside for exercise (which is preferable - 3/4 times a week for 40 minutes), it might be better to teach kids to generally opt for more healthful behaviors (i.e. take the stairs rather than the elevator, walk to school, ride a bike, do not eat in front of the TV). I teach health education in EPA, and one of the topics that we stress when talking to the kids about exercise is that commercial diet programs don't work (for everyone) and that they are a waste of money.
3)Body image: This isn't something that either article addressed, but I feel that at least briefly talking about body image and what being "healthy" means might provide a framework and perspective for what we're trying to accomplish. This might involve introducing the notion of BMI, but we need not do that (especially since we only have 10-15 minutes). As Minkler pointed out, recidivism rates are rather high when trying to implement behavioral changes. We want to encourage the kids to become healthier individuals and set personal goals that are attainable rather than trying to become the image of someone they've seen on tv or on a billboard. This is also a good time to talk about the effect of advertising on personal choices.
4)NUTRITION: So, I think this is the biggie. The "Suffering in Silence" article talked about high obesity rates, hypertension, and high cholesterol (this is appicable mostly to adults, but kids are at risk, too). I think we should lay it all out for the kids and be honest with them about the fact that not adopting a healthier lifestyle puts them at risk for developing these conditions (visuals would be great like bar graphs). I think childhood obesity is more pertinent to the students. While I'm not a big advocate of the food pyramid, it does provide a good starting point to discussing what our diets should be comprised of. Off the top of my head, I think we should stress concepts such as simple vs. complex sugars (the latter take longer to break down so you feel "full" longer), eating slowly (takes time for your stomach to tell your mind that you've had enough), serving size (nutrition labels!! also something we can include in the handout/pamphlet: how to interpret them), what veggies/fruits/fiber do for us (lots of vitamins/minerals - tell the kids why these things are necessary). I think as part of the handout we can also provide a meal chart to help the kids document what they eat so that way it is easier to realize if they are or aren't eating healthy. The "Suffering in silence" article also pointed out high anemia rates which can be fixed with servings of meat (beef, turkey) as well as beans. Fruits like oranges and veggies such as potatoes/tomatoes can help in iron absorption as well.
5)Sleep - Neither article talks about this, but getting enough sleep can help with mood, weight, and general wellbeing. Plus it costs nothing (with all the benefits)

These are just a few ideas. Whatever we decide to do, visuals and activities are essential. Nobody likes listening to someone talk for 10-15 minutes without a break.

Handout:
1)Nutrition label guide
2)Meal chart to help document what you eat and what nutrients you're getting
3)Part of this could involve a cartoon maybe?
4)For the adults, the "Suffering in Silence" article talked about lack of water; we should encourage them to save and reuse plastic bottles (good for the environment and ensures that they don't become dehydrated). Additionally, build awareness about the "California Workers Compensation Insurance System." Many of the workers probably do not have health care through their employer, but that doesn't mean that if they get hurt on the job that they cannot get money to pay for medical care. The "Suffering in Silence" article talks about how all employers (especially in ag.) must be part of this system, but few workers know about it.

Creative solutions to these age-old problems

What Gabe Garcia had to say about people KNOWING things and still not ACTING on them resonated with me. What barriers do we need to identify that will fully give us a picture of how to solve this problem? It's like a design problem in engineering: you need to know the specifics of everything, identify several factors that you want the finished solution to accomplish, and then try a few different ways--COMPLETELY different, mind you--that could accomplish this end goal! For instance: PROBLEM--How can we ensure that pregnant farm workers get adequate care and don't overwork themselves? Have doctors dress up as farm workers and work alongside women, making sure that the women know resources available? Have high school/college students trained in some capacity to identify such women perform crude examinations and let trained professionals know? Wheel out enormous feather beds (with shaded canopies!) out onto the fields so that the women can lay down when they're feeling ill? Work out some sort of daily contract so that overseers cannot fire in the middle of the day due to non-working? Organize teams of women who can register for the day under one person, so that the same amount of work is accomplished? Of course, these all have pros and cons but the important thing is to get all ideas, no matter how silly or ultimately unfeasible, down because really good ideas often come out of silly ones!

