n the wake of police killings in Baltimore, Ferguson, Mo., and other cities, doctors — and the medical schools that train them — must also be part of the solution, says a new editorial by doctors at Johns Hopkins Hospital in Baltimore. A community-health approach to medical school will better train doctors and, authors say, better serve traditionally underserved patients.
The article, published Thursday in the New England Journal of Medicine, holds up as an example the Medicine for the Greater Good (MGG) curriculum created at Johns Hopkins in 2011.
The MGG curriculum, now required for graduation from Johns Hopkins, consists of 12 one-hour workshops spread over an academic year. Each covers a specific topic, such as health policy, social determinants of health, or behavioral counseling. Residents must also design and complete a community-based project.
Among the most popular of these is the lay health educator project. In it, residents go to local churches and other community gathering places to help residents become health educators in their churches and neighborhoods.
“Medical students are coming to medical school from different experiences,” said Dr. Erica Johnson, a co-author of the article. “It’s not always clear to them, in the context of medical school, to think about some of the disparities that exist.”
These disparities are stark in Baltimore, where black residents were subject to segregation and unequal care as recently as the late 1950s. The result is a community where people in poor neighborhoods can expect to live shorter lives, with poorer quality of life, than their rich neighbors.
Freddie Gray, the 25-year-old black man who died in a police van in April, is an example of the impact of this disparity, said lead author Dr. Sammy Zakaria, associate program director of the residency program.
“He was being poisoned since he was a kid,” said Zakaria, pointing out that during Gray’s childhood, he lived in one of the worst areas of Baltimore, with old and crumbling homes. As a boy, Gray had a blood-lead level of 37 micrograms per deciliter (10 is considered dangerously high). “At that level, you can’t control your emotions or impulses, and of course you’re going to have multiple encounters with police.”
Zakaria also described a resident’s home visit with a dialysis patient. He had been labeled noncompliant by the hospital, because he did not go to all his appointments.
“It turns out that the patient had one leg amputated because of diabetes, and to get to his dialysis appointments, he had to go to a bus stop without a top on it,” said Zakaria. “So when the weather was bad he was missing his appointments.”
These are the kinds of home-life situations that medical schools should train doctors to ask about and to take action on, the authors say.
“Residency programs have a duty to raise awareness of the socioeconomic determinants of health and to train young physicians to recognize and change the circumstances responsible for poor health outcomes,” they wrote.
Dr. Rachel Kruzan, who graduated from Johns Hopkins in May, says she benefitted from the MGG curriculum. “I learned how to communicate with my patients and to anticipate questions they might not be comfortable asking.”
Kruzan grew up in a Chicago suburb with a dentist dad and a mom who was a nurse.
“We were a pretty health-literate family,” she said. “I didn’t know that there were people who didn’t have access. I wanted to help people who have a fractured relationship with health care.”
Zakaria said that it’s crucial that doctors think beyond simply providing the best care.
“Freddie Gray had excellent health care, which is why we know so much about his lead levels,” said Zakaria. “But he also shows us that, unless you deal with the underlying issues, even the best health care is of marginal value.”