Dr. Spenser Chen is a CIR member and fourth-year internal medicine-pediatrics resident at the University of Pennsylvania

Can you tell me a bit about CIR’s walking tour program?

Many of us come to a new city for our training, myself included–I’m not from Philly—but we take care of folks who have called the community around our respective hospitals home for generations. The walking tour is meant to help us learn about where we practice medicine and understand the context in which we treat and take care of patients. 

Philly is unique in a number of ways. One in six physicians train at some point in Philly and over 90% of trainees in Philly are now unionized under CIR. Philly, home to the nation’s first hospital and medical school, also sits at the forefront of the nation’s shifting drug supply. So I think there’s a lot to unpack and understand for us to do medicine here. 

Can you talk a bit about your experience on the tour and what kinds of things you learned?

We started at around 10 am in Washington Square Park, doing a walking tour through historical areas of Philly. CIR partnered with local organizers who led the tour for us. It was focused on understanding Black history in Philadelphia, learning about physical sites along with historical policies, and their impact on the communities and physical buildings that we see today. The tour was meant to go deeper than just the social determinants of health that drive health disparities of which we are all keenly aware—to understand the history and construction of both social and physical structures that lead to the systemic violence that we see today in our city. 

We walked through some of Philly’s most historic neighborhoods, many of which have undergone extensive gentrification. They look very different from the early days of the city, so it was surprising to learn, for example, where many people who died during various epidemics were buried, and where bodies were stolen for medical students to dissect. We also walked by the historic site of one of the first Black hospitals in the country, established because Pennsylvania Hospital excluded Black patients and other people of color). 

After the walking tour, we participated in a training session with Savage Sisters, a local harm reduction organization led by people with lived experience of substance use. They have done a lot of incredible work in national trainings, street-based outreach, harm reduction, and trauma-informed care. A lot of it was understanding what folks are already doing in the community, learning about their approach, and, most importantly, hearing directly from people in recovery who shared their experiences and insights.

Overall, it was a great experience. It was inspiring to learn about the active, community-based work happening across the city and to see how lived experience informs compassionate, effective approaches to care.

Do you have any advice for interns working in a new city or neighborhood? Is there anything you wish you had done differently? 

I’m a deep believer that all medicine is social medicine. Physiology is of course biological, but the bulk of how we deliver both medicine and care are through socialized processes. This is why it is crucial for us, as practitioners of medicine, to understand the local context of how medicine interacts with folks and the community at large. 

For example, the horrific Holmesburg Prison “experiments” in Philly are a significant part of the collective memory of many people here, especially communities of color. From the 1950s through the 1970s, a Penn dermatologist conducted unethical medical experiments on incarcerated people at the Holmesburg Prison, which led to the development of modern dermatological treatments such as Accutane. Today, survivors and advocates continue to seek reparations, but there has been little meaningful accountability. In 2021, the University of Pennsylvania issued a public apology, but many have criticized it for not being accompanied by material reparative action.

Stories like these are important for anyone practicing medicine in Philly, because they help explain the historical experiences that shape community trust in the healthcare system. As outsiders, we may not know this history, but learning it helps us better understand how to approach our patients and the care we provide. 

Is there anything else you’d like to share? 

With the recent wave of unionization with CIR across the country, it is an exciting time to be in training. We have an opportunity to build real power through labor in medicine and re-imagine how to use this power toward advocacy and health equity.

Physicians have traditionally not seen themselves as part of the broader labor or service workforce. Instead, medicine has long been viewed as an elite profession, and its approach to advocacy has often reflected that perspective. When it comes to health disparities, we know what the problems are. We have been talking about social determinants of health and health disparities for decades. Attempts toward change have typically been pursued through expert opinion, top-down advocacy, and lobbying policymakers from positions of professional authority. These approaches can be effective in some ways, but there’s a reason we haven’t seen more meaningful change. 

This is where physician organizing, a grassroots, bottom-up approach, presents a new opportunity to affect that change. Afterall, I think our process matters. It has to begin with partnership and curiosity. Fundamentally, this is what the walking tour and the workshop with Savage Sisters were trying to accomplish. They were an invitation to reorient how we practice medicine: to center relationships, build genuine partnerships with communities, and develop the collective power needed to improve health for all of us.