With the approaching End of Poverty and the End of Suburbia, I thought it would be a good time to declare the End of Medical School.

No, I am not a pre-med who failed orgo and wants revenge, nor am I studying for the Boards for the 60th day in a row. I have not had to do a 40 hour shift in the ER and I have never done lab research. Actually, I am quite protective of my sleep (at least so far), and prefer to leave the guillotining to the professionals.

I am a rising second year student (doesn't that sound so much better than first year?) in a medical school whose mission is to "educate physicians in the scientific, ethical, humanistic, and socially responsible dimensions of medicine and to advance the ability to diagnose, treat, and prevent human illness." Who wouldn't want illness to be diagnosed, treated, and prevented? I believe in health as a human right -- the idea that all people, because of their innate humanity, deserve to be free from disease and illness. If this mission defines not just my medical school but medical schools in general, why in the heck would I call for the end of it?

The most striking thing I have learned in medical school is that declarations are simply paper, and without action, words mean little. For all this talk about educating socially responsible, humanistic physicians, I have awfully little contact with humans and rare opportunities to interact with society. It is difficult to get excited about healing the sick with heavy books on my back, heavier debt in my pocket, and hours of sitting on my tuchus. I am having some trouble learning how to think critically about health care and human rights when no one takes the time to explain the health care system (even generally) to me and human rights is a footnote in an optional reading one day. Granted, I have three more years of school left, and it is possible that these topics will be discussed. However, I know enough upperclass students and know enough about the curriculum to feel a sinking in my gut. I have a sense that it should not be this difficult, that there should be a better way for me to learn how to heal the sick -- and not just some of the sick, but all of them.

It has crossed my mind that I am simply the squeaky wheel and that the rest of my classmates are humming along, becoming ethical, humanistic, socially conscious physicians. Each of us has his own reasons for wanting to become a physician, but oddly, no one really talks about these reasons. Only hints, comments on the side, participation and attendance in certain classes and events give clues to people's motivations, but it is safe to say that not all my classmates want to work with underserved populations, very sick patients, or even patients at all. Some want to go into health care administration and be the head of a hospital, some want to work in third world countries, some in the community clinic, and most are not really sure (that's where I fall). I suspect there is a person or three who is in medical school because they are trying to live up to some expectation -- either their family's or their own -- of what they should be doing and who they should be.

Med school may not be designed to effectively educate me to be the kind of physician that I want to be, but is it working for them? It works for those folks with the should-expectations, if only because it is the degree that matters, not the content or the knowledge or the ability to help people.

Are the rest of my classmates, and even medical students in general, satisfied with their educations? The American Medical Student Association recently conducted a survey that showed they are not. In fact, only 17% of students polled were very satisfied with the curriculum their school offered. 24% of students stated that they are not provided any education on health disparities. In terms of classes or electives offered, 47% have none about the business of medicine, 35% are missing technology advances in medicine, 31% go without global HIV/AIDS, and 26% can't take a course on complementary and alternative medicine. One student said, "Medical education has not evolved at the same pace as the health care delivery system. We are being trained to practice in an environment that no longer exists."

The environment that now exists is a grim one. As of 2005, there were 46 million people in the United States who did not have health insurance, which is about 16% of the population, or about 1 in every 6 Americans.

Even those with insurance face barriers to accessing affordable, excellent care that does not require them to drive 50 miles away, wait for hours, or see their physician for all of 4 minutes. Actually, some research suggests that face time may be getting slightly longer, but doctors are asked to do more -- from nutrition counseling to creating advanced directives -- in about the same amount of time, and often for less money. Folks in rural areas suffer from the lack of access to qualified health care providers in a way not so dissimilar to people without insurance.

The picture on a worldwide scale is even less rosy. People still die of AIDS by the millions, particularly in poor nations. Billions of dollars have been spent to combat this pandemic, yet we have only slowed the death rate from rising so quickly. Tuberculosis is a preventable, treatable, and curable bacterial infection that plagues developing countries, prisons, and poor areas of wealthy nations. In parts of Harlem, death rates of certain age groups are as high as those in Bangladesh. These two places may be worlds apart, but they share a high burden of disease and death from infections.

It is easy to declare a health care crisis, whether it is on a national or international scale, but something seems odd about this "crisis." We are one of the richest countries in the world, experiencing an unprecedented level of advancement in technology of all types, and medicine is no different. Billions of dollars -- both public and private -- are channeled into medical research, "amazing" discoveries are made, and yet, billions of people in the world die of preventable, treatable, or curable diseases. This fact may seem obvious (or even fitting to some), but it is not how the world has to work. If you believe that health is a human right, then it follows closely that societies should direct health care resources toward those with the greatest need, not the greatest means to pay. The people with the greatest need are most often the poorest and the sickest.

This idea of a "preferential option for the poor," is not a new one. I have chosen this profession that based itself on the relief of suffering, and I believe that the focus on caring for the poor should be taught in medical schools alongside anatomy and physical examination. If nothing else, students should graduate knowing that they have the power, if not the obligation, to devote themselves to caring for populations who struggle against poverty. My sense is that this does not occur at my school, much less medical schools in general.

Between the state of health in the world, the realities that my classmates and I will face if we choose to practice medicine in this country, and the shortage of health care workers here and abroad, I wonder if that student in the AMSA survey was right: that medical schools are doing students and patients a disservice by not training students to practice in the world that exists.

Medical students will inevitably become physicians (at least, most of them), and physicians will inevitably work with people (at least, most of them). How they work with those people, which people they work with, and where they work depends at least partly on their exposure to different ideas, specialties, and locations. Students should be offered courses on health and human rights, advocacy, the business of medicine, working with underserved populations, and other topics future physicians will need to navigate the present and future world of medicine. More importantly though, as a part of the standard curriculum, all students should be taught about issues of justice in health care in ways that inspire critical thinking and facilitate action in the community. Only by educating students to do the work of healing the world's sick in this way, not with lectures and limited options, can medical schools be active players in shaping the way health care is delivered in the world, instead of passive enablers of injustice and inequality.

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