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Doctors need to be political advocates for patients, expert says

by Mar. 11, 2014, 11:47 AM

Doctors and other health care workers of the future need to be political advocates as well as personal advisers, said the director of Vanderbilt University’s Center for Medicine, Health and Society.

“If we really do believe – and I think the evidence is strong – that people’s morbidity and mortality is linked to their zip code as much as their genetic code – then doctors need to be aware of how social factors can make people sick and kill them,” said Jonathan Metzl, holder of the Frederick B. Rentschler II Chair at Vanderbilt and director of the center.

“Doctors need to be advocates for improving not just biological conditions, but also social ones.”

Training beyond medicine

In an article co-written with Helena Hansen of New York University and published in Social Science and Medicine, Metzl calls for health care workers to be trained in the basics of economics, urban infrastructure, and other societal factors that can affect the health of Americans. The training could be incorporated as part of pre-med undergraduate curriculum, and perhaps be included in new employee orientation at medical facilities.

Metzl says the extra training will make doctors and other health care workers “structurally competent.”

“Structural competency would teach health care workers to better recognize how, even after the Affordable Care Act, medical issues such as hypertension, depression and obesity sometimes represent the downstream effects of societal decisions about such factors as food distribution networks, transit systems, or urban or rural infrastructure,” Metzl said.

Structural humility

Doctors must also be able to recognize when they are out of their depth on certain issues, and be willing to collaborate with community activists and lawmakers. Metzl calls that “structural humility.”

“There’s a moral message that has been lost in the healthcare debate,” Metzl said. “And that’s that we have a social mission to keep everybody healthy in a democratic country.

“I feel that medicine has not been vocal enough about making that point.”

To see more of Jonathan Metz speaking about disparities in health care, see the opening of The Politics of Health conference from 2013.

Read the Social Science and Medicine article.