What is Public Health?

What is Public Health?

Let’s start out by dispelling the misconception that physicians are trained in public health and therefore should be consulted as experts during public health crises. For the most part, this is NOT TRUE. Physicians are trained to provide medical care – to diagnose, treat, and manage individual health problems. While some medical schools do teach epidemiology (the science of public health), it is not enough to head out into the world as a public health professional. If you’re a physician with a Master of Public Health (like I will be!), then you certainly have more credibility to speak on matters of public health as a physician. And the reverse is true as well – experts in public health who did not go to medical school are not doctors! The medical and public health professions need to work together beyond times of crisis and both need to be consulted by policy makers. Doctors alone should not be asked how to contain a pandemic – simply put, we are not trained to give that advice.

So, let’s get into it. What exactly is public health?

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The Friday Five 11.20.20

The Friday Five 11.20.20

Happy Friday! We made it to the end of another week! I spent a few days finishing up child psychiatry and then started adult psychiatry. There is so much to learn to best help these patients manage their mental illnesses and I am doing my best to stay on top of the studying. And of course, it’s almost Thanksgiving! I know there is a lot of extra stress and anxiety around how to see family safely or if to see them at all. I listened to this podcast episode with Dr. Fauci and it gave me a lot to think about in terms of how we continue to protect ourselves and our loved ones. And here are a few (well, five) other things I enjoyed this week!

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We’ve Got to Stop Meeting Like This

We’ve Got to Stop Meeting Like This

And by this, I mean every six months.

But then again, we’ve never lived through a global pandemic for months on end while trying to still live our lives, so I hope you’ll forgive me.

Since I was last here, a lot has happened. I moved back to Miami to start my third year of medical school and after months sitting at home studying for Step 1 (so long, farewell forever!), I was finally able to be in the hospital seeing patients! I started with 10 weeks of internal medicine and hopped between two general inpatient rotations, outpatient primary care, hepatology (liver) clinic, and the cardiology inpatient service. I learned the bread and butter of medicine during those 10 weeks — heart failure, hypertension, hyperlipidemia, infectious disease, liver failure…you name it, I probably saw at least one patient with it. The shift from learning for a multiple choice test to applying it to real patients was a struggle. One minute you have to pick the correct anti-hypertensive for your fake vignette patient, the next it’s a real patient with financial concerns, comorbidities, and a history of medication side effects. All in all, I am happy I started my year off with internal medicine. It offered such a breadth of experiences caring for patients admitted to the hospital, patients needing clinic follow-up for chronic conditions, or specialty care. It set me up perfectly for my next rotation, family medicine.

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Supreme Court to Rule on Access to Abortion in Louisiana

Down in New Orleans in 2016

I would say “how has it been 6 months since I posted here?!” but then again, I know that happened – the last semester of my second year of medical school and Step 1 happened. So here I am, 6 months later, getting back on the horse. I’ve still been posting over on Instagram, but I’m also just getting back to posting there after a break for my dedicated Step 1 study period.

A while back, I posted on my Instagram stories about oral arguments at the Supreme Court for June Medical Services v. Russo and asked if folks wanted to learn more about the role of the judiciary in abortion care. After hearing a resounding yes, I’m finally getting around to it. This was initially intended to be a post on IG, but the judicial system and processes that go with it are *complicated* to say the least and resulted in a post that was far too long. So I’m going to share here instead.

At first I thought I’d work my way forward from Roe v. Wade to today, but it seems more relevant to start in the present and look back to see how we got here. This post is going to look at the specifics of June Medical (and I’ll update it as soon as there is a decision!) and then forthcoming posts will look at Roe, Casey, Whole Woman’s Health (in more detail than presented here), and others.

So let’s head down to the land of beignets and jambalaya and get to it.

The Supreme Court is due to hand down a decision any day now in June Medical Services. At issue in the case is this: does the decision of the U.S. Court of Appeals for the 5th Circuit’s to uphold Louisiana’s law requiring physicians who perform abortions to have admitting privileges at a local hospital conflict with the Supreme Court’s 2016 ruling in Whole Woman’s Health v. Hellerstedt.

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Health Care Sharing Ministries

Last week, Washington State fined one of the larger health care sharing ministries $150,000 and banned it from offering its product in the state because it was operating as an unauthorized insurer. Other states are warning consumers to watch out for these plans, which can look like insurance but are not.  Health care sharing ministries (HCSMs) are organizations in which members share common religious or ethical beliefs and agree to make payments to (or share) the medical expenses of other members.

The groups originated in the 1980s in small religious communities and were exempted from following coverage guidelines mandated by the ACA. An estimated 1 million people belong to a HCSM, up from 200,000 before the ACA was passed a decade ago. 

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When We Know Better, We Can Do Better

How much does your doctor know about health policy and how it impacts you as a patient?

Unfortunately, not enough. Medical students are given little to no knowledge on how policy and politics influence the system we will train and ultimately practice in.

I’ve already written about this a few times, so check out this post on engaging in advocacy as a medical student, this one about integrating health policy in medical school, and this post on how medical schools are failing students on health policy.

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Federally Qualified Health Centers Do It All

Did you know that 1 in 12 people rely on Federally Qualified Health Centers (FQHC) for health care?

What is a FQHC? It’s a community-based organization that provides comprehensive primary care and preventive care to all persons, regardless of ability to pay or health insurance status.

The care includes health, oral, and mental health/substance abuse services. FQHCs operate under the Health Resources and Services Administration (HRSA), which is part of HHS.

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Will the ACA Survive the Scales of Justice Yet Again?

In late December, the U.S. Court of Appeals for the 5th Circuit struck down the individual mandate of the Affordable Care Act but ducked the central question – is the rest of the ACA valid after Congress zeroed out the tax penalty for not having health insurance?

The case was sent back to the lower court to reconsider how much of it survives; the lower court judge previously ruled the entire law unconstitutional. This move reduces the likelihood of the Supreme Court considering the case before the 2020 election, but the Democratic-led states defending the law might appeal directly to SCOTUS.

The case was brought by 18 Republican-led states and the ACA has been defended mainly by a coalition of Democratic attorneys general, as the Administration refuses to defend the law.

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Sunshine, Ocean Views, & Not Enough Doctors

The Florida Keys usually conjures up images of sunshine, ocean breezes, and copious cocktails. But beyond the vacationers paradise, there is the reality of life in the Keys – and needing access to health care.

Across the 137 square mile archipelago, there are only 266 health care providers for 74,000 residents (and 2.25 million annual visitors). The Florida Keys has a serious shortage of health care providers and services.

There are two main types of shortage designations, as determined by the Health Resources & Services Administration (HRSA).

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More Than Medicare-for-All: Proposals to Achieve Universal Health Coverage

Since the passage of the ACA, more than 20 million Americans have gained health insurance. But the fight for affordable and accessible universal coverage continues.

Here are just some of the proposals that have been introduced in Congress:

  • The Medicare for All Act of 2019 (H.R. 1384/S.1129) would establish a national health insurance program administered by HHS.
  • The State Public Option Act (H.R. 1277/S.489) would allow states to offer residents of all incomes the option to buy into Medicaid. This option would compete with private plans on the ACA Marketplace.
  • The Medicare Buy-In & Health Care Stabilization Act of 2019 (H.R. 1346) would allow individuals aged 50 to 64 to buy into Medicare and provide some marketplace stabilization.
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