Systems Based Practice – 5.1: Understand the institutions and individuals that participate in healthcare delivery and the role of the physician in the health care system.
One of the most pressing issues that has been facing the American medical system is the obesity epidemic. This widespread and growing problem is one that cannot be cured by a doctor simply diagnosing the patient and then prescribing a medicine to treat. It requires a multidisciplinary approach, and I have been lucky enough throughout medical school to have seen a few of the approaches that are being used right now.
One program that I have been able to volunteer with is Food is Health, which works to improve diabetes outcomes of those with food insecurities by providing education on nutrition and lifestyle changes along with the food needed to implement them. Patients pick out free healthy groceries for their household and are encouraged to bring family members along to participate, with the goal of improving the health of the entire family.
One such family was a mother with two kids. This family, and many families like them, helped me realize that although I was intellectually aware of how socioeconomic barriers like food deserts can make healthy choices difficult, I was still taking many things for granted. When the family started picking out groceries, the mom admitted that she was not sure what an avocado was. As a student on a strict budget, I think of avocados as a bit of a luxury; however, I was still amazed to find out how foreign they were to this mother. As we continued, I was again surprised as I introduced her to produce such as bell peppers, squash, and mangoes. Later, it was her youngest child’s turn to surprise me. He was so excited that he would have bananas to eat that he started singing and dancing about them. Seeing his excitement about a fruit I considered inexpensive and mundane showed me how access to fresh produce was not something to take for granted; and I was delighted to be treated to a song and dance about both bananas and avocados when the family returned the next week.
Another family I saw was a woman who would get groceries for her household of six and would eagerly share how much the healthy groceries were improving their lives. Her kids now loved oatmeal for breakfast and apples with peanut butter for snack. She also reported how she was able to be a much better mother for them now. When the Columbus Dispatch came to interview her about the Food is Health program, I heard about how much her life had changed in the six weeks since starting the program. She had lost 40 pounds without actively dieting, had enough energy to pick up a job painting houses, and no longer had to miss her son’s soccer games because of the need for frequent bathroom trips due to her diabetes.
This experience emphasized to me the importance of making sure that families have both the education and resources to improve their health. A parent may be aware that their child needs to lose weight, but if they do not feel they have the knowledge or means to make that happen, lecturing on the perils of obesity is not going to help. It will be important for me as a future pediatrician to understand what resources are available to families and help them access those resources. As someone who wants to work with the underserved, I hope to be lucky enough to work with a social worker who can assist families in getting the assistance they need to access healthcare and other.
During my fourth year of medical school, I also had the opportunity to rotate with Healthy Weight and Nutrition at Nationwide Children’s Hospital, where I got to see a multidisciplinary approach to weight management for kids. I first had the opportunity to shadow the doctors, nurse practitioners, dietitians, physical therapists, psychologist, and social worker who worked in the clinic. After seeing everyone’s role on the team, I was then able to see the patients myself and work with the other team members to best serve the patient. I listened to input the other team members had regarding their area of expertise and was also recommend patients to see certain team members based on what I felt their needs were that day. I was also able to attend evening sessions put on by interdisciplinary team members to see ways they were working to address obesity outside of the clinic. Shown below is a flier for a teen class called Empowering U where teenagers learned from dietitians about nutrition in various settings including grocery stores and a farmer’s market that I was able to attend. I was also able to see classes put on by physical therapists to help kids and teenagers be more active and find activities they enjoy enough to continue beyond the class.
There are many areas of healthcare that require a multidisciplinary approach to address. During residency I will continue to learn from and work with these team members. They will be crucial to helping my patients access the care and resources they need, as well as addressing specific needs unique to the patient.