Wednesday Aug 08, 2012

Social Justice Inspires Passion in Students, Residents at National Conference

What do you call it when more than 900 students and nearly 950 residents gather for three days of workshops, policymaking sessions, and exhibits? It's the National Conference of Family Medicine Residents and Medical Students, which convened recently in Kansas City, Mo., and proved to be one of the most successful conferences in recent years.   

The event is the nation’s largest conference of medical students dedicated to a single specialty, and it featured the nation's largest residency fair.

The theme for the conference was social justice, which is a particularly meaningful topic to family medicine. We know that the care physicians and other providers deliver accounts for only 10 percent of health outcomes. The other 90 percent of health is affected by genetics, behaviors and environmental factors. 

The social determinants of health -- such as safe housing, economic security and education -- are our most powerful tools to make lasting improvements in the health of our communities. We know how often patients bring these concerns into our exam rooms, even when the stated reason for a visit is back pain, a sports physical or a new cough. The World Health Organization defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

Gloria Wilder, M.D., M.P.H., our inspiring opening keynote speaker at National Conference, challenged AAFP members to bring a broad-based definition of health to the conversation on health care. In championing health care reform, the easy advocacy target is incremental change to our disease-based delivery system. The more difficult objectives are those that affect the social determinants of health, but these are the very changes that will have the largest impact on the health of our communities at the lowest cost. As family physicians, we are ideally positioned to take the lead in this conversation. By knowing our patients and their communities, we can advocate for all of their health needs, not only those in the health care arena.

Many of us came to medicine because we recognized social injustice and believed medicine was a profession that could effect change in people’s lives. Students and residents are particularly close to this predisposition, and their work at the National Conference reflects intense optimism for the future of family medicine. At the business sessions, we heard 65 resolutions, the most of any National Conference I’ve attended in the past five years. Passionate debate was heard on topics such as Medicaid expansion, free clinics and pharmacy assistance programs.

(You can read more about the student and  resident congresses online.)

Richard Roberts, M.D., J.D., another champion of our profession, was the perfect bookend to Dr. Wilder’s talk. A past president of the World Organization of Family Doctors, or Wonca, he led us on a journey around the world to show the importance of nonhealth-care-based interventions to affect the public's health. Invoking Barbara Starfield, M.D., M.P.H., he asked "Why family medicine?"

There is clear data that communities with more primary care providers have better health outcomes, and communities with more family physicians have even better outcomes than communities with equivalent numbers of primary care physicians. Although the media frequently highlight the importance of primary care, we have reason to proudly support the unique qualifications of our specialty.

The AAFP has had amazing success with national advocacy efforts in the last few years, and a recognition that primary care matters appears to be growing exponentially. Much time has been spent on abbreviations affecting our system, such as SGR, RUC, and CMS. As the election season intensifies and budget talks resume later this year, we naturally fall into a dialogue that can resemble alphabet soup.

Stepping back to reflect on social justice reminds us why we're fighting these battles: better health care -- and health -- for all.

It also empowers us all to strive for purposeful, lasting changes in our own communities. So take a minute to reflect. Take a cue from Dr. Wilder -- how do you define health, and how are you championing social justice in your community? How can our discipline intensify efforts in this area? 

Please share your comments with us below, or take some time to be inspired by those who do.

Jessica Johnson, M.D., M.P.H.is the student member of the AAFP Board of Directors. 

Comments:

Why the term "social justice"? This implies that the bulk of our patients are somehow victims of injustice. I'm not sure where people are practicing to feel that their patients are somehow victims, but the only victims I see, for the most part with few exceptions, are victims of themselves with mostly self-inflicted diseases. I would say that 80-90% of the chronic diseases we see are self-inflicted. Call me jaded, but when you re-admit the chronic COPD-er for the 6th time in 5 months who continues to smoke a pack a day, it's hard not to be. Don't get me wrong, some are truly victims or are simply ignorant of common preventative health care, but when you take the time, energy and resources to educate them and yet the majority decide to not listen, then these patients lose their "victim" status in my book. Many will cite lack of funding as a reason patients are victims, but again, with the ever-growing $4 generic drug list, I get incredibly frustrated to hear a patient state they couldn't afford their medication and yet they have the newest iphone, clothing, and a pack-a-day smoking habit. Social injustice is out there, don't get me wrong, but I think social integrity, and the lack thereof, is a FAR bigger problem that is poisoning our culture.

Posted by Scott Graham, MD on August 09, 2012 at 10:02 PM CDT #

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