Medical Advocates of the Underserved
Addressing healthcare inequalities as a core component of US medical education
Cesar Padilla | | Opinion
Let me take you back to the first day of medical school. We all remember our nervousness as we embarked on this new and exciting journey. We learned about the fundamentals of physiology and the Hippocratic Oath – but our memories are foggy and incomplete when considering our own history. As educators, we love to teach about the Greco-Roman origins of medicine, but we omit one of the most powerful stories – the story of the Parisian hospital that inspired the first such institution in the United States.
Hôtel-Dieu is considered one of the oldest actively operating hospitals in the world. Serving as a Catholic and charitable institution, it became widely known for combining high-quality education and medicine with free healthcare for the poor. The hospital survived the middle ages and, during the Age of Enlightenment, became a dialectical hub for doctors, scientists, and students from across the globe.
During the 1730s, the US (known then as the Thirteen Colonies) was starting to become an independent nation – though still under British rule – and its founders began to look to Europe for ideas of progress. Thomas Bond, then a US medical student seeking to expand his medical education, traveled to Paris to spend time at Hôtel-Dieu. Hospitals did not yet exist in the US – the idea of providing free medical care to the poor and sick was indeed a radical idea. But Pennsylvania, Bond’s home state, was a major trading port and often the site of disease transmission. Unsurprisingly, the need for a hospital was dire and Bond became feverish with the idea. He returned to the US inspired and, alongside powerful political friends (Benjamin Franklin), succeeded in building Pennsylvania Hospital. The first US medical school, the University of Pennsylvania, became an affiliated institution.
The inception of US medicine has blueprints from the charitable philosophy of Hôtel-Dieu, but where is the story in our textbooks? Why don’t medical students learn about the most influential hospital in our history?
Hôtel-Dieu and Pennsylvania Hospital stood on a foundational theme that transcends time – our commitment to underserved communities. Over 270 years later, this ethos has renewed life. Influential think tanks are rediscovering the duty that corporations should have to society and the wellbeing of the underserved, given that their inception is only possible through the government’s public infrastructure.
Medical schools are also beginning to understand the power of integration – helping maturing physicians understand underserved communities on a person-to-person level. During the COVID-19 pandemic, Harvard Medical School helped Latino and Hispanic medical students to launch “Quetzals of Health” – a program that connects students with undocumented members of the community. With little access to public support and healthcare, these people often live in the shadows of society.
In the US, maternal mortality is three to four times higher in Black women than in white women. In my first job after medical training, I helped launch a program to link medical students with pregnant minority patients. Our hope was, and still is, that the Maternal Minority Health Alliance will become an integral part of the medical school educational curriculum. Its purpose is to create meaningful relationships between medical students and community members who are at risk of worse health outcomes – just like Thomas Bond intended.
A reformed curriculum, in which integration with surrounding communities becomes a core component of students’ learning, would signal the potential rebirth of US medical education. Working with legislators and community leaders to create tangible solutions for underserved groups would give medical students necessary experience of the fundamentals of healthcare – understanding human health from a translational, cell-to-society level.
The modern hospital was built on the ethos of providing free care for the poor and sick. The story of a lonely medical student inspired by the charitable hospitals of Paris deserves recognition. Let’s honor it by teaching medical students our history as doctors, scientists, and healers – and, most importantly, by educating them to become advocates of the underserved.
- B Collins, “Care for Undocumented Immigrants” (2021). Available at: http://bit.ly/38kYVwM.
- Penn Medicine (2017). Available at: http://bit.ly/2OaHAQ8.
- G Melillo, “Racial Disparities Persist in Maternal Morbidity, Mortality and Infant Health” (2020). Available at: http://bit.ly/2OBzM9T.
- MiMentor (2021). Available at: https://bit.ly/32ZI4g1.