Doing this exercise and reading over each question listed brought me memories rather than answers. “What was hard about purchasing the food with this budget?” brought memories of playing a fun game as a child, where my mother would tell my sister and I to try to grab as much on the list as we could without going over $20. “How do dietary restrictions impact your experience?” My mother and sister both struggle with food allergies, and we would receive different vouchers or pre-packaged bags with food that contained items we could not eat. “How do transportation issues impact your ability to access food?” This brought memories of college where I worked as a waitress; this job was ideal because I could take home leftover food, without which I may not have had dinner every evening. However, there was no busing nearby since it was an affluent area, and I could not afford a car, so I would walk 3 miles there and 3 miles back. This was worth it as it was a plentiful source of free food. Similarly, in my second job during college, I would get a slip for a free meal from the cafeteria with each shift. Several of my coworkers and I would work shifts or ask to do extra cleaning work to get a meal slip.
In summary, exercises like this raise a lot of thoughts and emotions for me. They are often framed in such a way as to ask “what did you learn about your patient’s experience”, “how do you now understand their struggles”, etc. It presents things as “us” vs “them”, the experiences of “underserved people” vs the experiences of “medical students/doctors”. Whether it is about food insecurity or homelessness, there always seems to be the underlying expectation that medical students are not people who have had these sorts of experiences and have not lived these realities. Furthermore, while the intention of this sort of project is good, I have often felt that it doesn’t get the “point” across. It’s one thing to go to the store and pretend to live like this, and it’s a whole other reality to actually live in such a manner because not only do you have to worry about what you are going to eat for a meal, but people also have to choose between rent, water, electricity, medicine, school supplies, and so forth. Can someone to the store and get one month of meals for $133? Absolutely, I have seen it done on less, but can you go to the store with $133 while the credit card debt is piling on, you need $1500 for rent tomorrow, purchase a $75 prescription, and all you have is $1150 in your bank account? I think this kind of understanding comes more from having meaningful conversations with patients about their struggles, rather than simply doing thought experiments or exercises.
I understand the role of this exercise since, based on my personal experience in medical school and socioeconomic statistics put out by the AAMC, I know that the majority of medical students have not experienced the difficulty described above. However, I think students would benefit even more from hearing about these difficult decisions directly from the patient. Even better would be hearing about them from a peer or attending with lived experience, because people from these backgrounds are a part of the medical community. Overall, I believe that it is vital that the medical community is thoroughly taught to listen, be sympathetic, understanding, and open-minded to change, not only when talking to patients but also when talking to their peers. I also believe it is vital to have people of diverse backgrounds in roles of leadership, and as physicians, to help give voice to the unique experiences and challenges different groups face.
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