Luke Antonczak

fp0375
SOC 2000
Service Learning Journal
When I first started this project, I assumed that connecting my experiences in the
emergency room to the sociological concepts that we learned in class would be relatively simple.
In the beginning it turned out to be much more difficult than I imagined, but as time progressed it
became much easier. Originally, I had thought that as we covered more material it was easier to
connect things to my experiences, but this was only partly true. I realized that a major contributor
to why making connections had become easier for me was that I had begun to adopt sociological
thinking. I no longer had to stretch to make connections, but saw them in the smallest
interactions that I had with the staff and patients in the ER.
The first time I really noticed this revolves around an interaction that I had with a patient
and their family as they were being discharged from the express care section of the ER. I was
walking past their room on my way to change out the sections soiled linen bag, and I was asked
if I was a doctor. I was a shocked by that, and I have to admit a bit flattered as well, because I
dont think I look anywhere near old enough to have made it through med school. Unless the
patient and their family thought I was some sort of Doogie Hawser-esqe savant, I didnt see
much reason as to how they could possibly think I was a doctor. I thought about this further as I
was going about my duties that night, and I came to the realization that they assumed I was a
doctor because of the way I was dressed. The uniform that Providence requires its male
volunteers to wear is slacks or khakis with a solid colored white shirt and a blue jacket that
identifies them as a volunteer. A tie is optional with the uniform, but I prefer to wear one as I

went through 13 years of Catholic school (kindergarten through 12th grade) so Im pretty
comfortable wearing a tie.
The patients were so accustomed to seeing all the nurses in scrubs, they assumed
someone wearing shirt and tie must be a doctor. To add to this, the blue volunteer jacket looks
somewhat similar to a doctors white coat, and I could see how someone who is not familiar with
the structure of the hospital could make that assumption. This led to me drawing the conclusion
that the clothes someone wears act as a symbol, and help people determine how they should
interact with each other. Once I had figured this out, it reminded me of two separate interactions
that I had a few week weeks before. The first of these was when one night as I was walking
through the hospital to get to the ER to start my shift I was stopped in the hall by an older
woman. She was very upset that she had been waiting for over two hours to get a MRI, as there
was some apparent issue with the machine, and that whatever staff member was there during that
time had left. This woman had barely let me get a word in edgewise through this entire
conversation, so I had been unable to explain to her that I was a volunteer in the emergency
department, so there was nothing that I could do to remedy the issue that she was having with the
MRI. I was dressed professionally, so she just assumed that I was someone important who could
help her with her issue. This whole interaction was just further evidence to me that people saw
the uniform I was wearing as a symbol.
Wearing a shirt and tie as a symbol of professionalism is one that is very deeply
embedded in our culture. My shift is around the same time as another volunteer, and we often
end up working together. This was true to a greater extent last semester when we had an hour
overlap in our shifts. Unlike me, when he is volunteering he wears khakis and a white polo shirt.
The more time I spent thinking about clothes as a symbol, I realized that there is a pretty big

difference in the way that people, both staff and patients, treat the two of us. The main difference
is that people tend to be slightly politer towards me. It isnt a significant difference, and I doubt
the people we interact with even notice it. I know that I didnt until I started paying more
attention to all of my interactions in the ER for this project. In our culture, a big part of how we
interact with each other is determined by how a person presents themselves.
Another observation that I have made in during my time volunteering is in the
demographics of the patients that I see there. It wasnt something that I noticed until I read the
chapter in the text book about the sociology of health and illness, but the overwhelming majority
of the patients who are in the ER are women. The text book mentions that women are much more
likely to take the sick role than men are, and that seems to hold true in the ER as well. It could
just be total coincidence, but if I had to put a number on it, I would say that at least 75% of the
patients that I see admitted to the ER are women. To add to that, as Southfield tends to be lower
income, a good portion of the patients that come through the ER are really there for medical care
that could be better provided at a doctors office, or even an urgent care. A lot of cases seem
simple things like the flu, strep throat, or repertory infections, but the people who come through
the ER either cant afford the treatment that they would get elsewhere, or cant afford to take
time off of work to go elsewhere during regular business hours. This is so prevalent that one of
the six teams in the ER, Express Care, is totally devoted to things like this. They will take care of
the things that can be done quickly. If a person needs a few stiches, to get checked to see if they a
broken bone, or have some simple tests done, this is where they are sent. Express Care has the
highest turnover rate out of any of the other teams, so it tends to be where I spend the most time
while I am volunteering, because most of my duties revolve around cleaning rooms and changing
linens.

