In the summer of 1965, the year that Congress passed the Voting Act, Medicare, and Medicaid, a medical student at the University of Chicago, Fitzhugh Mullan, MD, traveled to Holmes County, Mississippi, to join the civil rights movement.
He lived on a farm and went door-to-door to encourage black people to register to vote. He helped them sign their children up at a previously all-white school that was being integrated. He organized a local health association. And some nights he sat with a shotgun on his lap to protect a country church that had been targeted in an unsuccessful firebombing.
The son and grandson of doctors, Mullan had lived a comfortable and sheltered life, unaware of the poverty and injustice he saw in rural Mississippi. He had gone to medical school knowing he wanted to do good, without knowing exactly how, but his experiences in the South set him on his path in life. “I wanted to be a civil rights doctor, a doctor for the people of Holmes County and others like them,” Mullan said.
Back in Chicago, his eyes were opened in other ways. Only one in 10 med students were women and only one in 72 was black.
“When I returned north, it was to a medical school that was riven with inequities like those in Holmes County, though perhaps less blatant,” Mullan said in his keynote speech at Commencement for the Class of 2018 on May 21.
He began organizing students around the idea of social justice. They started a lecture series that brought speakers to campus to talk about racism in medicine, the Chicago ghetto, and the war in Vietnam. They ran a summer project that placed medical, nursing, and dental students in organizations around the city. In 1967 they marched with Martin Luther King Jr.
Mullan went on to serve in the U.S. Public Health Service, reaching the rank of assistant surgeon general. In 1997 he joined the faculty of George Washington University, where he is a professor of health policy and management and of pediatrics.
His message to the 124 students in the Class of 2018 was that medical education must reach beyond healing patients, alleviating pain, and finding new ways to treat disease. It also requires what he calls a “social mission.”
“Social mission recognizes that there are inequities in the world, and more to the point, in access to health and health care,” Mullan said. “Social mission is a broad idea that speaks to what a person or an organization does to reduce disparity and promote equity. It is not about scholarships or awards scores or the number of students graduated. It is about what a person or a school does to improve its society, its neighborhood, its community, the poor.”
Medical schools, Mullan said, have an obligation to address the social mission aspirations of their students. “If they are not the champions of social purpose, who will be?” Mullan said.
While the country has made some strides in addressing inequities in medicine, education, socio-economics, as well as racism and gender bias, much remains to be done, Mullan said. Our health system still fails to care for all people, and disparities and inequities persist.
“We need doctors who understand these problems and are committed to fixing them. We need physicians in all specialties who will work in rural areas to treat the poor and low-income populations. We need physician-research scientists and policy leaders to tackle these equity problems. We need a hospital chief medical officer who opens a disparities solutions center that turns hospital-wide attention to inequities in the institution. We need the anesthesiologist who is concerned about differential patterns in pain management in her institution that seem to fall along racial lines for no good reason. We need medical school deans who will make it a personal priority that graduates of their local inner city high schools are entering their medical school class four years later,” he said.
To the applause and cheers of the graduates, Mullan praised the School of Medicine, singling out two in the in the graduating class, Robert Rock and Tehreem Rehmann. As first-year medical students they created the U.S. Health Justice Course, an elective that focused on issues of diversity and disparity. It has since grown into the U.S. Health Justice Collaborative to address such issues in the New Haven community. Rehmann and Rock recently received an Elm/Ivy Award for their efforts.
“Your activism calls to me across the decades,” Mullan said. “It is exciting to see how much your initiatives and our programs back then have in common.”
Choices you make about where you practice and how you practice will either maintain the status quo or extend the reach of health and health care to those who do not have it today. We have some work to do.
Fitzhugh Mullan
Indeed, Rehmann and Rock were not the only activists in the graduating class. In his invocation, Dipankan Bhattacharya, who graduated with both MD and PhD degrees, noted student activism on several fronts.
“Standing here,” Bhattacharya said from the stage, “I see leaders who have filled a void in the curriculum by starting the U.S. Health Justice Collaborative, and the patient navigator program. I see leaders who fought for the rights of the LGBT community. I see future Nobel laureates who have already published their cutting-edge research in numerous prestigious journals. I also see writers and singers and dancers and artists who have used their creative skills to bring the community together to educate and innovate.”
In the audience, Richard Kayne, MD ’76, HS ’79, FW ’81, past president of the Association of Yale Alumni in Medicine, said he also noticed increasing activism among students. “Robert and Tehreem are the vanguard, but it is just growing and growing,” Kayne said.
As he concluded his remarks, Mullan issued a challenge to the graduating class.
“You are now inheriting the future of medicine,” he said. “Your work, your practice style, and your priorities are all choices that taken together can change public thinking about what it is to be a good doctor. Choices you make about where you practice and how you practice will either maintain the status quo or extend the reach of health and health care to those who do not have it today. We have some work to do.”
At the ceremony Dean Robert J. Alpern, MD, Ensign Professor of Medicine, bestowed the Dean’s Award to John Forrest, MD, HS ’70, FW ’71, who for more than a quarter-century has directed the Office of Student Research. In the citation for the award, Alpern said, “He is responsible for building the office of student research and he has transformed the student research experience.”
Teaching awards also went to several other faculty and residents. The Charles M. Bohmfalk Prizes went to Akiko Iwasaki, PhD, professor of immunology and of molecular, cellular, and developmental biology, for excellence in teaching the basic sciences; and to Jeremy J. Moeller, MD, MSc, assistant professor of neurology, for excellence in teaching clinical science.
The Leonard Tow Humanism in Medicine Award, supported by the Arnold P. Gold Foundation, went to Katherine C. McKenzie, MD, assistant professor of medicine (general medicine).
The Leah M. Lowenstein Award, presented by the Office for Women in Medicine to a faculty member whose humane teaching reaches and influences all students, regardless of gender, race, or socioeconomic background, went to Karen J. Jubanyik, MD ’94, FW ’97, HS ’00, associate professor of emergency medicine.
The Alvan R. Feinstein Award, presented to a faculty member chosen as outstanding teacher of clinical skills, went to Susan H. Forster, MD, HS ’81, clinical professor and director of medical studies in ophthalmology and visual science.
The Francis Gilman Blake Award, awarded by the graduating class to the most outstanding teacher of medical sciences, went to Rachel Liu, MBBCh, assistant professor of emergency medicine, and director of point-of-care ultrasound education.
The Betsy Winters House Staff Award, presented to residents designated by the graduating class as having made significant contributions to the education of medical students, went to Gabriella Grisotti, MD, and Sara H. Perkins, MD.