ABH President Addresses Class of 2027 at UMN White Coat Ceremony
On August 18, 2023, 176 first year University of Minnesota Medical Students received their White Coat in a ceremony designed to acknowledge this rite of passage into the field of medicine and inspire learners to embrace this journey with humility and privilege. ABH has been honored to be part of this prestigious ceremony for the past nearly 20 years. ABH President Zeke McKinney, MD, MHI, MPH, welcomed the students into the profession of medicine and shared the power our language can have in shaping our perspectives as well as the health of individual patients and our communities. Watch the ceremony here or read Dr. McKinney’s full message below.
My dear first-year University of Minnesota Medical Students, it is an honor to address you as President of Advocates for Better Health, or ABH, a community-oriented public health organization that previously was the Twin Cities Medical Society. Please accept my warmest congratulations and heartfelt excitement as you continue to advance forward toward your career as physicians.
Historically, Twin Cities Medical Society was the professional association for physicians, residents, and medical students who live in the 7-county metro area, but about two years ago we started our transition to become not a medical society as much as a collaborative organization to advocate for our patients’ and their communities’ health beyond the clinic walls. So hopefully you can engage with ABH to take a deeper dive into the areas you might not talk about in school.
This name change from Twin Cities Medical Society to Advocates for Better Health is a relevant one, as the language we use to talk about different things has a power to it. In my field of Occupational and Environmental Medicine, which is all about environmental hazards and the health and safety of workers, the biggest insult you can give us is calling us “occupational therapists.” I love working with OTs, but I can’t do their job and they aren’t physicians. I’m just joking on myself a bit here, but the point is still true in that if no one can associate the word “occupational” with doctors, then they actually have taken some power away from me. But my specialty isn’t who I’m worried about. So Shakespeare wrote that "a rose by any other name would smell as sweet,” by which he meant that it doesn’t matter what you call something because it still is what it is. And theoretically that’s true…
But it’s not realistic. Especially for us in medicine, where we have an immense degree of power and privilege, because patients come to see us when they’re most vulnerable, society puts a lot of implicit trust in our profession, and we have this deep scope of scientific knowledge. So even though we can’t change what something actually is or isn’t, we can and do empower people and concepts simply by how we talk about them. Or we can take power away. So we have to be really careful with our choice of words.
Maybe this sounds over-the-top, but let’s take a well-known word that has had so much power in medicine: “hysteria.” This word was used for centuries by physicians or medical professionals to describe any number of unknown or mysterious physical and mental issues in women, and more importantly, often put blame and/or shame on the woman for having such problems. And yes, maybe we’re better than all of this now, but framing women in this way has had a significant societal impact since then in terms of continuing to perpetuate patriarchy and more commonly dismiss poorly-understood medical conditions in women.
And unfortunately, we have been similarly harmful in medicine with language that is still used with regularity. You may have not seen this yet, but you will, where when we as physicians encounter a challenging situation with a patient, we sometimes label them in such a way as to dismiss the systemic and societal factors that may be affecting them. That’s called “actor-observer” bias in social psychology, where people are quick to blame their own problems on external or situational forces, but are equally quick to blame other people’s shortcomings for the problems those others have. Here’s some examples.
We will talk about “difficult” patients that do not passively interact with us, or “noncompliant” patients who don’t follow our treatment recommendations, or calling a patient a “poor historian” when they don’t know how to answer our questions to our liking, or “malingering” patients when they show up over and over again seeking help for something we can’t diagnose or treat. And we write these words in peoples’ medical records!
Let me frame it for you another way. Maybe your “difficult” patient is one who is asking a lot of questions or pushing back because they are scared or don’t understand what’s going on. Maybe “noncompliant” patients have fears about medications or surgeries that they haven’t been able to express very well. Maybe the “poor historian” isn’t answering your questions well because they haven’t been to medical school and residency, and haven’t even been to the doctor in a few years, and they honestly have no idea WHY you’re asking questions in the way you are… so they don’t really know how to give you the answer you want.
Maybe your “malingering” patients have gone to see lots of doctors because none of them were able to really help the person; and if that sounds unlikely, let me assure you this is happening all the time right now with long COVID patients, because we truly don’t have enough scientific knowledge to treat them well. And with other conditions where science hasn’t filled in our knowledge gaps yet, such as postconcussive syndrome, mast cell activation syndrome, chronic fatigue syndrome, fibromyalgia, these same issues are frequent, just not as prevalent as with COVID.
Let’s make it even more simple. We know substance abuse is an illness, for which people absolutely should seek our help, and yet sometimes we refer to such patients as “addicts,” a stigmatizing word that reinforces the reasons people would NOT seek our help. Even look at what is happening now with the legalization of cannabis, which is a scientific name; almost all the time I hear this discussed in the media and amongst clinicians, folks talk about legalizing “marijuana,” a Spanish word that became associated with concepts of “reefer madness”, without thinking about the century-long propagation of stigmatizing cannabis use in association with Mexicans and Black people that led to the War on Drugs and insanely disproportionate rates of drug-related incarceration in these populations.
Or even something like thinking about and asking someone about their preferred pronouns. All of these ways we use language have the ability to demonstrate that we see someone as a person, as someone we want to treat the way we want to be treated.
The good news is that despite these particularly bad cases, we have done better in a lot of ways. Although weight-shaming still exists in medicine, approaches such as Health at Every Size (HAES) shift the focus on healthy behaviors and functional outcomes rather than on weight loss as the only goal in and of itself.
But we also need to look at ourselves and think about how words can harm us as physicians too. We know that physicians face many system-based challenges right now, from seeing patients suffer due to barriers related to money, health insurance, food and housing access, to feeling like we do not have the time and space to treat patients how they need to be treated. And these have led to the epidemic of physician “burnout.” But wait! “Burnout” sounds like maybe we aren’t strong enough, resilient enough, capable enough… and that’s just not true. The work of a physician isn’t harder than it ever was, it is just different in a sometimes very non-satisfying way. And to acknowledge that, I’ll tell you that “burnout” is a bad word. It’s really called “moral injury,” in that we have cognitive and emotional dissonance about knowing how we want to practice medicine, but being unable to do so due to the systemic factors directing our practice. And by the way, hanging out with ABH is one way to try to do what you can’t at work.
So the point is that at least SOMETIMES acknowledging that SOMETIMES all of these issues aren’t the fault of an individual, whether a patient, a medical student, or a doctor, can open us up to considering that everyone might be trying their best to overcome whatever their barriers are to being their healthiest and whole self. And hopefully it makes sense that you wouldn’t want to be thought of as who you are when you make mistakes, because none of us are one-dimensional.
So for you as newly-inducted medical students, I offer one relevant suggestion as a place to start. Try not to use the word “only” too much. Because your patient is not “only” a person with hypertension, they are also a parent or child, they are also a firefighter or welder, they are also a hiking enthusiast or photographer. And YOU are not “only” a medical student – that’s dangerous language, and don’t take away your power – you are someone who holds the health of many patients and your communities in your hands, and you have the privilege and responsibility to empower your patients with the words you say to them and how you talk about them.
Thank you.