I don't think there's enough creative approach to this sort of thing, just a rehashing (albeit slightly modified) of old policies and ideas. What we really need is a huge brainstorming session(s) to identify issues, think of solutions, etc. Let's apply design criteria to this and see what we can come up with!! I can bring my big newsprint pad so we can identify problems and have a fun brainstorming party, if you guys are up for it (and if Quynh and Josh are okay with it too). I know we have some guest speakers though, so whatever fits into the schedule!

Health Care of Migrant Farmers

http://insurancenewsnet.com/article.asp?n=1&neID=200902031680.2_cd2a006ebdc6cf59

 

One of the great news mentioned in this article is the fact that Kaiser Permanante has pledged $2 million to support David Geffen School of Medicine at UCLA. This funding will be used to expand the Hispanic International Medical Graduate program. Ultimately it will increase the number of Hispanic physicians in California. As discussed in class, this will get rid of many social and cultural barriers between patients, specifically migrant farmers, and doctors. Because migrant farmers are a minority and poor, they would generally be intimidated by doctors to whom they cannot relate. By having more Hispanic doctors in California, these farmers can now turn to their physicians who would probably be bilingual in English and Spanish. By getting rid of communication barriers, many fears and misunderstanding at clinics will be eliminated.

As a result, preventative health care will be practiced instead of the patients seeking only emergency care. Thus, the general expense in medicine will decrease tremendously because health issues will be treated and prevented as much as possible before it is too late to do so in an emergency room which would lead to surgical procedures most of the time. However, there are still monetary issues to go see a doctor due to lack of insurance and transportation. This issue can be approached politically in that laws can be passed to enforce farm companies and owners to provide health insurance for farmers even if they do not have insurance or social security number. Although this approach may seem like a long shot, there must be public awareness of the importance of farmers in agricultural economy and the country’s economy in general in order to goad political leaders to push this law.

Thoughts on guest speakers

I was really impressed with the way that Dr. Garcia presented "case studies" of individual health advocates who weren't necessarily doctors. I think our society would be much healthier if more people would adopt these individuals' perspectives that "health" is more than "health care." This perspective is certainly encouraging for us as we hope to influence health (even if its just a little bit) as college students without "official" medical training! Also, I think the medical profession could benefit a lot from Dr. Garcia's mindset of partnership with civic leaders, activists, patients, etc. For those of us thinking about one day becoming doctors, we should remember Dr. Garcia's example and be ready to learn from all people (not just the ones who have a white coat and an M.D. after their name).  Memorable quotes: "We can't solve problems by using the same kind of thinking we used when we created them."   Also, we need to investigate "the causes of the causes."

I was late for Dr. Wise's talk (boo chemistry), but of the time I was there I was really struck by his thoughts on having the courage to step outside of comfortable routine.  It's both an encouragement and a real challenge to us, I think.  I also really admire his dedication to "his" communities in Guatemala - I enjoyed hearing his stories about his involvement there.  I tend to think of "global health" a bit abstractly - I think of doctors traveling around the world to all sorts of communities and doing great work, but I don't often think on the individual, personal-relationship level.  It was cool to hear that perspective from Dr. Wise.  The relationships he has with patients despite distance and cultural divides is not only a testament to his own work but also to the great potential of healthcare to build up a worldwide community.

Reflection on the Past Two Weeks

Well, for the past two weeks, I have been feeling this sense of inspiration, hope and confusion. I guess its natural for students to always be thinking about their future, but in my case I do it constantly. I think too much, to the point it confuses me. I have a conflict in trying to combine all my interests in one area. Especially with academics I am finding it very hard to do combine my artistic passions with what I feel my social responsibility; improving low-income urban communities and cities. But recently, I have realized that I need to take things with more calm. There is no deadline I need to follow. Dr. Paul Wise's talk made me consider, for the first time, taking a year off to explore my own interests outside Stanford. I have always been interested in healthcare but I knew being a doctor was not for me. I am interested my in the community building, getting to know the people, their stories and making sure that government and the community is doing something to improve the situations. Wise's talk brought me calm because I didn't feel pressured anymore. I felt that there is a way I can contribute to change. Meanwhile, the talk from Gabe Garcia cemented the fact that healthcare involves many different circles and not just medicine. There has to be a partnership between doctors, community and government leaders, policy makers and citizens in order to tackle the issues of healthcare. I feel that there is a for me to help. I feel that there are more possibilities. Im probably not making any sense, but hearing these two people talk and being in this ASB trip has began to affect me in deeply.

