Like a number of my peers, I am a career changer. Having started in social work, I shifted course four years ago this month, returning to school to complete the dreaded pre-medical sciences. Social work is an amorphous field, one that both the public and practitioners sometimes struggle to define. After all, it seems like they do everything, from individual therapy to foster care case management to public health education. More and more, physicians are also being tasked with “doing everything.” A growing body of research, for example, has linked adverse childhood experiences and other social determinants of health to poor outcomes over the lifetime. Interdisciplinary practice is clearly the linchpin of addressing these intersections, but the field continues to struggle to understand how.
As a social worker, I thought a lot about how to create change and how to empower others to be thoughtful, value-informed actors in their communities. The sudden transition to studying the basic sciences was, thus, jarring. Whereas in social work I often worked in the liminal space between the rational and irrational (what makes us act the way we act and think the things we think?), the sciences were somehow both rigidly delineated and also impossibly abstract (see Schrödinger’s cat). To my great surprise, however, I began to think like a scientist over time, applying rigid rules to natural phenomenon. Nobody cared about how the molecules felt, only how its electors were distributed. But then medical school happened. Medicine exists somewhere in between these two, which is why it is often described as both a science and an art. While this maxim was originally used to describe how to treat illness when we only had a partial understanding of its mechanism, it is evermore becoming a way to understand the relationship between the physiologic and the social. For example, physicians today are working to understand both the underlying mechanisms of COPD and why people don’t stop smoking. As physicians, we are taught to understand the body rationally: X process leads to Y disease. But the waters become muddied when we factor in human behavior: Why would someone smoke when they know the harms to be so great?
In my previous career I often struggled to describe what I knew how to do. As I’ve embarked on a new process of professional acculturation, however, I’ve begun to realize that my previous training gave me a way of thinking systemically, evaluating how individual experiences relate to the larger sociopolitical processes that shape everyday experiences. This, for instance, can help us understand how an individual opiate addition relates to prescribing patterns, the legal system, economic markets, and public health infrastructure. With my growing knowledge of medicine, however, I’ve been better able to understand the biophysiological processes that underlie both pain and addiction, creating a much richer understanding.
As the interaction between society and health becomes even more clear, medicine and medical education is changing. For example, our Doctoring course helps us to both learn how to listen to the heart and to counsel patients on exercise, and the Paths of Excellence give us an outlet to explore fields such as public policy and the humanities. It was in this spirit that I initiated two projects this summer to help us be better advocates for health. In one, I am working with the Center for Experiential Learning and Assessment to develop a self-reflection module paired to clinical simulation. Physicians are given the tremendous privilege of working with patients on some of the most stressful, emotional and personal aspects of their lives. How we process these situations, and learn from them, is an important professional skill if we are to gain comfort navigating these complex situations. In the other project, I am preparing a study to examine sexual violence amongst gay and bisexual men. Given that life experiences can impact the health of our patients in myriad ways, better understanding their context can lead to tools to identify and address these factors.
As summer draws to a close, I am struck by the tremendous intellectual diversity that defines medicine. From basic scientists to clinical investigators to public health researchers to health care economists, all collaborate to give an understanding of what makes us healthy and what makes us sick. No one discipline can do it alone, but also our collaboration is only as effective as our insight into what we bring to the table.