Social Medicine

medicine puzzle

Editor’s Note: This post is one of two pieces on the Introduction to Social Medicine and Global Health course at Harvard Medical School. Read the other piece here.

By: Komal Kothari, an MD/MBA student at Harvard Medical School and Harvard Business School

Komal Kothari is interested in practicing clinical medicine and applying business skills to improve health outcomes and lower the exorbitant costs of health care in the United States. She cares deeply about social justice and hopes to develop solutions to address social determinants of health and health care disparities.

When I see a patient in the hospital, I ask about his or her symptoms and almost immediately have an inkling of the diagnosis. So I narrow my line of questioning, confirming what I already suspect. In other words, I get a limited view into the patient’s life and chart a course of action based on this partial awareness. This way of clinical practice is efficient and sensible; it allows doctors to make split-second decisions and to saves lives. Yet, through studying social medicine, I have learned to better understand the human being behind the disease. These teachings have enriched my patient encounters, enabled me to heal more effectively, and brought greater meaning to my work.

In the Introduction to Social Medicine and Global Health (ISM) course, offered to first-year students at Harvard Medical School, which Kasper and colleagues described in their recent Academic Medicine article, I examined the stories of individuals and the social, political, and cultural forces that colluded to bring them to their present day circumstances. For example, one case study we discussed was about a boy named Santiago (not a real patient’s name). Santiago was exposed to cigarette smoke and cockroaches at home, which caused him to suffer frequent asthma attacks. The case gave us an unobstructed narrative and made it easy to pinpoint why he was not getting better. In real life, as the ISM course teaches, the root cause may not be so apparent so doctors must actively seek it out.

At a pediatric clinic where I spent some time during my third year, I saw a toddler who had a speech delay and exhibited subtle signs of emotional dysregulation. I discovered that he lived in an unstable home and did not have access to books to build his vocabulary. That was the story begging to be heard, and I was able to uncover it because of what I had learned in the ISM course. Just seeing this patient’s physical symptoms did not mean as much as being able to place his case in the context of the health care disparities that affect low-income families. Similarly, just reading about health care disparities did not mean as much as witnessing their direct impact on my patient. This powerful marriage of theory and practice was critical for my medical training.

By exploring patients’ buried stories and relating them to their social context, I gain a much broader view into their lives and can chart a better course of action for their care. In the ISM course, I learned not only to diagnose a problem but also to do something about it. My peers and I debated how best to handle Santiago’s situation and what resources we might offer. Seasoned clinicians also shared their experiences in helping patients with complicated social circumstances. In essence, the holistic approach that the ISM course promoted forced me to grapple with the macro-level issues that affect my patients’ lives and to develop the skills necessary to systematically tackle these issues at a micro-level.

Apart from enhancing my effectiveness with patients, the ISM course motivated me to keep my finger on the pulse of all human suffering. The Syrian refugee crisis, the marginalization of Black Americans, and the death toll inflicted by gun violence are just some examples of today’s social issues that lie within the domain of medicine, even if at first they don’t appear to, because they create suffering for fellow humans. Understanding this has inspired me to lend my voice to the voiceless and to be a lifelong advocate for healing wounds beyond the ones that are skin-deep.

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