Think and do: How to change the world

One of the questions that I am often asked is why I chose to study public health in addition to my medical training. The answer is simple: I believe that the therapeutic relationship can and should exist outside the four walls of the doctor’s office. While medicine and therefore physicians will always be necessary to cure disease, I see problems in the world that must be solved on a structural level — from the environments in which we live and work that promote unhealthy behavior, to the very real disparities in access to and quality of care.

I am aiming for a career that allows me the ability to practice medicine as well as engage in public health intervention work at a local or regional level. Where my colleagues will use their non-clinical time for pure bench or clinical research, my focus will be on applying medical and public health knowledge in tangible and durable ways both in and out of the hospital.

Pure research is absolutely necessary to advance the state of knowledge on health and disease, but applied research touches more lives. In pure research, the goal is solely descriptive, or the trial or intervention often ends when the project is over and it is time to publish. To me, this belies a flawed mindset: “I’ll do the research to find answers, but it’s not my job to use that knowledge in a tangible way. I will leave it to someone else to do.” Sadly, just because the findings are known doesn’t mean that the necessary intervention will be “built” or the targeted patient groups will “come.” Allusions to old baseball movies aside, this is certainly true of the policy arena: policy is largely driven not by science but by public opinion and the hot topic du jour. See: Debates around climate change, evolution, physician drug testing, etc.

In applied research, the intervention should be the primary motivation, with reporting “outcomes” only as a supportive and secondary motivation. “Moving Beyond Description” was the subject of a panel at the 2014 National Health Policy Conference that advocated focus on “community-based interventions that address disparities in health and healthcare utilization and outcomes” and less purely descriptive research. There are many examples of successful intervention research endeavors, from the Hip Hop Stroke program by Columbia’s Dr. Olajide Williams that teaches children to recognize the signs of stroke and call 9-1-1, to the National Diabetes Prevention Program funded by the CDC to prevent type 2 diabetes in adults through evidence-based lifestyle change.

To accomplish this type of work, connections need to be made between hospitals and community organizations, both of which do good work and change lives daily, but in different ways. With my dual training, I can forge these connections more easily. Therefore, instead of working in silos and speaking into vacuums, hospitals and community organizations can align themselves towards common goals.

This is why I want to do public health, why I studied health policy, and why I believe that “thinking” without also “doing” is morally tenuous. As a doctor I want to treat patients, but as a physician-public health professional, I want to change the world around me.

Image credits: SimonAlexAnderong.com and Blogspot.com.

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