Getting the real story on health
By Dana Goldman
Emory fourth-year medical student Alexis Ritvo is a go-getter with an impressive resume. She earned a bachelor's degree from Harvard and a public health degree from Emory's Rollins School of Public Health. In between, she spent time researching schizophrenia. But on a recent weekday, the future psychiatrist sat in the Grady Memorial Hospital pharmacy waiting for her number to be called. It's the place where many of Ritvo's Grady patients go to have their prescriptions filled. She arrived at 8 a.m., waited for three hours, and left empty-handed.
"I failed to get a prescription," Ritvo says. "I was 10 away from having my number called when I had to go to my next lecture." Her go-getting ability had run up against the realities of a complicated and often under-resourced public health system.
The assignment Ritvo was trying to complete by filling a prescription came about as a result of an emerging focus in Emory's medical school on social medicine. Social medicine looks at how economic, social, and cultural conditions affect health, so that health care providers can better understand and work with their patients to improve health outcomes. In the case of the Grady pharmacy, Ritvo says the lesson was clear. "I thought, gosh, if I'm having trouble, and I'm about to graduate with a medical degree, I can only imagine how some of these patients feel." She understood more clearly that cost is by no means the only barrier keeping patients from taking their medications. "We want people to be working and holding down jobs," she says, "but then they're going to have to take an entire day to get their prescriptions filled."
Lessons on the ground
 |
In a month-long social medicine elective this spring, Ritvo and a group of medical students and residents gained firsthand exposure to many of the social determinants of health that their patients encounter. Following individualized schedules, they toured one low-income community on the west side of Atlanta with a 97% unemployment rate, miles away from the nearest grocery store. They also visited homeless shelters, jails, nursing homes, patients' homes, and HIV and tuberculosis clinics. Some spent time shadowing Grady's chief of staff and chief medical officer to get a grasp of how Grady looks from the top-down. The elective also included weekly lectures on social medicine as well as lessons about legislation and lobbying efforts that affect health care. In addition to the elective, funded this year by Emory's Office of University and Community Partnerships, medical school faculty members have been integrating the lessons of social medicine into the rest of the curriculum as well as faculty development.
Grady internist and the elective's course director, Maura George, says these efforts to understand patients' health literacy and lifestyle pay off in the long run. "These factors are things we don't think about very much because they seem outside true science and the typical courses we take in medical school," she says. "But if a patient doesn't buy into what you're saying or has poor health literacy, you're not going to be effective at all."
Take the recent patient with high sodium levels who asked, "Do cheeseburgers have a lot of salt? I eat those every other day." George showed the patient how to read nutrition labels, with the hope that a simple, quick lesson might do more for the patient's health than increasing medication dosages.
The social side of medicine
For Emory medical resident Roger Alvarez, the spotlight on social medicine has helped him better understand his patients' backgrounds and how he can be helpful to them. Take, for instance, the high number of patients he treats who come to Grady straight from jail. "We got to tour the DeKalb County jail, meet with the doctor who sees the patients there and refers them to us, and see what our patients' experiences are on that side of things," Alvarez says. The result? "I know more about what we need to do to ensure continuity of care."
Both Roger Alvarez and Alexis Ritvo say learning about social medicine and social services for patients has already affected their work in significant ways. "In a practical way, I'll be able to give patients some specific guidance about resources and what to do next," says Alvarez. "I'll also be able to better understand where they're coming from."
For Ritvo, the lessons on lobbying and legislation stand out. Before this elective, she says, "I'd never set foot in the state Capitol or seen a committee hearing." Now, she's been three times and understands how social policy—for example, legislation requiring drug testing for welfare recipients—may impact her patients. "It was interesting to see where I may be able to get involved as a physician in the future," she says. After completing the elective, she says, "I won't have to get up as much nerve to introduce myself to my state senator and get involved in legislation."
The social medicine lessons the students have learned also are impacting George. "It's taught me to listen a lot more than I talk," she says. Asking questions about a patient's life and lifestyle is about more than just good bedside manner. In the long run, it saves you time," she says. "You get the real story from the patient."
And that makes all the difference.
Related Links
