May 07, 2019 03:07 pm Chris Crawford Kansas City, Mo. – Family physicians might stave off burnout by stoking their passion to improve patients' health and advocating for initiatives that benefit their communities.
That's exactly what a panel of family physician leaders described during a session at the AAFP's National Conference of Constituency Leaders here on April 25 -- how each of them pushed for change in the neighborhoods they serve to directly impact public health.
Participating panelists were Manisha Sharma, M.D., interim chief medical officer for Community Health Group in Chula Vista, Calif.; Richard Bruno, M.D., M.P.H., a family physician with the Baltimore Medical System; and Ravi Grivois-Shah, M.D., M.P.H., M.B.A., clinical associate professor in the Department of Family & Community Medicine at the University of Arizona College of Medicine, Tucson.
During an April 25 breakout session at the 2019 AAFP Leadership Conference, Manisha Sharma, M.D., interim chief medical officer for Community Health Group in Chula Vista, Calif., discusses how getting hit by a drunk driver at age 22 led her to become a family physician and patient rights advocate.
Moderator Jay Lee, M.D., M.P.H., director of primary care at CareMore Health in Los Angeles, kicked things off by asking how the panelists' passion for patient advocacy began and how they went from working inside the four walls of their clinics to outside that box.
Sharma said when she was 22, she was hit by a drunk driver in a crosswalk.
"From that moment on, I had a preexisting condition; my health insurance company dropped me, and I had four open-hip reconstructive surgeries over seven years," she said. "I channeled my anger from this into becoming a patient rights advocate and activist. And I thought, if I am going to do this right, the best way to be someone's patient advocate is to be someone's doctor, so in my early 30s, I decided to go to med school."
Sharma said she knew she wanted to pursue family medicine because it resonated with social justice issues she was interested in.
In her current position at Community Health Group, Sharma said she still sees patients by working with the American Civil Liberties Union and treating patients at the U.S./Mexico border.
"Because I realized I can never do the work of system change and social justice if I don't take care of the people I am supposed to be serving," she said.
For Bruno, his advocacy story started in his hometown of Little Rock, Ark., where he volunteered as a counselor at a summer camp for kids with disabilities.
"It was an amazing experience for me because I was taking care of kids who were having low blood sugars in the middle of the night, and I had to figure out how to check their blood sugar and all of these other things," he said. "I recognized that a lot of these kids were falling through the cracks of the health care system. I remember one of the kids with cancer's parents had to sell their house to afford expensive treatments."
Bruno said the experience made him want to get involved not only in taking care of children with special needs, but also in helping to fix the broken health care system.
That decision was further solidified when Bruno's high school friend Luke died from a brain tumor that probably wouldn't have killed him or bankrupted his family if he had just had health insurance at that time.
That's what led him to medical school, said Bruno: "to find a way to use my experience and my skills to try to fix the system so that no one has to pass away like Luke did. That was the social justice underpinning to my career trajectory."
Nowadays, he added, his "big schtick" is legislative advocacy.
For example, Bruno described how plastic microbeads from personal care products were passing through the Baltimore sewage system and into Chesapeake Bay, where they bioaccumulated and moved up the food chain, posing hazards to marine animals and, ultimately, humans.
During a group project for his master's of public health degree program at Johns Hopkins Bloomberg School of Public Health, Bruno's professor, who was a state legislator and ER physician, suggested the group help write legislation to ban the microbeads.
The group went to Maryland's capital, Annapolis, and met with legislators, lobbyists for the companies that use microbeads in their products and environmental activists, said Bruno, who also penned a Feb. 16, 2015, op-ed on the issue.
"We came up with common language, and the bill passed. It was signed by the governor of Maryland and it became law that in X number of years, companies couldn't manufacture or sell products in Maryland with these plastic microbeads in them," Bruno said.
Richard Bruno, M.D., M.P.H., a family physician with the Baltimore Medical System, explains to audience members how he helped get plastic microbeads in personal care products banned in Maryland.
"It was cool that we were one of the first states to pass this type of legislation," he noted, adding that the bill served as model legislation for other states and even set the standard for a federal law that subsequently was enacted.
Bruno said he continues to put on his white coat and visit the state legislature every year to advocate on behalf of his patients and community.
"I say, 'These are the folks that I am seeing, these are the problems that they're having, and we have to fix it and change the system,'" he explained.
The third panelist, Grivois-Shah, said his community advocacy story started in junior high school, when his mother dragged him along to meetings in Glendale Heights, Ill., to discuss how to best raise money for the local library.
"My mom had just gotten her citizenship, and she was inspired to get involved in her community," he said. "So, she got involved with Friends of the Public Library. I saw her passion, and it really drove my own passion in community development."
Grivois-Shah said he found he could take his passion for changing systems and bettering communities and use that in family medicine. During his residency in Chicago, he joined a government advocacy group and traveled to Springfield, the Illinois state capital, to advocate for expedited partner therapy, mandatory bike helmets and other issues he felt strongly about.
Ravi Grivois-Shah, M.D., M.P.H., M.B.A., clinical associate professor in the Department of Family & Community Medicine at the University of Arizona College of Medicine, Tucson, tells conference attendees about working to get two Chicago coal power plants that were affecting community health shut down.
When he was a family physician with Cook County Health & Hospitals System, Grivois-Shah said he began the crusade he is most proud of: fighting Chicago's coal power plants.
As a delegate for the Service Employees International Union, he learned about two coal power plants in mostly Latino neighborhoods in Southwest Chicago that were spewing particulate matter and soot into these communities.
The Chicago-based Respiratory Health Association asked SEIU to advocate passage of an ordinance banning particulate matter emission above a certain threshold, which would force the plants to switch to natural gas or close down completely. The association had pursued this goal for the past decade.
A single alderman with questionable ties to the power plants' owners was blocking the measure's passage -- until, that is, Grivois-Shah convinced SEIU to pull support from the alderman's reelection campaign unless he got behind the clean energy effort.
"Well, right before the runoff election, I was at a press conference thanking the alderman for his support of the ordinance on clean power and clean energy in Chicago, we endorsed his reelection campaign, and the coal power plants are now closed many years later, thanks to our advocacy efforts," he said.
Grivois-Shah assured attendees that they don't have to go big with their advocacy efforts -- like trying to pass universal health care -- right off the bat. Many of the things he has advocated for are what he called "low-hanging fruit" that can change a neighborhood and drive your passion.
"Tackle those small issues in your community, because you can make an immediate impact on your neighborhood that will really change lives," he said. "Then keep on fighting for those bigger issues, as well."
Lee wrapped things up by saying family physicians should aspire to become what they wrote they wanted to be as family physicians in their personal statements for medical school.
"We wrote about the things that these folks (the panelists) talked about: really making a difference, not just with the patients in front of you but also in the communities that we serve," he said.
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