Berks County Medical Society Medical Record Fall 2018 - 6

Editorial Comments: "What the Patient Needs is a Doctor"
continued from page 5

Despite the emphasis on productivity as measured in RVUs
and reimbursement dollars, and the rapidly rising percentage of
U.S. GDP spent on an increasingly sophisticated, technologically
advanced health care system, the return on our investment has been
disappointing, to put it mildly. Health outcomes in other developed
countries that spend far less per capita on health care outshine those
in the U.S. year after year. What are we doing wrong? There are
so many answers to this question I want to acknowledge right now
that the issues being discussed here are just pieces of a much larger
puzzle. Without addressing these particular pieces, however, the goal
of improving our country's health in a cost-effective manner will not
be met.

is strongly correlated with those social determinants known to
predict worse health and premature mortality.1 Specifically, risky
behaviors such as smoking and alcohol and other substance abuse,
along with obesity and exposure to environmental toxins, become
more prevalent with lower socioeconomic class. He argues that the
prevalence of poverty and degree of income inequality our society
tolerates is a major obstacle to attaining improved population health.
Dr. Stead came to a similar conclusion from his experiences working
in several city hospitals serving indigent populations: "You have
also come to face the fact that, when the social systems have broken
down and education, housing, food, and jobs are absent, doctors just
don't do much good."2

It is self-evident that if the most important determinants of
health are related to behavioral, socioeconomic, and environmental
factors, these realms must be incorporated into any effort to arrive
at a healthier population. With the reimbursement shift currently
underway towards paying health care providers based on health
outcomes rather than on volume of services, providers who fail to
find a way to efficiently learn about the social determinants of each
patient's health and utilize that knowledge to provide more effective
care will be penalized. In his article, Jerry Zhu creates a clinical
scenario which illustrates the potential adverse effects of paying
insufficient attention to a patient's particular life circumstance on her
potential to recover from a myocardial infarction. When patient care
is informed by knowledge of pertinent social determinants, patients
do better and physician satisfaction rises. At the close of his article,
Jerry presents recommendations for concrete steps physicians can
take towards better incorporating knowledge of social determinants
into their practices.

Truly 'owning' patient care, therefore, includes advocating
for our patients in the larger social and political realm. As Dr.
Schroeder puts it, "...in the absence of a strong political voice
from the less fortunate themselves, it is incumbent on health care
professionals, especially physicians, to become champions for
population health. This sense of purpose resonates with our deepest
professional values and is the reason why many chose medicine as a
profession." Advocacy-for our profession and for our patients-is
one of the four 'compass points' guiding the activities of the Berks
County Medical Society. Recent examples of patient advocacy
initiatives include taking a leadership role in combatting the opioid
epidemic in our community and in the successful effort to bring
a federally qualified health center to Berks County. If you are a
member, thank you for your support. If you are not and you want
to step beyond the exam room in caring for your patients, consider
joining us today.

While better knowledge of patients' life circumstances can be a
valuable tool for providing the best possible care, physicians who
don't venture beyond the exam room themselves to tackle the most
important determinants of health are accepting a life of limited
usefulness. Dr. Steven A. Schroeder (currently Distinguished
Professor of Health and Health Care in the UCSF Dept. of
Medicine, and previously President and CEO of the Robert Wood
Johnson Foundation) points out that social class status in the U.S.

6

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www.berkscms.org

1

S.A. Schroeder, MD. 'We Can Do Better-Improving the Health of the American

People'. N Engl J Med 2007; 357:1221-1228
2

'Gene Stead Looks at Doctoring: A Piece of a North Carolina Doctor's Mind'. Adapted

from the Frank R. Lecocq Lecture delivered at Duke University Medical Center on April
23, 1993.


http://www.berkscms.org

Berks County Medical Society Medical Record Fall 2018

Table of Contents for the Digital Edition of Berks County Medical Society Medical Record Fall 2018

Berks County Medical Society Medical Record Fall 2018 - 1
Berks County Medical Society Medical Record Fall 2018 - 2
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