The practice of medicine is limited by what we can control. As students, we are taught to believe in the power of science, the importance of hard work, and the momentum of technological advancement as prime determinants in our patients’ outcomes. However, as we get further along in our careers, we come to realize that many of the factors that contribute to poor health are beyond our control at the bedside.
Health isn’t simply about one’s blood pressure or your weight, their serum cholesterol or how many minutes a day they spend exercising. Health is, in fact, determined by much larger social factors such as access to health care, education, protection from discrimination, and environmental safety. As doctors, we can treat the diseases that result from inequities or stressors resulting from these social determinants, but we can almost never address the larger social factors themselves. By the time our patients get to us, if they can get to us at all, our efforts are often simply putting a dressing on much larger wounds we don’t always have the power to heal.
Years ago, I was on call overnight when we got word of a critically ill patient who was being transported in by medical helicopter from a small rural hospital in North Georgia. This was a young patient, thought to be healthy, who woke up the previous morning with tearing chest pain. This patient, however, did not have health insurance, and concerned about her out of pocket medical costs, she took some antacids and went back to bed, hoping the episode would pass.
More scared about the cost of her care than the severity of her symptoms, she waited. And waited. And waited.
She waited until she was so sick that the small regional medical center closest to her—still a long drive away from home—was unable to treat her condition. And now, critically ill, literally hours from death, she was being transported by air to my tertiary care hospital in Atlanta.
The patient had an aortic dissection, a condition where the inner layer of the body’s largest artery shears away from the outer wall. It has one of the highest mortality rates of any surgical emergency we encounter. She was a young patient, and we worked on her desperately, operating throughout the night, cracking open her chest, pouring blood into her body as she hemorrhaged on the table, shocking her heart once, twice, when it stopped beating.
We brought her up to the ICU after eight hours of surgery, and watched as her family sat at her bedside, wondering if she would ever wake up.
None of this had to happen.
This patient’s primary risk factor for her aortic dissection was garden variety high blood pressure. High blood pressure which could have been caught at an annual physical, treated with standard medication, and managed with regular preventative care. Because the patient was granted none of these points of access, her interface with the medical system was catastrophic and nearly cost her her life.
This is but one story, but a version of which we see play out, in ways large and small, every day. Lack of access to basic preventative care. The high costs of essential medications. Socioeconomic disparities in health outcomes. Public health perils like governmental infringement on reproductive rights, absent gun control laws, and a growing uninsured population. These social determinants of health are beyond my ability to treat as a health care practitioner. They are, however, within the purview of government.
So to improve the health of my patients, I have decided to run for State Senate. Health care is the #1 issue in this upcoming election, and I strongly believe those of us working at the front lines should have a seat at the table, and that we need health policy written by those who know it best.
Certain interest groups interested in keeping public health out of political conversation have told physicians to “stay in our lane,” as though the larger issues that affect our work and our patients should be none of our concern. But our lanes are wide, and they stretch to the horizon. And there is no stopping a group of hard-working, devoted professionals utterly committed to the mission of improving the health of our patients and our communities.
We have the benefit of an advanced health care system, staffed by the most highly trained, talented practitioners in the world. So let’s think broadly, act locally, and fulfill our oath to protect and work hard for the patients we have dedicated our lives to serve.
Image credit: Michelle Au