Every once in a while I get that unquenchable urge to write something down. That happened tonight when I finished reading a three-part essay series about resident physician wellness. The author had some strong and important ideas about resident wellness, but also said something about the need for physicians and medical education to address the social determinants of health, a topic that has been a favorite of my since it was introduced to me in undergrad. What she said sparked one of those primal “me must write!” moments, so I went to Facebook to get the idea out and hopefully generate some discussion.
Here is the quote and part of my Facebook post. I’d love to hear what you think! (And if you are interested in resident/physician wellness, I recommend the series–it is powerful! Wellness essay #1)
“[Medical] trainees are expected to know more, but do not produce more value. In surveys, physicians often cite as a main cause of burnout the perceived inability to help their patients in meaningful ways. The thing is, this is largely a correct perception. The United States spends dramatically more per capita on health care than any other wealthy country, yet our population is not healthier. The burgeoning field of social medicine has shown that, more than any set of medical treatments or interventions, social factors — economic inequality, food insecurity, pollution, discrimination — determine health. Our health care system is like a single stitch in a ruptured abdominal aortic aneurysm. The perpetual emphasis of medical training on the biological sciences leaves doctors unprepared to treat what really ails their patients. The fundamental practice of medicine must change to accommodate these realities, and that means we must train doctors differently, too.”
For the past few years, I’ve thought many times about helping my future patients to achieve true, whole-person wellness. I’m on the home-stretch of medical school now and I am so grateful for all I’ve learned. It’s been a privilege to feast on knowledge compiled over decades (centuries, actually) of inquiry and practice. But I’m not sure that I have all the right tools (yet!) to help people really be healthy.
My public health studies during undergrad introduced me to the social determinants of health (how economics, education, neighborhoods, etc. impact one’s health), which quickly became one of my favorite subjects to learn about. I started to see what really makes people sick. Now, medical school has helped me see what a healthy human body should look like and introduced me to ways we can influence the body to nudge it toward better health. But I don’t think I can help patients become truly well unless I can figure out a way to fuse these two disciplines. So I guess that is my question: how do we marry the health sciences and the medical sciences? They’re already on the same team, working toward the same goal (healthy humans!) and I think working together more effectively will be powerful.
Medicine for Health 
I really love this!
I’ve worked in family medicine for the last three years and I worked in internal medicine for the three years before that. I think the goal of better health is what we are all working towards. The one thing I see as a hurdle is that people don’t like to hear about when they need to change bad habits and even if we tell them, they still have their agency to ACTUALLY follow through.
I’ll use myself as an example. I’ve used food as my “treatment” to soothe the pains of years of childhood abuse. I’ve spent the last 11 years of my adult life trying to undo and overcome all of the bad habits and heal all the broken parts. I’ve certainly had success! But I know I’m far from my goal and I know my body habitus is FAR from where it needs to be. (Here’s the point I’m trying to make) In my annual physicals, I’ve NEVER had a provider ask me what I’m doing to lose weight and improve my health. (I fully comprehend what will happen if I don’t make changes.) I sit there wondering why nothing is being said so that changes may be encouraged as a preventive measure instead of, hypothetically, being told I need to lose weight along with a new shiny diagnosis of hypertension/hyperlipidemia/pre-diabetes/etc.
I think so much of medicine (hospitals, clinics, practitioners) depends on good “reviews” and when you need to tell someone something they don’t want to hear, that good review may be hard to come by.
But as I talk with patients about their new heart-healthy diet or diabetic diet I’m AMAZED at how little people know about nutrition and the food they eat.
If we all ate smaller portions of more nutritious food, if we all got more physical activity every day, if we went outside more and were staring at a screen less, and if we talked more frequently about mental health we would be a much healthier people.
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