When I first embarked on this question years ago--could physicians address social determinants of health in the clinical context? YES! This was my conviction. I believe in the physician as public health professional and as the community-responsive physician. Some physicians choose to wear different hats in a day even--caring to patients in clinic, hospital, volunteering with community organizations, advocating for policy change and researching on public health issues BUT most physicians in the US just practice medicine--what WE are best trained for. SO could we care for patients, group of patients, community, vulnerable populations, treat acute problems, manage heart failure, diabetes, stroke, mental illness as well as address issues such as poverty (very grandiose I know), racism, income inequality, physical inactivity, illiteracy, access to healthy food, transportation, crime, etc.? Could we refine our clinical skills, improve systems-based practice, coordination of care, team work, collaborate with public health department/researchers, explore further the interaction among various health determinants, divert some (MUCH MORE) resources from heatlh care delivery into addressing social determinants. I became interested in pay for performance in population health promoted by Dr. Asch and others, a lofty concept but complex in implementation. People say Obamacare, ACO are the baby steps in that direction. This website is perhaps an attempt to answer this question...
Our nation just experienced a tragic event at Sandy Hook. Dr. Suzanne Koven in her blog asked "Did any doctor ask Nancy Lanza about guns?" Would it help? Did Ms. Lanza have a PCP? Did Mr. Lanza ever seek help or disclose to anyone any trouble? answers we may never know. What is the role of doctors when it comes to gun violence? (stick to the A1C, LDL, BP and other quality measures in the 15 min visits right?). What is the evidence on gun violence? (stay tuned...)
"I wish to do something Great and Wonderful, but I must start by doing the little things like they were Great and Wonderful"