How underprivilege made me a better doctor: Zhou

Interesting and pertinent account by Stephanie Y. Zhou of another aspect of diversity: social class in medical school and among doctors:

My family was supported by a homeless shelter before we moved into subsidized housing — the attic near the hospital. Food came from the food bank or soup kitchens. Clothing was second hand from the church donation bins. My parents did not have a university education, but they found jobs as factory workers and on most days, we seemed to have enough to get by.

To me, these were all part of a mundane, normal life, but in the context of privilege, these aspects suddenly became salient as a mark of “underprivilege.” Placed at a school attended by mostly middle-class students, this underprivileged experience became part of my identity, and to be different was incredibly isolating.

Although I initially tried to distance myself from my identity, I now acknowledge that it is a part of me I shouldn’t erase. To come from this background grants a different, more subtle form of privilege beyond that of wealth and social networks. I call it an “empathic privilege” that allows one to be more cognizant of the social determinants of health that patients often leave unspoken when seeking medical care.

In another sense, I also feel comfort in the presence of patients with lower socioeconomic status, whereas others might feel unease and frustration, because working with these patients helps close the gap between my identities.

I share my story because those with the underprivileged identity do exist in medicine, but they are a silent minority. Race and gender are easy to see, but low socioeconomic status may not be visible. Speaking about underprivilege may seem out of place, when now, as a result of luck and circumstance, you land among the most privileged.

Medical schools continue moving toward making the admissions process more equitable and diverse. However, measures to maintain and support diversity beyond the intake stage are often not in place. Students are then put in the position of negotiating a dual identity — one consistent with the medical culture, the other staying true to their social and cultural origins.

Medical schools should look one step back and one step forward in the admissions process. Before students from under-represented backgrounds can begin to use application subsidies or affirmative action initiatives, getting them to contemplate medicine in the first place requires an alignment between their identity and the identity associated with this vocation.

I encourage medical students and practicing physicians to be open about their stories, to humanize the identity of medicine so it doesn’t seem so lofty to those at a lower starting line — to show that a lived experience in poverty is valued by medical schools as much as, if not more than, having volunteered at a homeless shelter.

Looking forward, schools should continue diversity initiatives postadmission, whereby physicians from under-represented backgrounds support a culture of mentorship for like students, to facilitate development of their identity and strengths.

I am grateful to have lived in the dual worlds of underprivilege and privilege. I know what it feels like to not have choice, to have external factors, such as money and other people, dictate the path of my life. For many patients, it may feel the same — when their bodies and their lives are now in the hands of others.

Underprivilege has also taught me the importance of valuing chances, to hold on to them, offering my wholehearted effort toward these opportunities, because they were the threads of luck that helped pull me to the side of privilege. These experiences have taught me more about empathy and hard work than any medical school class could, and for that, to have been underprivileged is perhaps the greatest privilege in medicine.