Sign the Dotted Line-Personal Reflections on Privilege in Medicine and the Doctor-Patient Relationship

Vol 7 #3

Kayla Ashley Simms MD, PGY3

Being a clinician often translates to making choices that directly impact others. Moving through a psychiatry residency program at a prestigious and costly medical school signifies my progression along this decision-making continuum. With fresh credentials and a well-practiced signature, I am positioned to make choices that will be a mark on someone else’s life and a symbolic representation of my life’s work.


Yet, I remain conflicted by this role as my own decisions have outwardly reflected personal privilege more-so than hardship: Should I go to medical school? What specialty should I pursue? Where should I travel to for electives? While medical training is demanding of time and energy, it has never made me grapple with putting food on the table nor having a clean outfit to wear to work. I have come to believe the promise of obtaining doctordom’s privileged status repeatedly demands prospective candidates be privileged in the first-place. Full-time studies, MCAT prep courses, and the availability of volunteered time seem but meager sacrifices in the context of my own background of being white, wealthy, and well-off.


Clinically, the job of advocating for patients can feel at odds against the pressures to systemically judge them. Bed pressures, service-allocation, and triaging cloud our algorithms and altruism into something more transactional. Much of this has been hidden in the crevices of curriculum development, certainly, and yet l can’t help but feel responsible for the consequence of our perceived summit’s viewpoint in society and the types of people we most often select to put there.


So ultimately, the decisions I make as a clinician impact lives that I myself may never live…


I know it’s been awhile

I don’t come here all the time

I’m here to ask a favour

Will you sign the dotted line?

You don’t quite understand, Doc

And I know that’s hard to hear

You think you know it all sometimes

But I know you don’t know fear

Not the way that I’ve seen it

Through the pain in my daughter’s eyes

With no food on the table

Her smile, a disguise

I know you’ve made tough choices

Like which specialty to pursue

And where you’d want to study

Should your stethoscope be blue

Our choices have just been different

It’s not that I haven’t tried

I dropped out of school at 16 years

After our grandma died

I robbed a couple stores you see

To pay my sibling’s way

My sister was an athlete

A star runner in her day

I sold drugs to my neighbours

To keep the heat on in our home

I’m not proud of these choices

But I’ve made it on my own

I know you’ve had it tough, Doc

Like when you almost quit

Your take-home fees were getting cut

You were tired of the grit

I’ve had it tough too, you see

I spent a month in jail

I never slept a wink those nights

Kept praying I’d make bail

Now I’m in your office

And my choices have come and gone

I’m faced with tough ones every day

I can’t say if I’ve made them wrong

And as you stare down at this form

I know the look you show

You’re not asking if I’ll abuse these drugs

Because the answer you think you know

There’s nothing I can say to you

To ease the choice you face

My pain, I carry every day

Life’s Karma in this race

The empty stare you shoot me

As blank as the spot to sign

Another choice I’ll have to make

With this empty dotted line

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