Sooner or later I figured I should write a blog post about Medical School at UCSF. Hopefully I will put up some more thoughtful and reflective posts at some point in the future.
Last September marked the beginning of a great transition in my life – from the world of water and engineering to the world of health and medicine. It is exciting and at times overwhelming to be entering such a complex world, but I have really been enjoying med school so far. It is hard to capture in a few paragraphs what it means to be studying medicine, but I’ll try to give you at least a rough idea. UCSF is completely pass-fail for the first two years, and the curriculum is based on blocks divided by organ system or major theme. I just finished the 6-week cardiovascular system block in December, for example, and an now a week into the 3-week pulmonary (lung). We have an exam every three weeks or so. Even though the exams aren’t cumulative, it is like studying for the most intense final of undergrad every three weeks. I enjoy the rhythm, because I can focus on thing other than school for two weeks and then put it into high gear for the last week before each exam. The material is interesting and challenging, but it is not very stressful because there are no grades; we only need 70% to pass, and if we don’t pass a test we just take it again. I think it is a brilliant approach, because we can focus on learning as much as we can, and don’t have to play games of selective studying to optimize our test scores.
Since September, I have learned to take patient histories, practiced the routine physical exam, developed a basic understanding of human anatomy over many dozens of hours working with a cadaver in the anatomy lab, and begun the tremendous task of understanding the workings of the human body, how to tell what has gone wrong, and if and how we can intervene to put things right. I loved the cardiovascular block – all the talk of valves and flows and pressure gradients were comfortingly reminiscent of water system engineering.
In many ways I feel very much like I felt as a freshman at MIT – my interests piqued by so many issues and questions but with little knowledge or experience to grapple with any of them. I am thrilled that so many of my classmates are also interested in healthcare for the underserved, global health, health disparities, single payer health care, etc, and that our school not only allows but encourages us to invest our time in such issues. As I anticipated when I decided to come back to the US from Cuba for medical school, sometimes I get extraordinarily frustrated with the US health care system, or, as speakers on the topic tend to quip: the US disease treatment industry. I wish I had some sort of hope to offer in this regard, but I am only beginning to understand the depth of the issues. I believe we need some kind of single-payer solution, and am starting to work through the practicalities and subtleties. This Sunday I am going with a number of other students to a training and then Monday we will be meeting with California legislators about the state-level single payer healthcare bill. Then in the Spring, I will take a comparative policy elective which discusses the health care systems of a number of different countries, which may help me flesh out my thoughts a bit more.
I am often asked what kind of medicine I want to go into. I realize that I am only at the beginning stages of this process and my ideas will most likely change and evolve as I go, but right now I plan on doing some kind of primary care. I am interested in figuring out innovative ways to foster health and increase access to health care in marginalized communities. For a while, my debt will require me to do this kind of work in the United States, but after I have paid it off I want to move abroad, maybe to Latin America, maybe to some other part of the world. I have grand visions of being the village doctor someplace, training and supporting local health promoters, mentoring future doctors in the region, and maybe traveling occasionally to learn from others and share any insights I manage to glean. I am beginning to realize how much I love to teach and how teaching could serve to multiply my impact, whether that is by training health promoters or teaching medical students. However, I think I would rather teach in another country besides the US– solutions to global health issues must be born in the global south, in the minds and hearts of people who share a language, culture, and history with the people they want to serve.