The medical curriculum
The only part of our university medical curriculum I remember having strong opinions about is the lectures in preclinicals where highly respected professors or academics in the field would get up and whiz through a topic we have never heard of with heaps of technical terms we (okay, more specifically I) didn't understand. Which, combined with my own bad sleeping habits, made me fall asleep almost every single day. Which didn't inspire my interest in medicine. Worse still, I realised that they would give the same talk in the first week of first year, compared to several semesters later. Actually, some of them never seemed to care who their target audiences were - the lecturer sometimes stopped in the middle and asked, so what year are you guys in? Hmm, tailoring your talk to the level of your students? Learner centred education?
Aside from that, I actually respect the way the university reviews and revises its curriculum, having a dedicated education unit, and constantly updating and comparing its curriculum with other institutions around Australia and around the world. I liked how the weekly problem based learning correlated with practicals and lectures for the week. How in the microbiology and immunology semester, we learnt about the laboratory tests relevant to the case of the week. In clinicals, I enjoyed the mix of clinical time and tutorials, the focus on long cases to help us learn how to take a good history and examination.
Aboriginal health, racism, and on being Asian
Then recently there was an orientation for the rural health module, where we spent three days having talks and doing cases about rural and Indigenous health issues. Having a real interest in the area, and having spent a weekend at a national rural health conference several weeks ago, I was looking forward to the sessions. And gee, they were bad. At the national conference some students commented that even though they've heard about Indigenous health year after year, this was the only time that they began to take an interest in the area. In their experience, Indigenous health has always been poorly taught at their universities - an Aboriginal person would talk about the stolen generation, in an accusatory tone towards a room full of students, over half of whom were Asian or International students. They thought to themselves, umm, neither we nor our ancestors were even here back then.
I had fairly neutral experiences with Indigenous health teaching until recently. This time, we had a panel of Indigenous healthcare workers, half of whom were of Aboriginal descent, speaking to us about Aboriginal health. The first thing I noticed was that everyone on the panel looked at us without a smile. The talk itself, well it was condescending, it showed a lack of respect towards the medical profession. The very thing you told us not to do - that is, to be disrespectful or talk down on an Aboriginal patient, you did it to us. Whilst most of my classmates mentally or physically zoned out, I was busy jotting quotes down as examples of the tone in which we were spoken to:
"One thing I tell you students when you work with me..."
"I always tell the students, the Aboriginal workers can get so much more out of the patients than doctors ever can." Yes we respect Aboriginal liason officers for their insight into culture and community, but Aboriginal healthcare workers also need to respect non Aboriginal doctors and nurses for their medical role.
"Some have the luxury of having me (Aboriginal liason officer) in the consult."
"I don't like taking no very often."
"We are different to everybody else." How about the refugees from Africa, or the elderly grandfather from South East Asia. Do they not need the same patience and cultural sensitivity as an Aboriginal patient?
"Aboriginal people have a sixth sense, they can pick up when people don't like them because of their race. They (the Aboriginal patients) immediately think - I don't like that person, they are looking down at me." Okay, I can make instant (often erronous) judgments about others too.
I understand that they may have had bad experiences with mainstream nurses and doctors. I respect the work that you do. But talking down to future doctors isn't going to help improve Indigenous health. And yes there are challenges Aboriginal people face that other Australians may not face, such as the trauma of the stolen generation, family and community issues. However, when is it your own perception vs real racism?
What would you say if I were to say, hey I don't like the way I'm treated, people are always treating me different. Do you know, when I go to the shops in the supermarket, as I wait in the deli or seafood section to be served, I always feel that other (white, middle aged) Australians are served before me. And my first thought is, it's just because I'm Asian. Or even when I talk amongst a group of Caucasians, and when some people exclude me from the conversation, I think, it's because I'm Asian. Or when tram inspectors come on the train and scrutinise my ticket carefully I think, look, you only chose to come up to me because I look Asian. At times the racism is real, conscious or subconscious, but at other times it's just the way I perceive people's actions.
This is the scenario we're often given - a nurse or doctor said something insensitive, and the Aboriginal patient never trusted medical staff or hospitals again. I'm sorry if you (the panel) or your patients have had bad experiences. But you can't label the whole healthcare system as racist and evil, or avoid healthcare altogether because of the action of some individuals. When I went to a school camp in year five, a group of us went swimming at the local pool. I vividly remember an Aboriginal kid saying rudely, "Chinese, go back to where you came from!" I was upset. How about if I say, I had a bad experience, I'm not going to a public swimming pool again. Or alternatively, I don't want to have anything to do with Aboriginal people because they're racist.
It's unfortunate that we face racism. We need to respect others. Yet only you (and I) can choose how we respond to unpleasant experiences, and how we move on from those feelings you described of worthlessness, anger, alienation. On a similar note, we need to provide appropriate healthcare for Aboriginal patients, and have resources and funding allocated to close the health gap. But, only patients themselves can choose not to drink and smoke excessively, or to break out of the unfortunate cycle of abuse and unemployment (and that must be difficult if that's all someone has ever known, but whilst people can support these patients, no one else can make that decision on their behalf).
We don't deliver babies
The next day we had a group discussion with a midwife. We've heard and continue to hear all the horror stories about the hostility between midwives and medical students (and especially to females). About how medical students spend hours and hours waiting for the woman to give birth, and in the last minute the midwife gives the medical student a task and ushers in a midwifery student to delivery the baby. I'm sure midwifery students have similar stories about medical students. Ah, the midwife vs medical student rivalry.
The midwife tells us about a woman who chose to give birth "naturally" at home, surrounded by her family. But the evil GP or obstetrician advices her against it, and wants to take her away from her family to the local hospital. And she was upset that the doctor was not supportive of her decision, and even called her birth a delivery ("never say delivery - pizza are delivered, not babies," said the midwife). According to the midwife, he (the doctor) said "oh I delivered your baby," thereby not acknowledging her hard work over the last 9 months.
I hope you don't egg patients on to feel that their decisions aren't respected by their doctors. I believe in patient autonomy, yes it's my body, the birth of my child, and I can choose where it happens. But we are such a self centred society. The world revolves around me. If you choose to have a baby outside of well staffed, well equipped hospital where emergencies can be attended to, please don't complain that the doctors aren't bringing all that to your house. Doctors can be arrogant, dismissive, but they aren't the only evil ones. Patients can be selfish, and have unreasonable demands.
I wish I could say that I learnt much in those few days, but I feel that the sessions have taught interprofessional (unprofessional) hate, and portrayed patient selfishness instead of giving me tools to be a better doctor, or work well in a multi disciplinary team. Do you know why I was angry after the sessions? Medical students are prone to tune off when the topic isn't direct clinical, or science content. I care that we learn about rural and Aboriginal health in a way that inspires myself and my classmates to help, and not to dismiss social and healthcare issues as a "complete waste of time."
