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.
I wanted to write this post last week, but I had to play some serious catch-up with school work instead. I shared a little bit about the conference I attended in D.C. and the amazing celebs I met (!!) but I wanted to let you in about why I attended in the first place and why I think more medical students should be engaged in advocacy.
Prior to medical school, I worked at a policy non-profit in D.C. for three years. Part of my job included meeting with Congressional staff and legislators and running workshops to give high schoolers and adults the skills to be an advocate at the local, state, and federal level. I loved teaching about the basics of government, a little bit about a policy issue, and giving some tips for effective advocacy. [I’ll be back soon with my tips for effective advocacy!]
The “pre-clinical” years of medical school are pretty similar at most medical schools — anatomy, basic science courses, and organ modules. No matter how the curriculum works, you spend a lot of time watching lectures and studying in the library. I only have two weeks left of our cardiovascular system module and then it’s Spring Break and our last module of MS1, Neuroscience and Behavioral Science! I had a busier than usual day earlier this week and thought I’d take you through it!
I need to thank the Clare at Fitting It All In for blogging about her experiences in a post bacc premed program. When I learned that this type of program existed for people like me — career-changers who wanted to go to medical school (or other biomedical or health sciences careers) with no science background — I got onto Google and typed in “post bacc premed blog.” Her site was one of the first to come up! Now I’m in medical school after five years in the professional and graduate school worlds, a year in a post bacc, and a glorious year spent as a nanny for the cutest two year old. So, I think it’s time to pay it forward.
Every post bacc is structured a bit differently, but they’re all geared towards to same outcome: complete the basic prerequisites for medical school admission, immerse yourself in medicine (to varying extent at different programs), prepare for the MCAT, and have an advisor to guide you through the application process. This last point is why I decided to pursue my coursework in a post bacc program as opposed to a DIY situation at a community college — with the added bonus that I could do it all in one year. (Some post bacc programs are two years; mine had the option of a one or two year track.)
Nutrition education is lacking in most health professions education — either isn’t incorporated, exists in the context of specific disease-related diets, or glosses over the concept of nutrition and diet. Honestly, it’s understandable considering how much knowledge needs to be conveyed and learned — especially in medical school, the only health profession I can speak to personally. But, just as I’ve written before about the need to incorporate more health policy education, it’s time to also offer more discussions about nutrition and the vast impact of society and policy on the “what” and “where” people eat. [Also just as important is proper education on eating disorders. This post from my friend Clare of Fitting it All In is a great overview about caring for individuals with eating disorders.]
Obesity is common, costly, and poses serious health risks. So let’s start with some numbers to get our bearings about why this topic warrants our attention:
I may have hit snooze a few times this morning, but eventually I rolled out of bed, made some coffee, and started my morning routine of skimming the news and some journals for about 30 minutes before diving into my study tasks for the day.
I planned to post a short recap of this mornings offerings on Instagram, but there were just too many great reads that I wanted to share. Here is a brief glimpse at what I’m reading this morning [if I told you what was on every open tab, we’d be here until tomorrow morning]:
We are in a time when physicians are increasingly speaking the language of health policy and public health — “value-based care,” “co-payment,” “social determinants of health,” “accountable care organization” — and are increasingly asked by patients to ensure that a particular treatment or procedure is covered by their insurance before moving forward. This dizzying list of health policy terms (and the responsibility of a physician to understand the lingo) just keeps growing. And there is no better time to introduce students to this world than in medical school, when they are primed for learning and not yet overwhelmed with patient care.
On a short study break, a classmate and I were discussing how the public health and health policy courses we took in graduate school influence our view of the healthcare system as medical students. It was the most productive form of procrastination (nerding out about public health and health policy) but it was also supremely frustrating to talk about all the problems in the healthcare system. The ACA was such a monumental step forward and now it seems like we’ve taken many steps back–only 34 states have expanded Medicaid, states are implementing work requirements for Medicaid, and Congressional Republicans have tried to repeal the ACA dozens of times with no real replacement or effort to fix the provisions that aren’t working well.
The rigors of basic science prerequisites, medical school itself, and medical training make it a serious challenge to give students and trainees appropriate and comprehensive knowledge of the larger health care system outside of their own experiences. As two medical students with graduate degrees in public health and personal interests in varied health policy topics, we see the impact of limited health policy instruction in medical school curriculum. We hope Health Policy Ddx can help to fill this void and encourage broader interest in health policy among medical students.
The ever-evolving landscape of health care delivery has emphasized the need for health policy literate physicians. However, a small body of research has indicated that nearly half of graduating medical students feel they receive inadequate instruction in health policy. Another survey of medical students indicated that 58% of respondents felt they received “too little” health policy education. This is an educational failure for future health care practitioners–one that is also reflected in anecdotal evidence of our peers. For example, rather than harboring frustration when a patient does not take their prescribed medication, it is imperative that providers probe for intentional (and unintentional) reasons for medication nonadherence. This is just one situation where knowledge of the U.S. health care system and the barriers faced by vulnerable populations is particularly crucial. Perhaps transportation to the pharmacy is an issue, or the patient does not have consistent access to food and the medication requires it be taken with food. Understanding the system that impacts your patients’ access to care allows you to better provide more appropriate and individualized medical treatment.
Just as medical schools revamp their curricula to reflect advances in clinical and biomedical sciences, so too should they update their academic offerings to provide students with instruction in health policy and public health. Medical schools offer instruction on the biological mechanisms of vaccination and the schedule by which it should be provided, but often lack even a brief contextual discussion of the legal basis for compulsory vaccination. Students will memorize hundreds of medications, including those for conditions that inhibit concentration in school-aged children however, they will spend minimal time discussing that lack of access to food and physical activity (both under the purview of federal and/or state policymakers) can significantly impact focus in school. Medication might still be a necessity for some children, but looking beyond the immediate medical complaint to the child’s environment could impact how and what care is provided.
Medication noncompliance and understanding children with concentration issues are just two situations in which a greater understanding of health policy and public health would be useful. Providers will encounter situations like this every day, with nearly every patient, because each patient is a unique human being with unique experiences and environments. Patients do not live in a vacuum and we must understand the greater policy forces at work that impact how they lives their lives.
Health Policy Ddx will provide updates on pending legislation, brief overviews of important laws and regulations, roundups of ongoing and interesting policy research that impacts clinical practice, and everything in-between that might be of interest for health policy nerd wanna-be’s. Until all medical schools provide adequate, comparable instruction in health policy, Health Policy Ddx will try to level the playing field and infuse health policy into the everyday clinical education of medical students.