Neel Sharma: Lessons from the Bronx

I have just relocated to the Bronx in New York. At 29 I made it my mission to work and live abroad. I realised there comes a point when simply obtaining knowledge from books, online, or during conferences serves a limited purpose in medicine and in life in general. The only way to really learn is through experience. And by being a nomad I can admit to learning more than I ever could have imagined.

During recent faculty discussions, it was emphasised how patient management in the region is troublesome—for no particular fault of the patients I might add. But it is well known that the region suffers from socio economic issues that are worlds apart from the gentrified neighbouring borough of Manhattan.

The discussion focused on how often patients typically work several jobs in order to gain sufficient income to maintain daily living, not just for themselves but also for their families, and how that can impact on their health. They often have insufficient time to eat well or exercise, and insufficient funds to purchase more nutritious meals and even healthcare.

My mind began to wander during the discussion (as it typically does) and I realised one thing. How can we understand the needs of a population if we as doctors have typically never experienced such issues? It is still true today that entry into medical school seems to align with those traditionally more favoured in terms of wealth, social status, and race. These are facts which are often ignored. And whilst we discuss widening participation, it is something that is far from reality.

I myself have worked in centres and with colleagues who have never known such a patient population. And it is concerning to hear their insights, and their lack of realisation. In reality the patients we treat are not at all as fortunate as the doctors treating them. And without ensuring the appropriate selection and exposure during medical school and beyond we will continue to misunderstand the issues of the patients we treat.

Neel Sharma graduated from the University of Manchester and is currently based at the Albert Einstein College of Medicine, Montefiore Medical Center, New York.