If a patient has a more complex issue, or requires more intensive care they are sent to one
of the other five teams, which are Chest Pain, and Teams 1-4. There is also a section of the ER
that is reserved for trauma patients, but it has seen very little use while I have been there. Chest
Pain tends to have the least amount of turnover, as the patients that they see there usually require
treatments that take a longer time than the ones provided elsewhere, so I tend to spend the least
amount of time there. Even though these teams are designed to deal with more serious issues,
they also seem to mostly deal with patients who come to the ER because they cant afford to get
medical care in a different setting. This all combines to greatly reflect the social factors that are
currently impacting medicine. Medical care in the US is an incredibly expensive thing, and even
with the help of Medicare and Medicaid, many people cannot afford any kind of treatment. Due
to this, they are forced to go to the ER to seek even the most basic treatment because and ER
visit is much more likely to be covered by whatever insurance that they have.
The treatment of the mentally ill and disabled is another failing that I have noticed in my
time in the ER. There is no issue with the actual treatment of the mentally ill that I have noticed
in the ER, and it is more of an issue with the medical system as a whole that I have noticed.
There was one man, whom I clearly remember, who was admitted to the ER two weeks in a row
while I was volunteering. He was clearly mentally ill, and also clearly a frequent flier. When he
was admitted, both the ER staff and the EMTs who brought him in seemed very familiar with
him. It is a clear failing of our current medical system that this man was admitted into the ER
multiple times to be treated, instead of being sent to a facility that is designed to treat patients
long term. A significant part of this is a social issue, rooted in most peoples perception of mental
illness. In general, mental illnesses are not perceived as actual illnesses that need to be treated,
and because of that mental illness doesnt get the attention that it deserves outside of the medical

field. Due to the fact that mental illness doesnt get much public attention, it can be brushed aside
and because of that many people dont know how to properly deal with it. When people dont
know much about an issue that issue can be easily brushed off on a societal level, and therefore
wont be dealt with appropriately. People who suffer from mental illness should not have to
regularly seek treatment in the ER because they have no other option. This is a social issue that
needs to be addressed, to the point that there is more government funding to for mental health
treatment, so that sufferers of mental health can have access to either no cost or low cost
treatment. That way we wouldnt be faced with those who suffer from mental illness being
admitted to the hospital, only to be discharged soon after, then admitted once again.
This all goes back to the concept of the sociological imagination, and determining the
relationship between personal troubles and societal issues. Many people perceive mental
illnesses and how our current medical system deals with them as a personal trouble, when in
actuality it is a deeply ingrained societal issue. Our society has not yet determined an appropriate
way to deal with mental illness on a societal level, and because of that it is going to remain a
major issue. The first step to addressing this issue is to ensure that mental illness is identified as
being a societal issue, and then begin trying to find the best way to deal with mental illness from
there. When societal issues are viewed as personal troubles, the people who suffer from that issue
are marginalized, and do not get the attention they deserve. This makes the issue, especially one
such as mental illness, much worse. It already doesnt get the appropriate attention because it is
viewed as a person trouble, but with mental illness, many of those who suffer from the more
serious illnesses are homeless or members of lower social classes. Due to the fact that people
tend to look down upon members of lower social classes, especially the homeless, mental illness
is viewed not only as a personal trouble, but as a personal trouble of those who are not able to

support themselves in any other way, a personal trouble of those who dont have a proper place
in the social structure. It is a major disparity that in one of the richest countries in the world, with
all of the scientific and medical advances that we have had in recent years that class can still be
such a major determinant of how much and what kind of medical care that a person can receive.
This is especially true when other major industrialized nations, like Canada or the UK, have
socialized medical care systems that allow for more equitable treatment throughout society as a
whole. On the other hand, in those countries, the socialized health care systems can lead to long
waiting lists where the people who really need medical treatment will not necessarily receive the
treatment, just based upon where they are on the waiting list. The major take away from this, is
that it is not just the US medical system that is flawed, but that there is no one ideal medical care
system, at least not one that has been instituted yet.
An interesting thing that I noticed while in the ER is how some patients treat the nurses
and the ER techs radically different than how they treat the doctors. Often times when they are
dealing with a nurse or a tech, patients can be quite disrespectful, and sometimes they are even
busy on their phones while the nurses and the techs are trying to treat them. I have also seen on
occasion patients swearing at and getting very angry with the nurses or the techs. This is
especially true when they are waiting on results from some sort of test and cant be given food or
drink until the results come back, and the doctor looks over the results. Their behavior is usually
totally changed by the time that the doctor comes around. The patients are incredibly respectful
and often a model patient. After the information that I learned over the course of the class, I
determined that this was highly likely to be a class issue. Doctors, and even physicians
assistants are jobs that are looked upon as having more prestige than nurses or ER techs, even
though they are all incredibly qualified and perform important roles in the course of a patients

