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Frustrated with patient care? Try a population medicine perspective.

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There’s a parable-type story I’ve heard a number of times in various contexts. The details change slightly between versions, but the general idea is as follows:

“A man walked along the beach one morning on the day after a heavy storm. The storm had led to thousands and thousands of starfish being washed up onto the sandy shore. On the beach in front of him, he saw a boy pick up one of the starfish and throw it back into the ocean. Without pausing, the boy picked up another starfish and tossed it in as far as he could. As the man walked closer to the boy and continued watching, it was clear the boy was not just playing – it was as though he was on a mission to throw back as many starfish as possible. As the man approached, he said to the boy, “Look at all these starfish. Thousands and thousands of them are scattered across this beach. What you’re doing won’t make a difference!”

The boy glanced up at the man as he spoke, but then immediately bent over to pick up another starfish, and threw it into the water. He then turned back toward the man and responded, “It made a difference to that one.”

To give credit, quick internet search leads me to believe the story is an adaptation of The Star Thrower, by Loren Eiseley.

Inspirational and thought-provoking to some; eye-roll and gag-inducing to others. But regardless, both the old man and the young boy make good points. The boy was undoubtedly changing the life of every starfish he threw. He’d never be able to throw them all back in, though, and would probably not even put a dent in the thousands strewn across the beach. Making a true “difference,” as the man suggested, was impossible.

The starfish story is kind of like treating patients

If you find yourself quickly agreeing with the boy’s rationale, you probably feel rewarded when you treat a patient. Those who relate more to the old man’s perspective are more likely to get bogged down with frustrations related to patient care, such as:

  • Treating one patient with a chronic disease doesn’t do much in terms of decreasing the overall prevalence of the disease.
  • Lifestyle changes that lead to long-term health improvement are much more challenging to put into place than prescribing a medication that produces limited improvement for a single outcome.
  • Your work days are made up of endless streams of patients, each with their own problems and needs. It’s difficult to look past a patient list and see deeper goals and objectives for the work that you do day after day.

What if the boy and the man posted flyers throughout their town inviting volunteers to help them throw starfish back into the ocean? Or perhaps they could have done some fundraising to purchase a piece of equipment that would allow them to pick up and transport hundreds of starfish at a time.

A spin on the starfish story for healthcare professionals

The old man reminds me of my own thoughts during clinical rotations in medical school. The focus on individual patient care left me with an unfulfilled desire to made changes on a larger scale. When we expand our view of healthcare beyond traditional clinics and hospitals, it’s easy to see opportunities to “treat” entire communities or populations of patients. Consider a few examples:

If a trauma surgeon treats a patient’s injuries after a motor vehicle accident, it has no impact on the rate and severity of morbidities related to MVA injuries within the community.

If the surgeon notices a pattern of injuries in his patients who’ve been in MVAs and has an idea for a vehicle safety feature to address it, he could work with a company to develop the product and decrease overall injury rate.

An infectious disease physician, while managing a patient’s HIV, may take the time to educate the patient about preventing transmission of the virus; however, the rest of the population continues to practice unsafe sex, needle-sharing, and other risky behaviors.

A physician who works with a local department of health to put program into place focused on decreasing HIV risk-related behaviors could help to decrease the incidence of HIV in the area overall.

A family physician advises a highly motivated obese patient to lose weight through diet and exercise. Many of her other patients, however, never receive this personalized support due to co-morbidities that need to be managed and lack of time during appointments.

 This doctor could implement health and wellness offerings in her practice, such as nutritional counseling, group visits, or online education through a patient portal. Or she could partner with a local fitness center to offer discounted memberships to her patients.

When an addiction medicine specialist treats an opioid-dependent patient with buprenorphine, it has no substantial impact on the illicit use of opioids in the area.

A physician who develops an educational intervention aimed at practitioners who prescribe opioids within his healthcare system could increase knowledge about good prescribing habits and decrease the overall rate of opioid use in the community.

Balance patient-specific and population perspectives to fit your personality

The work that every one of those physicians is doing is imperative. Imagine if the orthopod decided not to treat the trauma patient because it would only benefit a single life! Obviously, individual patient care is necessary, important, and oftentimes life-changing or life-saving.

But we all feel fulfillment from different types of work. There is an overarching perception that doctors help individual patients, and in medical school we are taught how to treat individual patients. However, there truly is so much more to medicine. For doctors who feel they are ‘burned out’ or disgruntled by medicine, I often wonder if they’ve thought beyond the level of the individual patient. Many of them would likely be satisfied by work that involves treating a population and ‘making a difference’ on a larger scale.

Want to learn more about careers that involve population medicine? Check out the profiles on public health careers and governmental jobs.

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