Opinion : Population medicine
Submitted as a position paper for my Med. and Society ethics class:
In traditional health care delivery, the role of the physician has been to look after the health of the small group of patients who regularly come into his office. This model works great as long as everyone in a given area has a physician and goes to see them regularly. Physicians in this model can work together to solve local problems and can quickly implement public health policies by coordinating informative office visits. This model applies poorly to current healthcare in the US however, and therefore works poorly to implement change. The traditional model is poorly representative because not everyone in society has a physician and many people do not go regularly. Traditional models are also affected by current economic realities and modern health communication techniques that do not involve physicians. The reason that these realities are important is that patients do not live in a vacuum. Each person's health and actions affect the health and welfare of others in the general community. To serve the health interests of their patients, therefore, modern physicians must take on a public health role and tend to the needs of the community at large.
To serve the needs of the community, physicians should strive to achieve 4 things: rational, proactive, public policies that promote health and safety, expanded access to health care for all individuals, public education, and minimizing the cost of healthcare to society. While these imperatives do not trump the care that needs to be provided to an individual, these ideals must influence decisions and guide the actions of physicians in their private lives.
As far as influencing public policy, physicians have a duty to promote government policies and organizations that improve public health. They must use expertise and influence to gain benefits for everyone and to counteract economic and social forces that may seek to hurt patients for profit. This may include lobbying for clinics for the underserved, lobbying for healthcare reform, and supporting research in the public interest. Expanding healthcare access follows along the same lines, and may mean moving to underserved areas and supporting charity clinics.
Working to lower the cost of healthcare is another interrelated topic that should be strived for. Physicians should make treatment decisions that keep the cost low, no matter who is paying the bill. Sometimes, financial decisions that benefit patients must be made contrary to physicians own interests, but this is something that physicians owe society as professionals as long as the cost is reasonable.
A final duty of a physician to their community is that of public education. Doctors need to go beyond simply teaching their individual patients and seek ways to spread effective health messages to the community at large. This should be easier with modern media such as the internet, but also old-fashioned lectures should help as well.
To fully serve their patients, physicians have a duty to reach out to others in the community. When people are more educated about their health, have greater access to health care, and live under a government with pro-health policies, everyone benefits.
Labels: medical ethics, opinion
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