2021 Namey/Burnett Preventive Medicine Award Submission
By Shikha Patel, OMS-IV, Rowan University School of Osteopathic Medicine

The goal of preventive medicine is to prevent or slow the progression of disease and promote better health for patients. General preventive care includes routine vaccinations, screening exams based on age, gender and risk factors, and lifestyle and dietary modifications. Regular office follow-ups also serve an important role in chronic disease management and prevention. This art of preventive medicine is key in promoting overall patient wellness and helping patients lead high-quality lives. In this traditional practice of prevention, an aspect that is often neglected is that of advocacy.

There have been multiple definitions for what advocacy entails, but the following is used for the purposes of this post: “Action by a physician to promote those social, economic, educational and political changes that ameliorate the suffering and threats to human health and well-being that he or she identifies through his or her professional work and expertise” (Earnest et al., 2010). It is important to note here that advocacy is not just political as it is sometimes confused to be; the key element of advocacy is to promote change in the current system.

Medical training allows physicians to develop an in-depth understanding of health, medicine, and the healthcare system. Having this knowledge can enable providers to recognize problems at all levels that could be impeding patient health. However, merely acknowledging systemic issues will not lead to improved patient well-being. There need to be more medical students and physicians utilizing their knowledge and skills to take action and advocate for changes in the system which can lead to better health for patients. This blog post seeks to provide an understanding of the landscape of advocacy in medicine and propose solutions to increase medical student and physician advocacy efforts.

Patients do not live in isolated bubbles; they exist in an ecosystem and as such it makes sense that their health status will be determined by the ecosystem. Social determinants of health are the “conditions in the places where people live, learn, work and play that affect a wide range  of health and quality-of-life risks and outcomes” (Centers for Disease Control and Prevention, 2020).

In one study, researchers examined family physicians’ level of engagement in addressing social determinants of health through either clinical actions or population-based actions, which involved different forms of advocacy (Kovach et al., 2019). From 434 responses, results showed that only 43.3% of physicians engaged in at least one population-based action compared to 81.1% being engaged in at least one clinical action (Kovach et al., 2019). Some barriers to action were identified as time, staffing, ability to provide a solution, lack of financial incentives, lack of community resources, lack of education or training, and lack of resources integrated with the electronic health records (Kovach et al., 2019). Population-based action was also found to be positively associated with physicians working at federally qualified health centers (FQHCs) or in areas with low median household incomes (Kovach et al., 2019). In terms of political engagement, another survey showed that only 25% of US physicians said that they were engaged in other political activity related to health issues besides voting in elections (Gruen et al., 2006).

Even though individual physician advocacy efforts seem limited, there is no denying that the osteopathic medical profession acknowledges the importance and need for advocacy. The American Osteopathic Association (AOA) advocates at state, national and international levels on behalf of the osteopathic medical profession. Similarly, individual state and specialty organizations are also engaged in advocacy. The American College of Osteopathic Family Physicians (ACOFP) advocates on behalf of osteopathic family physicians and supports advancements in primary care. The Association of American Colleges of Osteopathic Medicine (AACOM) advocates to support osteopathic medical education. The Student Osteopathic Medical Association (SOMA) represents osteopathic medical students.

While advocating on behalf of the profession, these organizations give opportunities to their members who can join committees and working groups to become involved in advocacy efforts. These organizations also provide avenues for more direct advocacy. For example, AOA hosts an annual DO Day on the Hill to allow over 1,000 physicians and medical students to meet with their lawmakers in Washington, D.C.

Over the years, one method to increase physician advocacy involvement that has been repeatedly suggested is to increase training in advocacy during medical school. A survey showed medical school deans rated health policy related topics as significant to include undergraduate medical education (Patel, 1999). Another study showed that students who participated in the Leads Education Advocacy Development Scholarship (LEADS) program at the University of Colorado Denver School of Medicine were more likely to consider future involvement in health advocacy (Long et al., 2011).

In yet another study, researchers introduced an advocacy curriculum to a previously existing health care disparities course for first-year medical students at the Pritzker School of Medicine, and they found that a significantly greater amount of students identified themselves as advocates after completing the course as compared to before the course (Press et al., 2015). The researchers also noted that more students said they wanted to be advocates than students who identified themselves as advocates; the authors reasoned that this could have been due to a lack of empowering students in advocacy (Press et al., 2015). These studies all showed that including advocacy education during medical school can be beneficial in increasing overall advocacy efforts.

Historically, osteopathic medicine has prioritized primary care and preventive medicine. Osteopathic medical students are trained in evaluating a patient using a biopsychosocial approach and understand that systemic factors influence patient well-being. Thus, they are in a privileged position to serve as advocates to bring changes in the healthcare system and remove impediments to people being able to live healthy lives.

Increasing medical school training in advocacy could be a possible way to increase engagement in advocacy. Another way for medical students and physicians to become involved is by becoming active within professional organizations that are already performing advocacy work on a routine basis.

Attending events like DO Day or writing letters to/calling lawmakers can be a direct way to engage in political advocacy. Partnering with community organizations already seeking social change can allow physicians and students to become advocates and support their local communities. Using social media platforms can be a quick way to share their message to the public. Serving on advisory boards for local organizations can be another way to promote change.

Advocacy can take place in any form as long as the goal of promoting change in the system can be achieved. What’s most important is to start taking active steps towards advocacy. The profession also needs to do further research to better understand what is preventing advocacy and how to better support advocacy efforts. By engaging in more advocacy, current and future physicians will be able to make a positive impact on patient health and wellness.

Bibliography

Centers for Disease Control and Prevention. (2020, August 19). Social Determinants of Health.

Centers for Disease Control and Prevention. https://www.cdc.gov/socialdeterminants/ index.htm.

Earnest, M. A., Wong, S. L., & Federico, S. G. (2010). Perspective: Physician Advocacy: What Is It and How Do We Do It? Academic Medicine, 85(1), 63-67. doi:10.1097/acm.0b013 e3181c40d40

Gruen, R. L., Campbell, E. G., & Blumenthal, D. (2006). Public Roles of US Physicians: Community Participation, Political Involvement, and Collective Advocacy. JAMA, 296(20), 2467. https://doi.org/10.1001/jama.296.20.2467

Kovach, K. A., Reid, K., Grandmont, J., Jones, D., Wood, J., & Schoof, B. (2019). How Engaged Are Family Physicians in Addressing the Social Determinants of Health? A Survey Supporting the American Academy of Family Physician’s Health Equity Environmental Scan. Health Equity, 3(1), 449–457. https://doi.org/10.1089/heq.2019.0022

Long, J. A., Lee, R. S., Federico, S., Battaglia, C., Wong, S., & Earnest, M. (2011). Developing Leadership and Advocacy Skills in Medical Students Through Service Learning. Journal of Public Health Management and Practice, 17(4), 369–372. https://doi.org/10.1097/phh. 0b013e3182140c47

Patel, K. (1999). Physicians for the 21st Century. Evaluation & the Health Professions, 22(3), 379–398. https://doi.org/10.1177/01632789922034374

Press, V. G., Fritz, C. D. L., & Vela, M. B. (2015). First-Year Medical Student Attitudes About Advocacy in Medicine Across Multiple Fields of Discipline: Analysis of Reflective Essays. Journal of Racial and Ethnic Health Disparities, 2(4), 556–564. https://doi.org/ 10.1007/s40615-015-0105-z

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