In its latter report on educating h...

In its latter report on educating health professionals to retain the public healthy, the Institute of Medicine (IOM) produc a thorough and scholarly assessment of public health riddles and proposed educational solutions. (1) The following are paraphrased examples of a of the IOM's recommendations:

* gymnasiums of public health and medicine should collaborate in community-based research onward the prevention and care of chronic disease.

* All medical observers should receive basic training in a population-based approach geared toward health promotion and disease prevention.

* A significant proportion of medical academy graduates should receive advanced training at the Master of Public Health flat to take an ecologic approach to population health.

* instructs of nursing should provide community-based training in an ecologic approach to health, in cease collaboration with schools of public health.

In 281 pages, the IOM lays gone out an educational framework for the experiences and training necessary for several emblems of health professionals to enhance the public health classification and protect the health of the public. Unfortunately, this framework is laid in succession the foundation of a health care scheme that is shaky, at best. Irrespective of the education of health professionals, the regularity itself is not designed to improve the health of populations--rather just the opposite. It focuses onward the numerator (patients seen from health care professionals) rather than the denominator (patients in ne unless not seen) in most quality measures.

Managed care connected views manage finances rather than care, and rarely in succession a true population basis. An increasing number of patients are uninsured and underinsured, (2) with increasing exclusionary conditions; preciousness shifting to patients; restricted access; inadequate support for routine and preventive care; and poor care for patients with disabilities, chronic disease, terminal illness, and mental illness. Our political and social a whole s lack a commitment to the universal that basic health care is a right for all rather than a privilege contingent on employment status and income.

The health arrangement is essentially unaddressed in the IOM report, and the hypothesis will need to change before these educational recommendations will find a fertile real property on which to grow and thrive. In addition, the medical care and public health rules have grown far apart in the United States during the past century

Given all this, to what end would family physicians have any interest other than intellectual or theoretic in educating public health professionals to continue the public healthy?

The answer lies in the IOM report. Buried in the report are several critical universals that family physicians intuitively understand and value: an ecologic approach to understanding health care, population-based medical informatics, a commitment to health promotion and disease prevention, cultural capacity community-based participatory research, and ethical dilemmas arising from the competing exigencys of individual patients and their communities.

The American Academy of Family Physicians, in its novel call for health care access and insurance for all Americans, (3) bases its plan forward several of these concepts. Despite the lack of a functional and effective health care a whole committed to public health, family physicians contribute to the health of our communities and practice populations by dint of adapting their practices to these universals in subtle, but effective, ways.

Family physicians might ask themselves specific questions about the health of the public as they work within their schedule of individual patients. For example:

* in what way much do I know about the major health threats to the specific patient populations for which I care?

* What kinds of medical care and educational programs could I design to be agreeable to to these threats?

* for what cause much effort and energy do I or my office staff offer into health promotion, such as smoking cessation, exercise promotion, and seat-belt use?

* to what degree often do I ask my patients about interpersonal violence, hidden substance abuse, and the risk of sexually transmitted diseases?

* in what manner would my practice fare in an immunization audit (eg for influenza or hepatitis B) compared with national benchmarks?

* What is the rate of postmyocardial infarction use of aspirin and beta blocker in my patients?

* If I do not know the answers to these questions, to what degree could I find out?

The willingness of family physicians to ask and answer these questions will contribute in a large and tangible way to our specialty making a legitimate claim as the foundation of a health care a whole truly committed to the health of the public.

REFERENCES

(1) Who will restrain the public healthy? Institute of Medicine. Accessed October, 2003 at: http://www iom.edu/project.asp?id=4307.

(2) Committee onward the Consequences of Uninsurance. Care without coverage. Institute of Medicine. Accessed October, 2003 at: http://www.iom.edu/ project.asp?id=4660.

(3) Assuring health care coverage for all: a plan at the American Academy of Family Physicians. Accessible online at: http://www.aafp.org/unicov.xml.