As an aspiring physician, I felt I had a lot to learn from
Farmer and others in Structural Violence
and Clinical Medicine. Doctors are often critiqued as being out of touch
with patients and treating only their physical ailments, not the whole person
or the root cause of their troubles.
While I definitely know doctors in multiple specialties who break this
mold, spending long bouts of time with each patient to really get a grasp of
their struggle, I have no doubt that many doctors have work to do in their understanding
of structural violence and social determinants of health.
As Farmer himself points out, many doctors see social
intervention as not part of their job, and rightly so. The discussion led me
to wonder why public health and medicine are considered two separate and
sometimes competing fields. Farmer
discusses the ongoing debate in international health of whether to seek
proximal or distal solutions, essentially a debate of public health verses
medicine, respectively, and questions why it need be an either/or
approach. I would agree, and it is part
of the reason I am seeking both an MPH and an MD. In just a few weeks of MPH classes I have
already sensed that this degree is really getting me questioning the role of
the physician and how to be an effective, conscientious, and inspirational
doctor someday.
While not all aspiring MD’s will seek an MPH degree, there
are programs being implemented in medical school curriculums to increase
student understanding of the conditions of their patients and the medical
system through which they are navigating.
One article I found in particular discussed Penn State’s relatively new
program for all first year medical students to spend time serving as patient
navigators, which gives them a direct patient perspective to the challenges of
daily life, health problems, and understanding the health care system. The article (an interview with Terry
Wolpaw, vice dean) is linked below, but I felt her closing comment really
summed up the great potential this has for creating a new generation of public
health physicians:
“We expect that our
students will reflect on a patient’s journey through the health care system,
identify barriers, propose plans to health systems leaders to change those
barriers, and help implement the plans. We believe in the power of our
students and know that, given the opportunity, they will make a difference.”
References
Farmer, P., Nizeye, B., Stulac, S., and Keshavjee, S. 2006. Structural
Violence in Clinical Medicine. PLoS Medicine; 3:1686-91.
http://www.commonwealthfund.org/publications/newsletters/quality-matters/2014/april-may/qa-wolpaw
Sydney, I really think it is awesome that you have this mindset. It is future medical professionals like you that have the power and knowledge to make a difference in health care. I think that doctors today face a hefty challenge between what they originally sought out to do – truly, genuinely help people – and the demand the health care system pushes down on them, namely, the number of patients they see in any given set of time. The ACA is fortunately aiming to alleviate this challenge so that doctors can begin to focus on what is truly important, the patient. I am really proud that you see the value in obtaining your MPH. That fact alone sets you apart from many, and will be a great tool you will utilize throughout your career. It is awesome that other medical schools are seeing this value as well. Speaking of never losing sight of the importance of the patient, the book, Complications by Atul Gawande, may be of interest to you (feel free to Google the summary). I have a copy if you want to borrow it. Thanks for informing us of that awesome program at Penn State!
ReplyDeleteLisa, thank you so much for your positive feedback! I'd love to borrow the book sometime if you don't mind :)
DeleteAlong with this also think how health systems are organized around the world and how they contribute to this public health/ clinical medicine duality and the life of a doctor. There are some great books/ doctors out there....thanks for recommending Gawande. He is outstanding.
ReplyDeleteI totally agree with you Sydney!
ReplyDeletePublic health and medicine or dentistry shouldn't be two separate issues. Although; medical and dental students have this perspective within their curriculums, I admit that many doctors don't apply it within their clinical practice. I believe that insufficient incorporation of the bioslpsychosocial approach in dealing with medical problems beside lack of its clinical practice while being a medical student may play a significant role. I won't stress in my comment on lack of resources or number of patients seen by the doctor daily as contributing factors as this duality between public health and medicine is seen in both developing and developed countries.
The link between public health and medicine or dentistry is very strong. Actually, From my point of view, a successful dentist or doctor is the one who is dealing with the patient as a humanbeing not just a case or task. You maybe skilled but not successful!
You can provide an effective, but temporary, treatment for a respiratory condition due to smooking without being able to allow this patient to take steps towards smooking cessation if you have this duality in your mind. Similarly; you can fill a tooth efficiently but not enhance a healthy dietary lifestyle to prevent decay from start if you support this debate.
In fact, this is one of the perspectives that enhanced my initiative, as a dentist, to pursue my MPH degree!
Sidney, you bring up a very good point. When I first read the title of your blog post, I thought you would be discussing prevention versus treatment. I still think this part of the physician’s learning about the broader aspects of health. I applaud you for seeking your MPH before going to be a MD. We need doctors like you will be! I am very happy to hear about Penn State’s patient navigator program. If the student cannot commit to getting a MPH, it would be great for future physicians to at least have that experience. I believe this “extra” training makes it easier on everyone in the health field because of the learning gaps it bridges.
ReplyDelete