My Facebook feed has always been an eclectic place. Pictures of friends, clips from old TV shows, and collages of memes, news, and fun facts have always combined in a form of algorithmic chaos. But during the COVID-19 pandemic, and especially since entering medical school, my Facebook has been more than just eclectic. It has been confusing, contradictory, and even disconcerting. As I open up my feed, I scroll past pictures from white coat ceremonies, status updates about new research projects, and articles about healthcare innovations. But I also see dozens of posts from my family and friends promoting misinformation, decrying what they see as scientific patronization and tyranny, and expressing their lack of faith in institutional medicine’s ability to care for them and their families. My Facebook feed contains my personal commentary of the state of medicine. I have found myself reflecting (probably more than I should), on its content, as well as the combination of fear, optimism, and uncertainty that it sparks in me. I am not a sociologist or anthropologist; I can’t look at the contents of my social media and formulate a consistent social theory. But as I look at my COVID-influenced feed, I am growing ever more convinced that medicine is entering a new age, one that is reshaping my expectations, hopes, and fears.
I have always seen medicine as a slow but continual march towards progress. In the last 75 years, we have made enormous strides in understanding our bodies. It is incredible to me to think that we went from discovering the structure of DNA to being able to sequence and edit it in just a single lifetime. I remember attending a genetics conference for high schoolers. The keynote speaker gushed about iPS cells, CRISPR technology, and the dreams of building new organs, curing genetic diseases, and so much more. As I sat there listening, I tried to temper my excitement with a dose of reality. I knew that medical translation takes time, and what seemed so simple and intuitive on a powerpoint slide was much more difficult to do in a clinic. After all, medical history is full of false dawns. President Nixon launched the War on Cancer and the intelligentsia proclaimed that cancer would be history within a decade. But in 2021, I’m still doing research on pediatric leukemia and am in awe of just how molecularly complex cancer and its varieties truly are.
Lulled into a state of medically-defined pessimistic realism, I was happily awakened by the scientific and medical response to the COVID-19 pandemic. In a little under a year, we have not just one, or even two, but multiple highly effective vaccines to a deadly virus. I know these vaccines didn’t come out from a vacuum. Dr. Dave Wiessman spoke about his mRNA research at MS1 orientation. But for the first time, I don’t feel like I am hearing about a one-off medical miracle. I do not think the quick and effective development of the vaccines was an outlier. Instead it seems like a harbinger of a new medical era, one that fully capitalizes on the decades of foundational research to make meaningful and timely contributions to health. I finally feel like we are “almost there.”
But while COVID has provided a sneak peak of the future of medical innovation, it has also unrelentingly exposed the pitfalls of medical institutionalism that have been festering for decades. The seeds of elitist condescension, critical miscommunication, and even open deceit have finally matured. The outcome can be seen plainly in vaccination numbers, political discourse, and status updates on my Facebook page. Above the New York Times links about mRNA research was the post from my high school English teacher who held up the seeming flip-flops in scientific guidance as evidence that vaccination and masking were proxies for power, not public health. Surrounding the pictures of my classmates in their white coats were members of my church discussing ivermectin, zinc, and how big pharma and Democrats shut down hydroxychloroquine.
I have found myself alternating between writing off, being frustrated with, or even making fun of these perspectives. It is tempting to isolate myself in a healthcare bubble full of epidemiologists, researchers, and professionals who heed CDC guidance. But it was critical for me to acknowledge that COVID has dredged up a long-stranding distrust of institutional healthcare and brought it into the mainstream. It was even more critical that I acknowledge that the healthcare community bears a large part of the responsibility. My English teacher was not always skeptical of the medical establishment. But after her diagnosis with lupus, she had negative experience after negative experience with overconfident and inaccurate physicians who did not listen to her concerns. She found her answers on the homeopathic fringes of empiric medicine, and with those answers in hand, began to reconstruct her entire worldview. The people in my church questioned the COVID-19 vaccine efficacy and safety, eschwing it in favor of treatments with little scientific backing. However, many of them were people of color who were well aware of not only historical atrocities like the Tuskegee Experiments, but also their own experiences of casual racism that often pervade Southern healthcare. They trusted the word of their community over the word of the CDC or FDA. It took a lot of reflection for me to fully understand the role medicine played in my community’s rejection of it. It was so much more appealing to write their behavior off as innocent individuals swept away by malicious forces of misinformation and deception. It is a trap I still sometimes fall into. It is much more difficult to acknowledge that it was the scores of misguided actions by medical institutions and individuals that have sparked the mistrust, fear, and avoidance I now see.
There are few signs that the broken relationship between medicine and its patients is going away anytime soon. My friends and community members are not going to suddenly change their sources of information, forget the ways medicine has wronged them, and start trusting and listening to their doctors. Rebuilding that relationship is something I will have to continue to work against throughout my medical practice. And it is going to be difficult. When I was a pre-medical student it felt easier to distance myself from their comments and their cynicism. But now their words hit closer to home. Even as they liked and commented on my white coat pictures and medical school announcement, their posts against vaccines and accusations of medical tyranny feel personal. I never anticipated that my profession would be controversial. I never anticipated that such a large percentage of the population would reject what I firmly believe is a cure. I definitely never thought that my patients would think I am the one responsible for their illness. But all of those nightmarish scenarios are now feasible scenarios. Many have already played out during the pandemic. After reading post after anti-vaccine post, I have found myself wondering – What does it even mean to be a healer if no one wants to be healed? I know that thought is reductive. My community desperately does want to be healed. I saw that in the deepest way when my family’s pastor was hospitalized with COVID. Immediately, my Facebook page was filled with advice, suggestions, and pleas. They turned to their community, they turned to traditions and alternative medicine, they turned to faith. After he passed, their searching only intensified. They looked everywhere for something to alleviate their pain. They just did not believe that academic medical institutions held the solutions.
As I try to imagine what my future practice will look like, my mind wrestles with these two forces. Scientific breakthrough paired with institutional distrust. I’m not sure how these two forces will play out. I don’t even think they are exclusively antagonistic. But I know that medicine will continue to change at a remarkable pace. I know that I will be able to help people with treatments and cures that I can currently only dream of. I also know that while doing so, I may encounter more resistance, skepticism, and animosity than I previously expected. Ultimately, while COVID-19 changed much about medicine, it did not change its core. The medicine I practice will remain, must remain, centered on the special, even sacred relationship between physician and patient. The battles for health are not simply fought in the realms of public policy or in research laboratories. They are really fought in the clinic room, where I can make the intentional decision to consider each patient as a whole person, acknowledge their perspectives, and build a true partnership with them. As a medical student, I think the most important lesson that I, and my peers, can learn over the next four years is how to see the individuals we treat as our partners, not merely our patients. From that foundation, we can become the bridge between our communities and our institutions, mediating a relationship that works for the benefit of all. Each time I log-into Facebook, I find myself awash in exciting or scary medical prognostications. But each time I log-in, I am also reminded that medicine is a story full of faces. It is my responsibility to acknowledge, hear, and partner with each one.
Joshua Anil is an MS1 at the Perelman School of Medicine.
Image by Andy Revels, a CDY6 at the Perelman School of Medicine.
