Monday, March 26, 2012
Thursday, March 22, 2012
Wednesday, March 21, 2012
Friday, March 9, 2012
On February 22, 2012, President Obama signed legislation to cut funding from the Prevention and Public Health Fund. This fund was created by the Affordable Care Act (ACA) and invested $15 billion over 10 years to prevent disease and promote wellness in our society. This was a major advancement in U.S. health policy which shifted focus on creating a healthy and productive society rather than one that only reacts to disease once patients are already ill.
Prevention and public health are frequently the first place to start enacting cuts, but this is a huge mistake. Most diseases and causes of death in the U.S. are preventable, yet we continue to turn our backs on efforts to stop disease, illness, injury, and even death before they develop. When we have an unhealthy society, this affects many sectors of our economy as sick or injured workers are not as productive as they could be. Additionally, by continuing to only invest at the end of the line, care is reactionary and costly for the patients.
I think three primary reasons explain why investments in public health and prevention are often overlooked. First, people do not understand what public health is. It is more than just responding to infectious disease outbreaks or tracking influenza strains. Public health makes sure that the food we eat is sanitary, the air we breathe is clean, and that our roads are safe to drive on. Nearly every facet of our lives places us in danger, but public health professionals seek to minimize risks. Most public health interventions are inconspicuous and out of the public eye, so it is not surprising that political will for public health initiatives is minimal.
Second, prevention does not make anyone any money. Health care is big business these days and bottom lines for those in the health industry only decrease when people are healthy. Money comes at the end of the line: surgery for the diabetic with a foot ulcer, radiation for the cancer patient, and laser treatments for cervical pre-cancerous lesions are profitable interventions. Building a society that facilitates health and wellness reduces profits for many influential stakeholders.
Third, public health and prevention does not create the emotional appeal that many other political topics do. Take abortion, war, or even education. These issues are emotionally charged and can be divisive. Public health does not have the same appeal and as a result, it is often overlooked. Legislators are able to make cuts in this area without the political fallout or emotional reaction.
Cutting funds for the Prevention and Public Health Fund is unfortunate. Grassroots movements and public awareness campaigns are needed to highlight the necessity of public health interventions; I believe these campaigns should be led by primary care providers. Primary care providers are respected and are leaders in building a healthy society. Getting involved at the grassroots level is the best way to show communities, states, and the nation, how important investments in public health and prevention are to our country.
Health Affairs Policy Brief, “The Prevention and Public Health Fund,” Health Affairs, February 23, 2012
Schroeder, S., "We can do better -- Improving the Health of the American People," The New England Journal of Medicine; 2007; 357: 1221-28
Thursday, March 8, 2012
During the first two years of medical school, which are focused on basic science, Utah has found a way to better incorporate primary care values into their students' experience. First year students work as a medical assistant in a local clinic during their orientation month generating a better appreciation for the work that others on the medical team perform. Additionally, first year students work in a longitudinal clinic that they go to for a half day every other week. Continuity of care is a core value of all primary care, so Utah is exposing students to this important aspect of the field early. Also, during the first couple years, strong focus is put on clinical and communication skills.
Utah is alone in how they utilize the fourth year of medical school to better prepare students for their first day as a primary care intern. The curricular reform was derived from a need to make fourth year more productive and useful for students. The fourth year is broken into four components: longitudinal course, 4 week module, continuity care clinics, and teaching.
In the longitudinal component, all students in the primary care track spend a half day together, two times per month. Each longitudinal session is focused on an important issue or skill needed by primary care doctors. Some topic examples include communication, team building, ethics, public health, health reform, and health systems. The students have specific assignments during each of these sessions to tie it back into the rotation that they are currently on. For example, if a student is doing a cardiology rotation, they will have an assignment to bring in the primary care issue being discussed to that rotation. It is a way to make each fourth year rotation pertinent to primary care.
The four week module is a more intensive time to hone skills that are specifically needed by interns. They review note writing and see a lot of standardized patients to develop important technical and interpersonal skills.
The continuity care patient experience is the most exciting aspect of the primary care track. Towards the end of their third year, students recruit a panel of patients who they will track the entire year. Every time a patient on their panel has an appointment -- whether the appointment is for surgery, delivery, primary care, oncology, etc. -- the student accompanies them and serves as their health advocate. This experience shows students the inner workings of the U.S. health system firsthand, but also provides a valuable asset to patients. Having a medical professional present who knows your medical history inside and out improves care and outcomes. Kinks are still being worked out with this aspect of the track, but the idea is innovative and a very important component of their curriculum.
Lastly, the students in the primary care track have obligations to teach second year medical students. Primary care doctors need teaching skills for their patients and future medical trainees, so this is a time to develop those while reviewing important science knowledge and technical skills.
Utah is ahead of the crowd in terms of creating an innovative, primary care centered medical curriculum. It will be worth keeping tabs on how this program continues to develop.