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ext week I am supposed to take the third and final exam I need to pass in order to practice medicine independently.

I don’t know if I can do it with a clear conscience.

I was first scheduled to sit for the exam in November, around the time of the presidential election. I was helping our hospitalized patients vote through the Social Justice Coalition at Cambridge Health Alliance and trying to study at the same time. When I woke up to Donald Trump as our new president, I realized that my activism was just beginning. The test would have to wait.

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With Saturday’s protest march in D.C. looming, I’m once again struggling with how to balance my work in social justice with my work as a doctor.

Last weekend, I joined Massachusetts Senators Elizabeth Warren and Ed Markey and Boston Mayor Marty Walsh at a rally to save the Affordable Care Act.  Instead of studying for my exam, I braved the bitter cold for  five hours to affirm that health care is a fundamental human right in this country, and not a privilege. With my exam just around the corner, I really should have been studying.

But how could I not be at the rally? How can I be part of the solution if I’m not willing to sacrifice for the greater good?

Inauguration weekend poses the same dilemma. I want to attend the women’s march in D.C., or maybe the local demonstration in Boston, but I have this unshakable feeling that my professional obligations are holding me back. I do have to study. I do have to pass this test.

At times like this, I remember my interview with Dr. Eve Higginbotham, vice dean for inclusion and diversity at the University of Pennsylvania. She told me it’s all “a matter of prioritizing where you are going to place your energy.”

She gave me this example: When she was a student at Harvard Medical School  in the 1970s, one of her professors wrote an editorial in the New England Journal of Medicine that suggested minority students were bringing down the quality of medicine. The article was published two months before she was supposed to take Step 1, the first and most grueling of the medical licensure exams.

“A lot of students of color were upset about it and actually had a rally and called for [the professor’s] dismissal, but all that energy could have been better placed if we could have been able to focus on passing step 1,” Higginbotham said.“Certainly there are going to be these distractions…It’s just the way you respond to it that you can control.”

Distractions.

I feel distracted every time the president-elect entertains an anti-vaccine advocate, says something disparaging about women, or disregards the legacy of a living civil rights legend. It makes my skin crawl and I feel the need to do something. Do anything. But I know the 1,500 practice questions I need to get through aren’t going to do themselves.

This test I need to take isn’t a huge hurdle; 98 percent of doctors holding an M.D. pass it on their first shot. Still, it is essential to study because the exam covers a range of subjects in a variety of different specialties. Even though I’m focusing my training adult psychiatry, I will still need to know how to manage the medical care of pregnant women, newborns and children.

I was recently reminded of this quote by author Toni Morrison:

“The function, the very serious function of racism, is distraction. It keeps you from doing your work. It keeps you explaining, over and over again, your reason for being. Somebody says you have no language, so you spend 20 years proving that you do. Somebody says your head isn’t shaped properly, so you have scientists working on the fact that it is. Someone says you have no art, so you dredge that up. Somebody says you have no kingdoms, so you dredge that up. None of that is necessary. There will always be one more thing.”

It makes me wonder: Are all these “-isms” I’m fighting against preventing me from reaching my full potential as a doctor?

How do I know when to focus on my professional life and when to jump all in on social action? When to engage? And when to sit on the sidelines?

From the 9/11 attacks to the election of President Barack Obama, I remember exactly where I was and what I was doing during the highest and lowest moments in my lifetime. In my view, another low point is approaching. But I still don’t know what I’ll be doing in the days surrounding the inauguration. I don’t know whether I’ll march.

I do know I’ll face a lifetime of such choices.

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  • Cultural Marxism is everywhere and “useful idiots” abound. Where is it written that healthcare is a right? Truthfully, I think you mean it’s an entitlement for some and an expense only for the rich. I would advice you, for your own well being and for the safety of some of your future patients, to migrate to Cuba or Venezuela for your residency. Fight your social war there. Think of it….. finally working and living your true calling. Dr Che would be proud. Don’t mistake charity work with socialism or socialism for progress. It’s just empty promises and a dead end future but I guess you’ll have to find that out for yourself.

  • Thank you so much for sharing this. People who complain that you are “not 100% focused on your job” don’t realize that being there for your patient when eve their health insurance coverage has failed, and you spent 2 extra hours of your work day trying to make sure they get the medication they need, or that you can’t discharge your patient from the hospital because they don’t have the care they need at home or are desperate to leave too early because they are the only worker supporting their family – this is part of the work. It is our responsibility to know all the answers to the test, the judgement to apply the answers in the clinical context and advocate for our patients — because knowing all the right medications and their doses don’t mean anything if your patient afford them (or can’t even see you, or comes the emergency room too late because they couldn’t afford care sooner). This is all part of caring for our patients. This is part of being a citizen and caring for our communities. I have been reading and re-reading the Morrison quote. I do not have an answer for you. Like the rest of the long art, judgement is difficult, but you are not alone.

  • Thank you so much for this heartfelt piece, Dr Okwerekwu. I’m remind of the great aphorism from German pathologist Rudolph Virchow’s (of Virchow’s Triad fame), “Physicians are natural attorneys for the poor, and social problems should largely be solved by them.” People need you to advocate for them and a better healthcare system, so please keep up the amazing work and dedication to health justice. As fellow physician advocates are here to support you so you can continue your lifetime of advocacy both inside and outside the exam room. Please let me know if I can ever be helpful.
    In solidarity,
    Richard

  • I love the quote…”I braved the bitter cold for five hours to affirm that health care is a fundamental human right in this country”…and I fully support eliminating the right to sue for medical malpractice and a resulting elimination of malpractice insurance requirements for medical providers. I also would fully support a cap on medical provider salaries/allowable income at 2.5 times the national average salary/income of the American people. This would make this fundamental human right much more affordable for all and greatly reduce the cost of medical insurance, if it’s needed at all. Alas, if only we could get the medical profession to work for free to provide this fundamental right. Or does she mean the fundamental right to seek and procure medical care?

  • All I know is, you are the last person I’d want as my Doc. I want someone focused on the work, not hoping to slide by with a “pass” because this sore loser activism is much more important. A real Doc would be focused on being a great Doc, not someone juggling passing a test with going to protests. This isn’t a high school kid trying to pass Algebra while being a cheerleader. Future patients should have full disclosure of your lack of commitment to your training.

  • There are about 900000 licensed MDs in this country, about 600000 of them are in patient care roles, and fewer than 10% of those are racial or ethnic minority physicians even though the US population is about 30% Black or Hispanic. You are so close to changing those numbers for the better. You are so close to being where hundreds of thousands cannot. And your power of persuasion and your income will be enhanced with that degree.

    Focus. Take the test. Think of those actions as making a real difference for thousands of patients and pública you will care for and represent in a lifetime of service. Make a difference, be the difference.

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