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In between: Learning medicine beyond the hospital

Gallegos image - smallSMS ("Stanford Medical School") Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

My upbringing and career goals can be summarized as a collection of “in betweens.” I was middle child in a family that was first generation in the United States, and I grew up bridging my parents’ history in Mexico and the American Dream they hoped for. I was raised in Pasadena, Calif., enjoying the perks of an affluent suburbia but witnessing the challenges my parents faced as low-to-middle-income laborers. I had little dental or medical care as a child, as health insurance was inaccessible and my parents were unable to pay out of pocket. I grew up in between socioeconomic lines, blessed by my parents’ sacrifices to support me as the first person in my family to pursue higher education, but aware of the struggles that poverty creates.

One of the reasons I decided to pursue medicine is a desire to serve as a connection between the underserved poor and health care. I wanted to translate my experiences growing up in a Hispanic household without health insurance and with little knowledge of the health-care system into a career meant to empower underserved populations and improve their overall health. However, the image of the health provider I desired to be was at one time very narrow.

Initially, I was focused on making my way into the hospital, unaware of the health impacts that come from other fields. But through a series of undergraduate courses and extracurricular programs, I discovered the impact that public-health interventions, policy and ideology can make. I came to realize that in order to address health-care needs, it's important to understand the circumstances creating them. It's not just about dealing with high blood pressure, obesity and mental health - it's about drawing awareness to their causes and coming up with ways to prevent them. My career goal became to position myself between providing direct patient care and defining health prevention and maintenance practices.

When I was deciding where to go to medical school, I initially dismissed Stanford. I felt its lack of a public health school would hinder my goal of becoming both a health-care provider and a health-care promoter. Second Look Weekend not only dispelled this false vision of Stanford, but also introduced me to the Stanford that I've come to value highly: a center of excellence that positions itself between academic medicine and community outreach, and between scientific advancement and public health empowerment. From learning about social determinants of health in the Community Health scholarly concentration, to providing services such as health education through free clinics, Stanford creates an environment to learn about and participate in numerous public-health approaches. In doing so, it exemplifies what I believe is important in defining what the future of medicine is: caring for people and communities before and beyond the hospital.

Having furthered my interest for studying health in all practices, Stanford has encouraged me to supplement my medical education by seeking a Master's in Public Health at another institution. After a full year of clerkships, I came to see some of the ongoing problems in medicine - issues such as unequal access to care and unfair distribution of disease. As I work through my MPH program, I'm learning how policy, legislation and community programming can do more than any pharmaceutical or hospital-based treatment. Most important, I'm learning how to be a physician and a public-health professional.

I currently find myself in between two training programs but hope to come out with an understanding of how to unify them for the common goal of promoting health for my future patients and communities.

Moises Gallegos is a medical student in between his third and fourth year. He'll be going into emergency medicine, and he's interested in public-health topics such as health education, health promotion and global health.

Sketch by Moises Gallegos

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