treatment. When the patients interact with the doctors, they associate them as being a member of
a higher social class than they are, and their interactions are determined by that. Unlike how
patients view the doctors, the view the nurses and techs as being members of an equal or even
lesser social class, and that therefore they do not need to be treated with the same level of
respect. Often times I notice that even I, as a volunteer get more respect from some of the
patients that they give to the nurses and techs. Im sure that this is partially because as a part of
the volunteer uniform I wear a shirt and tie, which as I previously mentioned can be seen as a
symbol of professionalism, and even a higher level of social class. It wasnt until I started
thinking about these interactions in the ER that I really noticed how big of an impact that social
class really makes on our day to day interactions. Our lives are shaped by how we view
ourselves and others in relation to social class, and unless we are aware of how it influences our
actions, there is really nothing that we can do to change our actions accordingly. It reminds me
very much of the quote that was used often in class regarding culture, that the last thing that a
fish would notice is the water.
The fact that social class is such a major determinate of peoples actions is very
concerning, especially when current events, like the Black Lives Matter movement and the
current election cycle are taken into account. Class is such a major shaper of these events, but it
isnt one that is often discussed in the media, at least relating to things like the recent bout of
police shootings. It is not just race that determines this, even though it is likely a major
contributing factor, class plays into it largely as well. The young black men who have been shot
and killed by the police are almost always members of the lowest tiers of the social class system.
This is definitely a factor in the outcomes of these situations, as the police are going to be
inherently more suspicious and cautious when dealing with people who are members of a lower

social class, because there tends to be a higher crime rate among the lower social classes. Due to
that higher crime rate, the police go in to these situations with an unconscious bias. This is
further compounded by the fact that race is also a contributing factor to unconscious biases, so
police officers go in to these situations with multiple unconscious biases which creates high risk
situations. When activists try to address these issues, they focus on the race aspects of it, but not
the class aspects. Even the Occupy Wall Street Protests a few years ago did not adequately
address the issues with the disparities between social classes. They only targeted the upper
echelons of society, and failed to bring attention to the true issue. That issue is that the class
structure in the United States allow for people to be discriminated against based on their
perceived social class. This is problematic because it furthers the inequities that are already
created in our society by the class structure itself.
One interesting aspect of this can be seen in the current presidential race. The two
candidates that seem to be getting the most attention this election cycle are Donald Trump and
Bernie Sanders, and this is mainly because they are perceived as political outsiders, people who
can change the system. This clearly shows that people are aware of the vast differences between
the social classes, and they want something to be done to address this. Bernie Sanders supporters
provide clear evidence for this, as he is a self described socialist, and until very recently a
socialist candidate would not have garnered any kind of large scale support. This is very
interesting, especially because accusing a political candidate of being a socialist, or a communist
would be an insult, and something that would be used with the hopes of derailing a candidates
campaign. The fact that a socialist candidate has garnered large scale support shows that how
people, especially young college students, have started to view society and social class as
something that needs to be changed, to the point where it is more equitable. I find this especially

interesting, because as I am an economics major, it plays right into the aspects of society that I
really enjoy analyzing. When people call for a political revolution, with the hopes of totally
changing society, it seems that they lack a basic understanding of how much work that it would
take on both a societal and economic level to change the status quo. The systems that are
currently in place are so deeply ingrained within our society, it would be incredibly difficult, if
not totally impossible to change it completely, at least in the short run. This is especially true
because the main focus for this so called political revolution has been on the presidential
election, and not congressional elections where the real change can be instituted. Our current
system is definitely flawed, but for the moment it seems to the best that we can hope for.
Yet another interesting thing that I noticed while volunteering in the ER is the differing
roles that the staff play. They each play a different role depending on what part of their job that
they are doing, or if they are just interacting with their coworkers. How the nurses and doctors
behave when they are interacting with each other, is totally different from how they act when
they are interacting with patients. This makes sense, as they are acting in different roles
depending upon whom they are interacting with. When they are interacting with a coworker, they
are acting in the role of a coworker, and when they are interacting with a patient they are acting
in the role of a caretaker. I think that this transition between roles as people interact with others
in different situations is something that I have always implicitly understood, but which I have not
put much thought into until taking this course. The more I thought about it, the more I realized
that this is something that I myself have experienced. There has bene many an occasion where I
have transitioned between roles as I have gone through my daily life. One of the clear examples
that I can think of is that until recently I worked at Jets Pizza, and while I was working there I
fulfilled several different roles all in the same setting. Within that one small setting I would

