TCMS President Addresses Class of 2026 at UMN White Coat Ceremony
On August 19, 2022, 175 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. TCMS has been honored to be part of this prestigious ceremony for the past nearly 20 years. TCMS President Zeke McKinney, MD, MHI, MPH, welcomed the students into the profession of medicine and thereby, automatically enrolled as members of the Twin Cities Medical Society, and provided each with token gift of a pen light.
In his speech, Dr. McKinney talked about vulnerability stating, “the true heart of medicine is caring for individuals when they are most vulnerable” and the “invisibility that exists for individuals impacted by social determinants of health.” He declared the White Coat, a symbol of health and healing, is invisibility-resistant and challenged the students to find ways to ensure patients that their needs are not invisible. To use their ears to not only listen, but also hear and then use their voice to take action--to be visible and find opportunities to advocate to reduce all barriers to a healthy life.
Read Dr. McKinney’s full address below.
Dr. Zeke McKinney, MD, MHI, MPH
My dear first-year University of Minnesota Medical Students, it is an honor to address you as President of the Twin Cities Medical Society, affectionately known as TCMS. Please accept my warmest congratulations and heartfelt excitement as you continue to advance forward toward your career as physicians.
The past two to three years have shown is a remarkable number of social issues in which healthcare plays a role or is impacted. These have been related to enormous issues such as the impacts of systemic racism, rampant health misinformation and disinformation, legal challenges to reproductive care resulting in disparate access and adverse outcomes, and the divergences of public policy and public health. Although these may seem overwhelming in scope, they also provide opportunities for us as physicians to step forward and challenge society to do better to care for those that are vulnerable.
Historically, Twin Cities Medical Society has been the professional association for physicians, residents, and medical students who live in the 7-county metro area, but about a year and a half ago we announced that we will become an organization focused on supporting community-based public health efforts to allow medical professionals to advocate for their patients’ health beyond their clinic walls.
As a University of Minnesota Medical School student, you automatically become a member at no cost. So we welcome you!
This issue of vulnerability is an important one for us to consider, because the true heart of medicine is caring for individuals when they are most vulnerable. I remember when this became really clear to me as an intern working on the wards and in the ICU, and how at times there was an obvious divergence between the fear, anxiety, and uncertainty patients were experiencing as opposed to the methodical rhythm of their rounding physicians going about their day-to-day business. After having the opportunities to spend more time with patients outside of rounds, hearing their stories, one fact became truly apparent: when we are seeing patients in the hospital, it is perhaps the worst day of their life, or at least a really bad day. It is not as extreme in an outpatient clinic, but the premise still holds true: generally people don’t want to be there seeing us. All of which are because these situations are when people are the most vulnerable.
It turns out that this vulnerability is amplified for patients out there with chronic illnesses that may impact these patients’ lives profoundly, but on the surface, these patients appear completely “fine.” Nowadays, patients refer to these as “invisible illnesses”, because its invisible to an external observer that this person is actually sick or suffering, and sometimes for more complex conditions, it is invisible to clinicians as well because we don’t have imaging or biomarkers that can actually “prove” such an illness exists. A great example of an “invisible illness” like that is post-acute COVID syndrome (so-called “long COVID”), where people have a variety of chronic symptoms that limit their ability to go to work or to go about their normal life, but often clinical tests are negative, and to all appearances, the person looks fairly normal.
One silver lining of post-acute COVID syndrome is that it may have improved our cognitive biases in medicine against chronic illnesses like chronic fatigue syndrome, fibromyalgia, or other illnesses where the symptoms are often only subjective and medical testing yields only negative results. You might be surprised how many times where in legal proceedings (such as workers’ compensation cases, since I’m an occupational medicine doctor), medical expert physicians rely on stating “there are no objective findings” as means to disparage a person’s claim of illness or injury and ultimately get their claim denied. But in this extreme perspective, if we can only rely on “objective” findings, what do we do about symptoms of itching, headache, or pain? Do these not exist? By that rationale, infectious diseases didn’t exist 200 years ago since we couldn’t prove it?
Of course these examples are hyperbolic, but it’s to make the point that there are still discrepancies between the depth of our medical knowledge and the intensity of human experience.
And it turns out this same “invisibility” exists for those out there impacted by social determinants of health, whether it’s a lack of access to stable housing, reliable transportation, or a safe neighborhood; the experience of systemic discrimination and stigmatization; exposure to violence at home or in the community; not having enough food or healthy options for food; being unable to avoid environmental hazards like air and water pollution; or simply being able to afford the medications that WE are prescribing. When we treat patients, we talk about their high blood pressure, their cholesterol, or their diabetes, but we may not know anything about what they experience everyday. And when we do have the privilege of someone inviting us to learn about how life really is for them, most of the time we do not have a reasonable venue or intervention by which we can actually do anything about it; we don’t have the means to feed, clothe, or house our patients. But we can listen and be sympathetic and empathetic to them, that helps people not feel like they are invisible. Because this invisibility increases the stress and anxiety, and ultimately the vulnerability that patients feel when interacting with health care systems.
But more than not feeling invisible, the real question is how to make their stories and experiences visible to the general public. And that’s where advocacy comes in, and where you can get involved with TCMS if you want to try to do something about it.
So if you remember that I said the heart of medicine is caring for individuals when they are most vulnerable, well, the heart of public health is to ensure that we are protecting those that are the most vulnerable.
And we are able to do so, because with these white coats you have been given, these are actually invisibility-resistant! They make you highly visible. So when you show up, you are seen. And when you speak, you are heard. To a large degree, as a medical student you will have a lot more flexibility and time to spend with patients hearing these stories and understanding their experiences, and I encourage you to do that as much as you can! When rounds are over, go back to those patients that look like they wanted a bit more of the team’s ear, and find out what their concerns are. Find out where they came from. Find out what will make their life and their health better when they leave the hospital.
I know it feels like you can’t do a lot as a medical student, but I can assure you that this is one way where you can really make a difference for your patient and more broadly. Even though you may feel like you’re at the bottom of this hierarchy of doctors and trainees, that’s not how it is for the patient. To them, who may feel invisible, you are definitely seen and they will appreciate that you want to see them too.
So then you can take this power and use it to share these stories you hear, to ensure that our patients and their needs are not invisible to our health systems, not invisible to our colleagues, and not invisible to our policymakers. You can use your visibility to collect more data so we can bolster what we hear anecdotally with strong scientific evidence. You can use your voice to compel entities to provide more funding to mitigate the problems that our patients know all too well are barriers to them having as healthy of a life as they can.
This is precisely what we want to offer to you through TCMS as a venue. The ability to translate the challenges facing our communities into actions, where hopefully we can be more successful specifically because we are not invisible. TCMS has the benefit of having well-trained and engaged staff, so you can be supported in leveraging your visibility, amidst your busy life now as a medical student and later as a working physician. This can be as simple as bringing us the issues that you hear affecting your patients so we can start to investigate and develop programs in that domain, connecting us with the representatives of communities on these topics, helping us with the technical components of parsing out these complex topics, or writing articles or summaries to support specific efforts that we can disseminate on your behalf to parties in positions of power. But if you want to get more involved and more on these issues directly, we want that too!
With that said, hopefully you are seeing my visibility here as an example of how we can make an impact where and when it is needed.
Thank you.