In undergrad, I read an ethnographic study — a book — called Privilege, by Shamus Khan. In it, Khan described how students at an elite high school were taught to embody privilege, and how to leverage it to become the next “class of leaders” — a term that shouldn’t make sense in a meritocracy but that you still find embodied in the mottoes of academic institutions all over the country.
Like all academic work, there are criticisms of some of his points, but I think one point was particularly valid: that, at these elite institutions, students are taught that there is something innate in them that means they can change the world. It manifests itself in different ways, from lofty dreams of solving poverty in third-world countries to simply believing that the paper they wrote for a senior-level world history class might have something unique to contribute to the world of academia.
I am currently attending an elite institution. Columbia Vagelos School of Physicians and Surgeons is one of the most highly-regarded medical schools in the country, and perhaps internationally as well. And I see that same rhetoric at play: that, because we made it this far, there is something intrinsic about us that means we will change the world.
And, perhaps with the resources and capital that such an education provides us, some of us might. But it’s not intrinsic. And I certainly think that shouldn’t be goal.
The majority of students here come from vast privilege. You nearly need to be in the top 1 or 2% of earners to not qualify for financial aid. Our class is studded with people who went to elite undergraduate schools. I am in the minority here — coming from an underserved and rural area, qualifying as middle income, having held a job and paid rent before coming to school — and I don’t consider my disadvantaged at all. In fact, I was surprised that the Pew Research Center’s calculator put my family at middle income — I always considered myself upper middle class, which is just a euphemistic word for affluent. Compared to many people in my hometown and community, I certainly was.
Who out of us, really, would change the world for the better? And I mean really, really change it — not to discover a new class of drugs that makes healthcare cheaper for lower income families, but to create a world where lower income families aren’t even a thing, or at least don’t ever need to worry about whether they can afford both healthcare AND rent AND food AND clothes?
I don’t think it would be many of us. And I’m not excusing myself from this pool. Earlier today, I was discussing with someone about how residents, making an average of $50,000 a year but working upwards of 80 hours a week, really only get paid $12 an hour. I had to remind myself that, even still, we would be making $50,000 a year. Not only that, but that’s for a nearly-guaranteed, entry-level position in a career that will soon pay six (and, for some, seven) figure salaries. While I understand some people have families and mortgages and all that, I really don’t think I have a right to complain.
Hell, with loans and scholarships I’m living on about $30,000 a year plus tutoring money, and I feel like I’m swimming in cash.
No right to complain. Not when the patients we will be serving can’t always afford the bills.
Now, this doesn’t mean that we as medical students can’t be committed to addressing inequalities and social harms. We may care very deeply about — and work very hard to address — LGBTQI+ rights, immigrant rights, access for all, or the rights of people who have been institutionalized. And that doesn’t mean we can’t lead initiatives to try and fix problems we see in local communities. But I do think we need to be careful.
It’s easy to get a savior mindset. For example, I’m working at the Q Clinic, a student-run clinic serving LGBTQI+ identifying folks in downtown Manhattan, and it would be easy to let ourselves get in the habit of thinking that we are doing some great, societal good. But, in truth, our patients deserve better than medical students providing care in cardboard cubicles in the attic of a church. We’re doing good, sure; we’re providing a needed service, sure. But we aren’t changing the world. We aren’t even really changing the system that denies care to our patients on a regular basis; we’re still working within that system.
And I don’t really know if working from within the system is the best way to change it. The privileges that got us to this place are exactly the kind of privileges we need to eradicate to make our society a more equitable, humane place. We think: we’ve got to seize the power if we want to wield the power for good. But what if the problem is that we don’t recognize, or if we deny, the power that exist in the communities we are actually trying to help? What makes us more qualified than them? It think it’s easy to argue that there’s nothing, really.
I feel like this blog post, if I spend some more time fleshing out my argument and points, might be a better representation of what I’m trying to say. But I’m going back to my rule about trying to publish, even if it’s not perfect, as often as I can. I might revisit this idea to flesh it out. In all, though, we are not going to save the world, and thinking we can might actually do more harm than good. That’s not an excuse to be complacent, though — we have got to do the good that we can do, and make sure we’re not taking up the spaces for more qualified people to do more good, simply because we have privileges that allowed us to wield more power.