switch between the role of a delivery driver, a front of house worker, someone who prepared the
food, and an albeit unofficial manager. All of these roles were similar, but there was a definite
difference in how I interacted with people while taking each of these roles. I find this very
interesting, as the more I thought about this, the more I realized how integral a part of our society
roles are. They define our interactions with others, and if we dont take the appropriate role, the
interactions that we have with other can be misconstrued, and change the whole meaning of that
interaction. I also found it interesting, because as I thought about this further, I realized that the
reason that I left the aforementioned job at Jets was to avoid role strain between my role as a
worker and my role as a student. I quit at the beginning of last semester, as I felt that with my
course load, along with volunteering, and anther job that I have as a research assistant at a lab in
the pharmacy school I would not have adequate time for my job at Jets. I felt that out of all of
my responsibilities, my job at Jets was the least important to my professional development, and
the one that I could most afford to drop.
In my reading of the textbook, I was frustrated by some of the authors claims in the
chapter about medicine. The author seems to take issue with the medical system as a whole. One
of the things that the author described that frustrated me the most, was what he described as the
depersonalization of medicine. I know that it is totally anecdotal, but from my experiences in
the ER, I have noticed no such thing. You would think that the ER would be one of the places
where the issue of depersonalization would run rampant, as the doctors and nurses see their
patients for only very brief periods of time. The staff at Providence does a fantastic job caring for
their patients, and they try their best to treat the whole person and not just the symptoms of
whatever is ailing the patient. They take their time to talk with the patients and to make sure that
they get their medical history, even calling their primary care physicians if need be. Seeing the

whole process as they treat patients in the ER really inspired me, and it definitely helped me
reaffirm my desire to pursue a career in medicine. So much so, that at this point I have
considered that I may pursue emergency medicine as a specialty in med school. This may not
seem all that significant, but up until that point I wasnt very much interested in actually
practicing medicine, but instead wanted to get into and MD/PhD program and focus my career
on medical research. This is still my intention, but if on the off chance that I do not get into a
MD/PhD program, or pursue medical research with just a MD or PhD, I think that I would like to
pursue a career in emergency medicine. The author seems to have a bias against the medical care
system in the US, as the chapter on health and medicine was highly critical of the medical system
as it stands, especially what he describes as the two-tier system of medical care, this is
something that I touched on briefly already. As I stated previously, this is a major issue with
mental illness, and peoples actual access to health care, but I also noticed in my time in the ER
that they try their best to mitigate it. There are posted signs throughout the ER that they are
required by law to treat patients that come to them, and that they accept Medicare and Medicaid.
They also do their best to provide equal care to all of the patients that walk through the doors of
the ER, and more to the point of this, I have never noticed any one get any different level of
treatment unless they require more treatment than the typical patient. This was made clear to me
when I noticed that often, patients how come from a troubled back ground will have a social
worker, or even a psychiatrist talk with them as part of their treatment. At the beginning, I was
slightly surprised by this, but the more I thought about it, the more it made sense to me. If there
has on thing that I have learned from this course it has been that social factors impact our lives in
ways that we may not even be aware of.

