Medical students may not have a heavy clinical role from the early days of medical school, but as patient advocates they can have an outsized impact on changing the way care is provided.

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David H. Aizuss, MD, a member of the AMA Board of Trustees and ophthalmologist from Calabasas, California, has been advocating for patients since his days as a member of the AMA Medical Student Section. Looking back, what would he have done differently as a patient advocate? He offered some thoughts on that question.

David H. Aizuss, MD
David H. Aizuss, MD

“Our medical students are now the conscience of the AMA,” said Dr. Aizuss, who runs Ophthalmology Associates of the Valley, a multispecialty ophthalmology group, and is an assistant clinical professor of ophthalmology at the University of California, Los Angeles, Geffen School of Medicine Stein Eye Institute. “The medical student’s advocacy skills far exceed what we possessed back when I was a medical student. We were not nearly as effective as they are. Nor were we as outspoken as they are, and back then we tread very carefully as advocates.

“If I went back to my medical school days, I would have been much more vigorous and outspoken about the issues that I was concerned about—just like our medical students are today. However, having said that, we were very effective in changing the positions of the AMA and in a number of ways.

First, by advocating that they have a firm anti-tobacco stance. We got all the initial policy dealing with tobacco on the books with the AMA and you know they became much more outspoken in that area. Second, over those few years, we improved representation of medical students and policymaking at the AMA. When I first got there, we didn't have a medical student on every council or committee. Now we do.”

“When I was in medical school, the … involvement of my fellow students was extraordinarily limited,” Dr. Aizuss said. “At my medical school, there may have been two or three of us working in the AMA. And that was true at every medical school in Chicago where I attended medical school, so there may have been a core group of less than 15 students representing the hundreds of medical students in Chicago.

“If I did it all over again, I would try and convey to my fellow medical students the importance of involvement in organized medicine to have an impact on the greater world around us. That's the stellar achievement of the medical students who take advocacy seriously. Medical students—besides helping care for patients, which they're learning regardless—they have an impact on the care of all patients in the world around them through their activity and advocacy.”

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“As I went through medical school and became involved at the AMA, and as I continued my involvement as a resident, I began to appreciate how important health policy was in terms of the world in which we practice and the impact that health policy has on our individual patient care,” Dr. Aizuss said. “Did I appreciate it fully as a medical student? No. Do the medical students that I engage with now at the AMA appreciate it? I think they do. That's why you see such incredible energy amongst the medical students who do attend AMA meetings.

“If I could go back in medical school and talk to my fellow medical students, say, you know, this is the impact you can have on population health that you can't have as an individual medical student attending medical school. I would be shouting that from the rooftops.”

“Medical students can use their current experience in health care to help fuel their passion to improve health care,” Dr. Aizuss said. “We know the things that we deal with as practicing physicians—whether it's insurance companies that will not pay for care that you've rendered necessary to your patients, or attempting to prescribe medications that they can't get because of prior authorization problems, or seeing patients unable to access specialty care because there's a shortage of physicians.

“We all know that the only way we can resolve those issues is, No. 1, through health policy changes, and, No. 2, through government getting involved in dealing with third-party payers and monitoring the abuses that they are heaping on to the medical system and how they're interfering with care for patients,” he added. “And as a medical student, the only way you can impact those kinds of problems is by being involved in organized medicine. You can't do that alone.”

“As you go through medical school, you'll see these problems because now medical schools have a lot more exposure in outpatient clinics than they did when I was in medical school,” Dr. Aizuss noted. “So they seem to have a little bit more of continuity-of-care experiences. And they can really see the impact on patients when they can't get the medications that they need to control their chronic diseases.”

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“When I was a medical student, we had none of the training on social determinants of health or even in how we approach people who are different than ourselves,” Dr. Aizuss said.

“There is a role for medical students, though policy, to ensure that they receive the type of education and understand the need for diversity, equity, inclusion and everything we do, whether it's taking care of LGBTQ patients or minoritized communities. You come into medical school not fully understanding how little you know about these issues. Unless you're personally a member of a minoritized community, and even then, I think … it's important we all get on the same level of education in dealing with these issues.”

“If I was going to go back, I would say what I wish I did different is read some of the editorials that were in The New England Journal of Medicine and JAMA,” he said. “When you're a medical student, you don't really pay that close attention to journals like you do as you move on through your education. But if you pay attention to some of the editorials that are written, they pretty much focus on contemporary health care delivery issues, and that's an opportunity to educate yourself early that I certainly didn't take.”

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