Labour of love: why we need more working-class doctors

I HAVE recently had time to commit to researching my ancestry. I was not surprised to see that as far back as I could trace, my family has worked solely in manual occupations.

Whereas the men tended to be the heads of households, the women held so-called domestic duties roles and did not work in paid professions until my maternal grandmother started work in a shop. I am the daughter of a gardener and a cleaner – two childhood sweethearts who met in the village they grew up in, never owned property, never drove a car, never had a passport and, up until recently, kept their money as cash under the mattress.

Despite struggling to accept my place in society throughout my teenage years – and even more so as I began my medical training – I have, in my post-graduate years, come to see my humble beginnings as an asset to the medical profession. But in the UK (where I trained), with only 4% of doctors hailing from low socio-economic background, and similar statistics in Australia, it seems that I am a rare breed. New schemes and projects to recruit more working-class state-educated students into medical school are popping up, such as the special entry access schemes at La Trobe University. Personally, I think this cannot come soon enough.

I studied at what is considered one of the most prestigious universities in England, acquiring my place there first on a premedical course designed to widen participation. The university historically has a terrible record of admitting students like me from state schools, with nearly 40% of its 2017 places going to privately educated students. To put this into perspective, privately educated students make up 7% of the total population of students in England. I spent my years at university feeling like a fish out of water, transported into a world that I wasn’t sure I belonged in and with people I wasn’t sure how to speak to. Attending a university with some of the most privileged students in the country but going home at holidays to my mum’s government housing estate allowed me to walk in two different worlds. While I thought I was learning how to communicate effectively with patients in my group tutorials, it was in fact in the duality of my experience at the student bar and at my mum’s bingo hall that the real learning was happening.

Undertaking a medical degree is no mean feat. It remains one of the longest degrees at university and requires a commitment to lifelong learning. The commitment for such learning no doubt comes from many different sources for different people – parental pressure, financial incentive etc.

For me, my long nights of study, my days of lectures, my failed exams that knocked me to my knees, and the successful retakes that got me back up again came from my working-class roots. Whether I knew that at the time or not is a different matter. Growing up, I witnessed the struggles of finances, no more so than when I asked my father to pay for a tutor that everyone else was seeing to help my chemistry grades. Unbeknownst to me until after his death, he was coming home from his 12-hour day job gardening, eating a quick sandwich, and going out until sunset to be able to afford my 45 minutes of extra help every week.

An Australian report in 2018 showed that the gap between the rich and poor continues to grow, with the top 1% of earners earning more in a fortnight than the lowest 5% earned in a year.

The wealth differences between those from the working class and those from the most affluent end of society have an undeniable impact on young peoples’ life experiences. I came to university anticipating it would be a long, hard journey, but growing up in a home where I witnessed strong work ethics pushing against daily struggles gave me strength with my ongoing training and with the often long and tiring on-call shifts.

The difference in life expectancy in Australia between the rich and the poor is nearly 20 years, and is almost double that between Indigenous and non-Indigenous people. It is vital that our health care workforce includes people with lived experience of hardship and marginalisation.

I remember vividly an Aboriginal woman I met in the intensive care unit during one of my first weeks of working in Central Australia. We had just told her that we did not expect her husband to survive a bout of illness and I asked her if she had someone to be with her overnight. She looked me in the eye, smiled and said: “I am Aboriginal. I have known dying and I have known grief since I was a child”.

This had a profound impact on me. I could go some way to understanding this woman, because I grew up poor and I had also seen pain and death from a young age. By the time I graduated as a doctor, I had lost all four of my grandparents, a parent, an uncle and two cousins.

Now, when I console my patients who are facing a bereavement, it not only comes from a place of kindness but of knowing, and it is this empathy in medical professionals that has been identified as an important quality patients look for when choosing a doctor. Domestic violence, alcoholism, drug misuse, and suicide are not only issues we encounter as doctors with our patients, but all too frequently in our own lives. Their impact is often felt harder when living with social disadvantage.

It was Rudyard Kipling in his poem to his son who said:

“If you can walk with the crowd and keep your virtue, or walk with Kings nor lose the common touch … Yours is the earth and everything that’s in it.”

This is what I feel I do with my medical degree daily. At times, coming from a working-class home and entering a professional workplace has felt like walking in two different worlds. And while throughout my time at university this was a dichotomy I grappled with and frequently detested, I have since come to view it as a strength over my 6 years of clinical practice. I value my roots and see them as an asset that enables me to work effectively with a diverse patient cohort.

My mother was 41 years old when she fell pregnant with me. She has told me the story of having an amniocentesis for her pregnancy and distinctly feeling that she had no say in the matter, that she was lost in a midst of medical words that alienated her from a conversation she was sure involved her but that she did not feel part of. In her own words, the doctors who performed her procedure were from a “different world” to us and she didn’t know how to be part of it. I understand what it was like for my mum and dad not to feel part of the medical world and not to know how to ask questions or advocate for their own health. I am careful, because of my family experience, to not create a medical world that the patient feels excluded from, and that especially extends to my disadvantaged patients.

In my daily practice, I strive to challenge a system that continues to disadvantage the disadvantaged. I encourage all my medical colleagues to do the same, because it most certainly takes more than one type of person to be a doctor, and it is my firm belief that it is in our diversity that we truly find our strength as a profession.

With special thanks to Katie Smith for her support and suggestions for this article.

Sarah Saunders completed a BA (Hons) in Medical Humanities alongside her medical degree and enjoys the social complexities of medical practice. She is currently working as an Australian College of Rural and Remote Medicine registrar in the Northern Territory.

 

 

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.