M

y clinical colleagues, as part of today’s medical rounds, let me present our next case:

America is a 240-year-old patient with an extensive history, including great depression and growth, emancipation and immigration, suffering and suffrage. It chronically struggles with unity in diversity and an urban-rural divide. At its core, America’s long-term goal is progress, but it is in our hospital today for chest pain.

The pain is acute, likely brought on by the election season. America feels a throbbing ache that begins in the chest and radiates to clenched jaws and fists. This is accompanied by cold sweats with violence and protests. The sensation is not affected by party affiliation, nor is it associated with ethnicity or geography. Indeed, all parts of the country notice at least some symptoms of this national illness.

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The diagnosis is most consistent with unstable angina — a heart-attack-like chest pain that comes on when least expected. I see you nodding in agreement; perhaps you feel it too.

Although this national heartache is recent in onset, it almost certainly developed from decades of systemic problems in the cardiovascular, immune, and nervous systems, as well as in the health care system and the food, education, and economic systems. Not to mention the political system.

What, then, my fellow doctors, must we do for the American myocardium, the heart that cries for oxygen and aches for social justice? How should we respond when the byproducts of harmful policies have culminated in the sickness before us?

Some of you may be thinking that we can’t manage unstable angina on a national scale. I believe we can.

Consider the following proposals for treatment, one for the short term, and one for the long term.

Right now we need to continue increasing awareness among citizens and policymakers about the struggles that patients and their providers face each day. Write letters to the editor, call on mayors, reach out to congressional representatives, and stand in protest. Such actions are especially essential when we see our young children develop type 2 diabetes, our black brothers cry, “I can’t breathe,” and our uninsured parents show up too late to the health care system with advanced disease.

In the long run, we need to go beyond individually initiated, ad-hoc advocacy by increasing physicians’ work in social policy. The medical profession must create more formal, time-protected paths for doctors to collaborate with policymakers and other government officials.

The way to do this will be through graduate medical education, better known as medical residency programs. Residency is the rigorous period following medical school where new doctors acquire and refine their skills. These programs are supported by the federal government — predominantly through Medicare and Medicaid — which invests nearly $15 billion a year in doctor training. This investment ought to ensure that physicians are empowered to fulfill their Hippocratic duties. This oath calls on physicians to treat patients, prevent disease, and look after the social and economic well-being of the community. In essence, it is a pledge to care for the nation as a whole.

To that end, residents funded by graduate medical education should receive training in health policy as a complement to their clinical work. In addition, their participation in structured outreach initiatives, such as rotations in public health departments, offices of elected officials, and agencies like the Centers for Disease Control and Prevention, Food and Drug Administration, or Centers for Medicare and Medicaid Services, should be included in metrics for gauging the success of residency programs.

Revamping graduate medical training will take time, and the time to begin is now. America is in dire need of attention from doctors whose intimate understanding of humanity and society will be vital for treating its post-election pain. The nation needs healing, not polarizing politics. We must help repair broken systems and restore trust in politicians.

The medical profession needs to take these short- and long-term actions to keep the collective American heart beating rhythmically and vivaciously as one.

Maggie Salinger is pursuing a medical degree and a master’s in public policy at Emory University School of Medicine and the Harvard Kennedy School of Government.

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  • Great piece here! Something else to consider: This 240-year-old patient has about 160 years of mercury kicking around in its teeth, respiratory, cardiovascular, immune, and nervous systems, thanks to the old-school ADA. This hybrid professional and commercial/trade association has a hallowed attachment to a commercially successful amalgam with a neurotoxin that harms people over time with relatively common genetic methylation variants. See James S Woods et al four articles in PubMed 2011-2014 retracting the findings of amalgam safety in the Children’s Amalgam Trial.

    Your excellent, modest proposal for enhancing medical education should also include fully integrating dental into medical care, insurance, records and big data, as it is essential yet invisible to physician’s eye.

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