Wrapping Up the Community Service Selective
David Einstein, M'11
The Community Service selective: heralded by sandwiches, concluded with pizza, and then something in between. In my recent wrap-up session, we each described our CS selective and our reaction to it. We then struggled to define which settings were the most effective for community service. On one side, a student argued that the CS selective offers an opportunity for medical students to get beyond the medical sphere, to practice interacting with unfamiliar types of people through basketball or tutoring; another student rightly pointed out that more medicine-oriented selectives like Sharewood often enhance the student’s PD skills more than the patient’s health. On the other side, a Sharewood selective student felt that volunteering in a clinic allowed medical students to serve the community using their unique skills, as well as to practice simply listening. Our moderator then phrased this as a debate over the meaning of altruism.
The ability to interact with others is a primary goal of our Interviewing Course, and certainly the development of altruism could be considered a primary goal in any sort of community service. But I believe that the true goal of the CS selective should be service to the community, that is, to understand how to approach health as a phenomenon larger than the patient-doctor relationship.
To that end, the medical school curriculum must include more than opportunities for altruism; we should learn how to address the many non-medical needs of our patients, which will often affect them more than their chief complaint. My Sharewood selective was fun for its medical parts, but its most instructive element was in Case Management. Case Managers are essentially the social workers of the clinic, and their goal is to connect patients with public benefits like housing, food stamps, and Mass Health.
Knowledge of these benefits and the many procedures and agencies involved in procuring them should be a primary goal of the CS selective. Imagine not only being able to perform a full physical exam, but also to understand how a patient survives day-to-day and to advise on how to find a job. With the next patient one could carry on a seamless conversation about “SSI benefits” or “TANF,” and in the following meeting, one would be able to refer an AIDS patient to a local non-profit devoted to such patients’ housing needs.
I propose that the “Case Managers / Social Workers in Modern Medicine” selective be taken out of the medical selectives index, where it will rarely be chosen, and switched to CS selectives. Then, it should be dramatically expanded so that every student can learn how community service is performed in the medical world. Tutoring and playing basketball with school children should be de-emphasized; chopping vegetables for soup kitchens should be removed entirely.
Finally, it is essential for every medical student to understand the U.S. health insurance system and how it evolved to where it is today. Unlike altruism, healthcare is a topic that can be taught didactically; the Medical Ethics “allocation of scarce resources” session was a small step in that direction. Once we understand the economics and politics of the current system—and what role physician lobbying played in creating the managed care crisis—we will truly be prepared to understand and advocate for the community as a whole.
With this kind of an education, Tufts medical students would gain the skills to serve all patients and to develop a relationship with the community. And the community will be able to thank us for more than altruism and a band-aid.