Empowerment of women as a key factor, by Amy

As I'm going through the readings, my first thoughts are not on access to current health care but rather to preventative health care (i.e. education). Many of the case studies involve families in which the young parents are uneducated--as Sam mentioned in her blog post several days ago--and who subsequently have many children that must be sent to live with grandparents. The problems have now been compounded: young dependents, more mouths to feed, greater necessity for work. Now this may seem like a quick fix on the surface level: simply implement health/sex education programs and birth control options like condoms, etc. However, there is also the cultural/religious aspect: the Catholic church, which dominates in Latin America, shuns birth control for reasons that I understand on some level. I think the question really boils down to whether it is "morally worse" to wear a condom and prevent a natural pregnancy or to have dangerous abortions, separated families, and greater stress on the immigration/agricultural system. The question remains: how best to rectify the situation? Trying for changing religious/cultural ways of thinking falls into dicey territory, but I feel that education and empowerment of women is key into helping the situation.

By Tara Gu, Mindless Pre-Med

Please forgive the following ramble about my personal life as a sorry excuse for a post:

My first week at Stanford, during NSO, I attended a panel entitled "So You Want to Be a Doctor?" along with 350 other bright-eyed freshmen. This was a 9am panel, an unreasonably early time, now that I think about it, and at least 20% of the freshmen population was present. According to the Stanford Daily, it is rumored that 40-50% of each entering class is pre-med.

The more I thought about it, the more I was dismayed. I chose Stanford over a few (okay, one) smaller liberal arts schools where the focus was on individualism, and sitting in that auditorium full of pre-meds, I felt like just another fish in the sea, another cutthroat specimen renowned for trampling upon others to get ahead in the curve.

I have always been one to disdain conformist thinking. I question the validity of what others tell me and challenge the notion of unquestionable authority. I check facts on Wikipedia after someone tells me something. I'm Asian, but I dislike being with lots of other Asians, because they do Asian things like conform to one another's opinions. I am well aware that in being anti-conformist, I am conforming to the alternative, and yet, I take comfort in the fact that I am with only a small school of fish rather than a giant boatload.

Earlier this year, I went to Dr. Mike McCullough's talk about dispelling premed myths. He mentioned some things that made me re-consider why I wanted to be premed (I decided to be a doctor when I was 9 after religiously following ER every week), as well as why so people in general want to be doctors. Many people want to be doctors because they "want to help people." That's wonderful, but people aren't innately this good, are we? There are the considerations of high income, respected social status, parental pressure, power/control over others, not knowing what you want to do in life so you attend as many years of school as possible, etc -- all ostenisbly, of course, in the name of helping others. But for how many people is this choice that we make freshman year of college the right one?

"Survey results suggest that levels of professional satisfaction have dwindled substantially during the past few decades. In 1973, less than 15 percent of several thousand practicing physicians reported any doubts that they had made the correct career choice. In contrast, surveys administered within the past 10 years have shown that 30 percent to 40 percent of practicing physicians would not choose to enter the medical profession if they were deciding on a career again, and an even higher percentage would not encourage their children to pursue a medical career. In a telephone survey of 2,000 physicians that was conducted in 1995, 40 percent of the doctors said they would not recommend the profession of medicine to a qualified college student" (January 1, 2004 issue of New England Journal of Medicine).

Fewer than 15% of practicing physicans think they made the correct career choice? That's 1 in 8 people. That means out of 8 doctors, only 1 thinks she made the right choice freshman year of college. Ouch. In our generation of people who are afraid of commitment, why are so many people committing so early to something that they statistically will be unsatisfied with? Dr. Garcia's point about health being an overall state of being that not just doctors can "help" with really hit home for me. The desire to be a physician no longer resonates as strongly as it used to, and I feel like my desire to improve the overall health of the world can be satiated by almost any career choice I choose to pursue (currently, I'm torn between health and educational policy).

I am deeply saddened to admit that I too, am premed, and hope to God that I will make the right choices because those are actually the right choices, and not simply because premed is the new GenEd.