Exploring Health Care’s blind side with RWJF, AAMC, and TEDMED – its vision is improving

Findings from RWJ Physicians Daily Life Survey

Last week was an interesting confluence of learning and experience with iconic organizations in the health care world. During the week I was:

Unmet social needs – like access to nutritious food and adequate housing – are leading to worse health for all Americans, according to 85 percent of physicians recently surveyed by the Robert Wood Johnson Foundation. Although most physicians say patients’ social needs are as important to address as their medical conditions, four in five feel they don’t have the capacity to effectively address social needs.

This is health care’s blind side: Within the current health care system, physicians do not have the time or sufficient staff support to address patients’ social needs.

The above is from the Physician’s Daily Life Survey, done in 2011. The images on the right are findings from the study that I thought were interesting. In the first image, it can be seen that physicians in practice understand the limits of medical care and wish they could do more.

The second and third image tell me that maybe there are knowledge gaps, too. And it’s a “maybe” because of the way the questions were asked – do physicians think lack of patient motivation is at the heart of their un-health? Or do they think that lack of motivation to make healthy choices is trumped by motivation to solve greater problems created by community conditions? Social determinant theory would say the latter is true. We can’t know, though, unless we talk to people in more detail.

And…that’s where the forum moderation came in ( you can access it here, feel free to join in the dialogue ) – I served as a guest moderator for a week where people came together to share novel programs to bridge the divide between health care and social determinants. I learned that there are many more disciplines and health care organizations involved in figuring this out than I previously thought. There’s the Health Leads program that significantly reduces the friction of referring patients to social services that have the capacity to assist. There are models of “health impact investing” to create a tangible return on investment for the financing of upstream interventions. I really appreciated input from the Quantified Self community, because I have wondered if QS is slightly at cross purposes to social determinants. See what you think by reading the thread….

AAMC and future leaders

Finally, there is a discussion on the training of physicians, which was the perfect complement to my time watching TEDMED at AAMC in Washington, DC. I wanted to see TEDMED, however I asked my employer not to purchase a pass for me (which, I’ll be honest was on the very expensive side), so those funds could be used to support other programs for our members. As luck would have it, Lesley Ward reached out to me on behalf of AAMC to watch the live feed at their headquarters, which they sponsored this year, perfect compromise.

So there’s health care’s blind side and then there’s Ted Eytan’s blind side, which is that I am disconnected from the undergraduate medical education system in my daily work. Not only did I get to see great TEDMED speakers, I got to learn more about how this membership organization (much like the one I work for is one) is helping prepare tomorrow’s leaders amongst these discussions about social determinants.

The new MCAT

I had briefly heard about this change, and my last week stimulated my interest to see what the changes are. As the announcement and detailed preview guide shows, there’s now a greater emphasis on Behavioral and Social Sciences.

My curiosity was piqued so I went in to review sample questions relevant to social determinants. There’s a question on 122 of the guide that is about bias in care, and a question on page 125 of the guide that is about health inequalities based on years of education.

If you look on page 110 of the preview guide (I’m not copy-pasting due to copyright restrictions, unless AAMC says it’s okay), it’s impressive to see the description of social inequities, including a discussion of racism and institutional bias on the admissions exam for medical school. Think about it, it’s significant. On top of this, Darrell Kirch, MD, says something very important in introducing the new test , which is that it will encourage pre-medical students to take more sociology and psychology courses to prepare for it.

“Behavioral and Social Science Foundations for Future Physicians”

This is a report published in January, 2012, also by the AAMC that addresses the big picture of social influences in medical education. When I read it I say both, “This really needs to be integrated” AND I say, “there is a LOT that medical students need to learn to be competent physicians.” We need them to be excellent diagnosticians for individuals at the same time we need them to lead health improvement in society. There is a time/bandwidth conflict in these goals, and the examples in the report, which are about specific clinical situations, illustrate this without actually pointing it out.

If people are interested in learning about the  journey of our undergraduate medical system to address social determinants, this is a good start.

I also want to reflect on my own undergraduate medical education training. It was as exciting as it was demanding. It was actually fun to learn the secrets of the human body in an adult way (my dad was a doctor, so I knew some of the secrets in a non-adult way). Every day a new organ system or pathology was introduced and there was always more to be fascinated by in this finely tuned orchestra of DNA and cells that wasn’t made by us. Maybe the next phase will be to create that same excitement about the systems that are made by us at the same time, so that we can be great at what is vital for us to be great at, and be terrific collaborators and leaders in the reduction of health inequalities, which we will eventually treat anyway.

That’s the end of this long blog post, see what you think, comments welcome, and a great honor to be in the intersection of so much innovation all at once.



Thanks Ted for your comments….
Although it feels like it takes a generation to effect real change in academic institutions, the AAMC is working hard to accelerate the transformation. It starts with who we accept into medical school but continues as we become more thoughtful about the role models we emulate for new learners and the environment of care that they train in. Over 100 years ago, Flexner said that teaching hospitals should be the very best at applying great biomedical science to the educational environment…we need to expand that now to include the best insight into population health, health policy and a deep understanding of quality and patient safety.
The AAMC has a blog http://www.WingofZock.org that is actively soliciting feedback from all members of the academic healthcare team.
Flexner has a often reference quote…
“Nations have recently been led to borrow billions for war; no nation has ever borrowed largely for education… no nation is rich enough to pay for both war and civilization. We must make our choice; we cannot have both.”

Seems like the dilemma we are facing now over medical education.

 @Dr Joanne Conroy Dear Joanne, 
Thanks for taking the time to comment and add your perspective. I forgot to mention that I got to meet the “Zock” team last week and I think the openness to social media is a nod to understanding this dilemma and seeking creative solutions. I encourage people who talk and think about medical education to visit and interact (and follow on twitter wingofzock . Thank you again for the hospitality,

Ted Eytan, MD