Wednesday, March 30, 2016

National Doctors' Day

Today is National Doctors’ Day, “a day to celebrate the contribution of physicians who serve our country by caring for its' citizens.” Surveys show that Americans love their own physicians and appreciate the great care they receive even as they acknowledge that our medical system doesn't always work as well as it should. Because clinical care accounts for only about 10% of our health yet absorbs 95% of our health resources, some critics have concluded that our clinical care system (personified in physicians) is more of a deterrent than a contributor to our overall health. Fortunately, that view is in the minority because a high quality healthcare system is essential in maximizing the health and well-being of our society. Without excellent clinical care people would be dying sooner than they should, injuries and pain would be debilitating, and quality of life would be diminished.  Certainly, our healthcare system has some major flaws but our work should be to diminish its deficiencies and increase its effectiveness.
However, medical care alone can’t make us healthy. We need a broader approach to health which focuses on creating the conditions in which people can be healthy.  That task is the responsibility of everyone in our society as we work to create the policies, systems, and economic and social environments that give everyone the opportunity to be healthy. Included in that approach is building a robust and high quality public health system that can respond to the needs of our rapidly changing society. And that public health system needs to be integrated with our clinical care systems so that we have a continuum of protection, prevention, promotion, treatment, and rehabilitation services. And who better to help with that integration than physicians who can bridge the divide between treatment and prevention? 
Even though many believe that the idea of the “integration of medical care and public health” is a new concept, those who know the history of medical care and public health realize that a better term would be “re-integration” because at its foundation, health care has always been about both treatment and prevention. The oath created by Hippocrates, the Father of Medicine, that many physicians take as they enter the field of medicine states: “I swear by Apollo, the healer, Asclepius, Hygeia, and Panacea…” Asclepius is the god of medicine, Hygeia the goddess of public health, and Panacea the goddess of universal health. Thus, physicians take an oath to heal, treat, and prevent for the betterment of all. I can’t imagine a better and more time-tested statement of integration than this.
More recently, “Medscape,” an on-line resource for physicians, listed the most influential physicians of all time.  Hippocrates was on that list. So were the following:
  • John Snow, the founding father of epidemiology, who identified the source of cholera which led to a better understanding of disease transmission,
  • Louis Pasteur who was influential in understanding the “germ theory” of disease, developing pasteurization, and the development of vaccines,
  • Edward Jenner, the first person to deliberately use vaccination to control and eventually eliminate an infectious disease,
  • Robert Koch who discovered the cause of tuberculosis, cholera, and anthrax and designed a way to establish a causative relationship between a microbe and a disease,
  • Jonas Salk who created the first polio vaccine,
  • Benjamin Spock who underscored the importance of parenting and child development,
  • Cicely D. Williams who highlighted the importance of nutrition and education in the prevention of childhood diseases,
  • David L. Sackett who advocated for evidence-based and data-driven medicine,
  • Elizabeth Blackwell, the first woman in the U.S. to become a physician and who confronted discrimination throughout her life and helped train subsequent generations of women in the practice of medicine,
  • George Papanicolaou who developed a screening test for cervical cancer,
  • Ibn Sina/Avicenna who founded the field of preventive medicine, and
  • Ignaz Semmelweis who used vigorous statistical methodologies to demonstrate how the simple act of handwashing dramatically lowered death rates after childbirth.
All of these physicians embraced public health principles in their practice and impacted the health of people far beyond those they saw in a clinical setting. They were giants in their field because they embraced a broader vision of what a physician could and should do to help their individual patients and all of humanity. They modeled what Rudolf Virchow, the father of social medicine, said about becoming a physician: “Medical education does not exist to teach individuals how to make a living, but to empower them to protect the health of the public.”
Virchow was also prescient in his statements about health equity and health in all policies. “Medicine is a social science, and politics is nothing else but medicine on a large scale.”  The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.”  I think Virchow would have fit in well at MDH.
Finally, Charles Nathaniel Hewitt, the physician who founded the Minnesota Department of Health, spoke succinctly about the need for the integration of medicine and public health. “Prevention first, cure if you must; capacity to do in both directions.”
Without diminishing the contributions of doctors who focus on treatment of injuries and diseases, my heroes in medicine are those who took Dr. Hewitt’s admonition to heart and who embraced both treatment and prevention in protecting and improving health. Those are the colleagues I will commemorate and celebrate today on “National Doctors’ Day” because they have worked hard “to serve our country by caring for its' citizens.” Please join me in celebrating the physicians who are with us every day on the frontline of public health!