Ana sits on the exam table in front of me explaining how, in three short weeks, her mother will evict her from her childhood home. She is eight months pregnant and is studying night courses to become a paralegal. As her prenatal provider and primary care physician, I have been sending referrals to numerous community agencies in hopes of securing housing at the local YWCA.
Health and wellness are more than a simple product of access and initiative, as such a simplified formula is only enjoyed by a very small minority. The equation becomes more complicated as new factors enter, such as unemployment or housing insecurity. Despite their importance as determinants of health, such elements are seldom addressed in the medical interaction between patient and physician, and are thus discarded in the interest of a perceived efficiency.
As I contemplate the future of our country, the future of medicine and the future of reproductive health and justice, I am truly frightened of what is to come. Since our president appears to base his desires on what makes him popular, I fear that he will gut Planned Parenthood, turn over Roe v Wade, and make it even more difficult for women to afford and access care, all in the name of ego.
Physicians must begin to view domestic violence as we do influenza or vehicle safety. We must prevent it at all costs. And if it is not prevented, we must aggressively treat it. This will require extensive collaboration with colleagues, public health services and law enforcement. Though the challenge is enormous, physicians ought to address this societal disease and be at the forefront of care.
In April, I had the pleasure of attending the 4th Annual Lown Institute Conference in Chicago. The Lown Institute was named after and inspired by Dr. Bernard Lown, a renowned cardiologist who also championed social change by co-founding the International Physicians for the Prevention of Nuclear War, an organization to prevent nuclear war during the Cold War. The theme of the conference was promoting “right care” by addressing overuse, underuse and misuse of medical services through a coalition of patient advocates, community organizers and medical professionals.
In the past two months, a group of Harvard medical students have launched the “End Step 2 CS” campaign, an effort to do away with the portion of the U.S. Medical Licensing Exam that tests clinical and communications skills in a hands-on, day-long clinic simulation using standardized patients. Not only is the Step 2 CS exam a necessary public safeguard, it has greatly strengthened the curriculum of medical schools nationwide.