Written by Aaron Fox, MD, MS. Dr. Fox is an assistant professor of medicine and a clinician-investigator in the division of general internal medicine at Albert Einstein College of Medicine and Montefiore Medical Center; Co-director of the Bronx Transitions Clinic; and NPA Copello Health Advocacy Fellow.
Every Saturday morning, I see patients at the Bronx Transitions Clinic, which serves formerly incarcerated individuals. For most of my patients who are coming home from prison, acquiring stable housing and employment is a higher priority than managing their chronic illnesses. As a primary care physician, I may not be able to offer them jobs; however, without recognizing the impact of joblessness on their health and wellness, there is no way I can make a correct diagnosis.
At a time when more medical students are specializing, with narrower focuses and more emphasis on procedures and technological interventions, we need to train physicians to think broadly about health and wellness and give them opportunities to effect change. We’ve narrow-mindedly focused on problems that can (or cannot) be fixed—tumors to remove, joints to replace, hearts that need a “tune-up”—at the expense of prevention and health promotion. Data demonstrating the pernicious effects of some social determinants of health, such as poverty or racism, are irrefutable. But these social conditions are not easily fixed. Nonetheless, physicians need to attempt to address these problems.
Originally published April 16, 2015 in The Doctor’s Tablet, a blog from the Albert Einstein College of Medicine of Yeshiva University.