Having a social worker talk with at risk patients is thus a very important part of the
treatment process. The social workers can determine how best to continue the treatment of the
patients who do not have the resources to adequately continue with it, or have issues in their on
lives that would prevent them from making a recovery. The fact that the medical industry as a
whole understands the role that societal factors play in health and illness is something that I find
very heartening. However, I have noticed a concerning issue dealing with the social factors of
health and illness while in the ER, that of nutrition. The patients that come in to the ER in
Providence are often lower income, and because of that do not necessarily have an appropriate
understanding of proper nutrition. Often when the patients are waiting in the ER, they bring
snacks with them, and these snacks tend to be large bags of chips or candy and large bottles of
pop, iced tea, or other sugary beverages. These foods seem to be the norm for the patients, which
is very concerning, especially given the fact that they are already trying to seek medical
treatment. It is very hard for a patient to be able to adequately recover when they lack the proper
nutrition to keep themselves healthy, especially when many of them are either obese or
overweight.
The lack of adequate access to healthy foods, and the lack of understanding of proper
nutrition is major problem facing our society today, especially in poorer communities. This is
one of the leading causes in the obesity epidemic that has been running rampant in the United
States. I was recently listening to a Freakanomics podcast, where they mentioned a study where
people who frequented fast food restaurants were asked if they knew how many calories that an
average person should consume on a given day. This study was done to test the impact that
putting the calorie count of the menu items on the menu at fast food restaurants. The results that
they reported on the podcast showed overwhelmingly that the people who frequented fast food

restaurants had absolutely no idea on how many calories they should actually be consuming
through out the day, with some people saying that they thought they should be consuming as few
as 500 calories a day. This shows a fundamental lack of understanding of nutrition in lower
income people, which is clearly a societal issue. Michelle Obamas program brining healthier
lunches to public schools has been helping with this, as it beings to provide the basis for nutrition
in lower income students, especially those that qualify for the free reduced lunch program. At
home, these students do not have access to healthy foods at home, but providing them healthy,
affordable lunches at school is a good start to addressing this major public health issue. However,
only providing them with healthy food is not enough to completely address this issue, more
needs to be done.
Lower income people also need to be provided with education of and access to proper
diet and fitness so that they can stay healthy. This is something that needs to be further addressed
by the government, especially given the severity of the obesity problem facing the country. Some
of ways that this issue could possibly be addressed is by mandating that all public schools require
their students to take a class on proper diet and nutrition. This may not necessarily help much, as
it would depend upon the individual students in that case, but proving access to education is one
of the best options that we have to address the major public health issue that is obesity. Another
way that the government can begin to address this issue is by subsidizing healthy foods (more so
than what is already done) so that they will be more affordable to those with lower incomes will
have easy access to them. They often are forced to resort to eating fast food and junk food
because fruits and vegetables tend to be more expensive and harder for them to come by than fast
food and junk food are. This is compounded by the fact that in urban areas that are populated by
lower income residents there is often a clear lack of grocery stores, which stop those residents

from having any sort of access to healthy foods. This is a very serious problem when considering
the public health impacts that the lack of access to healthy food creates. The issue with obesity in
the country can only be made worse when the people who suffer from it have no way to access
the foods that could help them deal with their health issues. One of the only ways that this
specific issue can be addressed is by having the government come in an encourage grocery stores
to open new locations in these under served areas.
All in all, I have really enjoyed my experience volunteering at the ER at Providence. Like
I initially mentioned, I originally thought that it was going be to difficult to connect the course
material to my experiences, but that turned out to not be the case. If anything, my time in the ER
actually helped me to better understand the course content, one because I had to actually think
more deeply about sociological issues in order to complete this assignment, and two because I
was confronted with sociological issues first hand, especially issues relating to health an illness.
My major takeaway from the project has been that social factors play a major role in all of our
lives, that we arent even aware of until we sit down and think about it. This is especially true
when it comes to the social factors that impact health and illness. After working on this paper,
and completing the group project in class, I realized how important it is that medical
professionals have a good understanding how social factors play into health and illness. Without
such an understanding of social factors, doctors and nurses cannot appropriately treat, or even
diagnose their patients. It definitely makes me glad that the AAMC now requires sociology for
MCAT, as this ensures that our future physicians have at the very least a basic understanding of
how society impacts our lives. It is very important that the AAMC continues to encourage
aspiring medical students to have at least some background in sociology, and furthermore an
understanding of how society affects health and illness. It is even more encouraging that the

AAMC is now also encouraging students who do not have an entirely hard science background
to apply for medical school. This means that they understand how important a role that things
other than a purely hard science background plays in the development of a good physician, and
that they are trying their best to further the medical profession by changing the requirements for
medical school in this way. I am especially glad that I took this specific course, with the learning
community aspect and the focus on the societal factors of health and illness, along with fulfilling
my service learning requirement for the Honors College. I think that it has given me a real leg
up, as it has made think deeply about how social factors impact health and illness, which will be
an important set of ideas for me to have considered when it comes to me having to apply for
medical school.