The AAFP's 2018 National Conference of Family Medicine Residents and Medical Students opened Aug. 2 with a main stage event that featured a panel of health equity advocates discussing how to best address social determinants of health (SDOH), reduce inequalities in health care and successfully amplify patients' needs. A clear theme wound its way through those panelists' comments: We cannot improve the U.S. health care system going forward without first re-examining its past successes and failures.
Students and residents who attended the opening main stage event at the AAFP's 2018 National Conference of Family Medicine Residents and Medical Students gather around panelist Linda Rae Murray, M.D., M.P.H., far left, after the session to pose their questions.
Sponsored by the Health is Primary(healthisprimary.org) campaign from Family Medicine for America's Health,(fmahealth.org) the panel was moderated by renowned author and journalist T.R. Reid and featured Linda Rae Murray, M.D., M.P.H. of Chicago; Ned Calonge, M.D., M.P.H., of Denver; and Daniel Dawes, J.D., of Atlanta.
Learn from History
"You cannot practice medicine without addressing social justice concerns," Murray told a packed auditorium. "If you believe people have a human right to be healthy and have a feeling of well-being and be at peace and be able to enjoy life, then you have to address social justice," she said.
Murray explained that she was in medical school and residency during the 1960s and was heavily involved in the civil rights movement of the time.
- The AAFP's 2018 National Conference of Family Medicine Residents and Medical Students opened Aug. 2 with a main stage event that featured a panel of health equity advocates discussing how to best address social determinants of health, reduce inequalities in health care and successfully amplify patients' needs.
- Sponsored by the Health is Primary campaign from Family Medicine for America's Health, the panel was moderated by author and journalist T. R. Reid and featured Linda Rae Murray, M.D., M.P.H. of Chicago; Ned Calonge, M.D., M.P.H., of Denver; and Daniel Dawes, J.D., of Atlanta.
- A clear theme wound its way through those panelists' comments: We cannot improve the U.S. health care system going forward without first re-examining its past successes and failures.
"Start addressing social determinants of health by reading some books about U.S. history if you really want to understand how we got in this mess," she said. "Understand that what we do as physicians, as important as it is, is made possible and re-enforced by what is happening in the broad social justice movements of your day.
"You should be thinking about #MeToo, you should be thinking about Black Lives Matter, you should be thinking about the immigration struggles going on in this country," Murray declared. "To the extent that we lend our professional expertise and our relative privilege to speak out for those social movements, that's the extent (to which) we will actually make progress and your patients will end up with better health."
Offering further historical perspective, Dawes noted that physicians have been social justice warriors dating back to the days they lobbied for freed slaves after the Civil War ended, which he said led to the first discussion in Congress about addressing SDOH.
Still, it took another 100 years to begin moving the needle, said Dawes, with physicians pushing during the civil rights movement for equal health care for all U.S. residents, including minorities.
"Today, as we are at a critical juncture with the debate over Obamacare, this parallels what happened more than 150 years ago," he said. "Remember the incredible role that you, as family physicians, play. It's not just about providing health care. We need your help, working in tandem with multiple disciplines, to make sure that we don't allow that pendulum to swing too far and eliminate all the gains we have made in this health equity movement."
Advocate for Patients
Moderator Reid asked Calonge, who said he first attended National Conference in 1983, whether the country is dealing with health disparities better now than it did then.
"I would say that we're in a new era of raising awareness," Calonge responded. "In some ways, the civil rights movement was a great start, but I think we are beginning to realize that it wasn't enough."
Panelists at the opening main stage session at the 2018 National Conference of Family Medicine Residents and Medical Students discuss how to best address social determinants of health to achieve greater health equity. They are, left to right, Ned Calonge, M.D., M.P.H., of Denver; Daniel Dawes, J.D., of Atlanta; and Linda Rae Murray, M.D., M.P.H., of Chicago.
Calonge said the civil rights movement was aimed at improving equality, which hasn't been achieved.
"We really need to focus more on equity and the difference (between) those two things," he said. "Equality is everyone gets the same, while equity is everyone gets what they need."
Calonge challenged the residents and medical students in attendance to think outside the exam room.
"What can you do to move social justice, racial justice, racial equity and address the social determinants of health?" he asked. "Not just raise up the health care of your patients, but their overall health and well-being. You are a force -- in our society, we (as family physicians) are given a special place. I think we have a social responsibility to use that beyond the exam room and move the country forward in these issues around social determinants of health and equity. If you don't do it, who's going to?"
After the opening main stage event at the 2018 National Conference of Family Medicine Residents and Medical Students, panelist Daniel Dawes, J.D., answers questions from an attendee.
Murray extended this line of reasoning, saying: "I would argue: If you're not involved in things outside the exam room, you are committing malpractice. What I'm saying is you cannot practice medicine competently without being aware of and paying attention to these broader issues. Because they determine your personal ability to practice the way you want and have an impact on people's health."
Address Workforce Issues
The panel discussed a question posed via Twitter about addressing medical student debt to help solve the physician shortage crisis that America could face in the coming years.
For her part, Murray questioned why today's medical students are graduating with $300,000 in student loan debt.
Book Club Much?
Attendees at the opening event at the AAFP's 2018 National Conference of Family Medicine Residents and Medical Students on Aug. 2 asked the session's panelists to recommend books on the struggles of the American health care system and addressing social determinants of health.
Here are their recommendations:
- The Social Transformation of American Medicine, Paul Starr
- The History of White People, Nell Irvine Painter
- Black Reconstruction, W.E.B. Du Bois
- The Immortal Life of Henrietta Lacks, Rebecca Skloot
- Medical Apartheid, Harriet A. Washington
- An American Health Dilemma: Race, Medicine and Health Care in the United States, Volumes 1 and 2, W. Michael Byrd and Linda A. Clayton
- The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, T.R. Reid (panel moderator)
- 150 Years of ObamaCare, Daniel E. Dawes, J.D. (panelist)
Calonge pointed out that the way the system's created, it's become cost-prohibitive to attend medical school. "We have to get back to policies at the state level that say we value medical education and we're willing to dedicate public resources to that," he said.
"I am so amazed by you all, and so appreciative, to see so many dedicated people together in one place who made a decision that's going to contribute to the health of the country in a very substantial way," Calonge added.
Reid suggested that an intelligent single-payer health care system wouldn't stand for young physicians facing $200,000 or more in student loan debt and would pay for their tuition. He followed that up by asking the panelists whether they thought such a health care system could become a reality in the United States during their lifetime.
Not without activism, was Calonge's response.
Murray agreed, saying she didn't expect to see a single-payer system in her lifetime.
"It's not going to happen unless you join others in the country to fight to change our fundamental values," she said. "You have to demand the impossible or you won't get anywhere."
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