Written by Akua Nuako, medical student class of 2021, Washington University in St. Louis
I am often awestruck by the ingenuity of today’s medical advancements. During my first year of medical school, I’ve been captivated by research on promising developments like cancer treatments that only target malignant cells, gene editing that addresses health issues rooted in our DNA, and even drones specifically designed to deliver medicine to people in remote locations. The rapid evolution of health technologies fills my heart with hope for a future in which precise, personalized medicine makes today’s common health concerns obsolete. However, I am snapped back to reality everyday as soon as I step into the hallways outside of my classroom. Over the year, I have learned that several members of the warm maintenance staff who work so diligently to keep the environment of my medical education comfortable and clean have struggled to have their own chronic and acute health needs addressed that have the capacity to at once vastly improve their quality of life and plunge them into destitution. After witnessing this inconceivable and unacceptable phenomenon, I have become determined to tailor any treatment plans I negotiate with patients to fit into the contemporary, complicated policy landscape and to fight to make health access a right for all people throughout my medical career. I know that health policy will be a crucial tool in this mission.
It’s evident that medical visits entail much more than just conversations between physicians and patients about clinical concerns. Health policy determines many steps of the patient healthcare experience that occur outside the exam room. Before we seek out care, we must verify which doctors accept our insurance (or self-pay, for the 9% of Americans that lack health insurance) and whether the service we are seeking can be provided within our desired timeframe. When we arrive at the clinic, we’re required to check-in, fill out intake forms, and have vitals and a history taken by nurses. Last but certainly not least, we must face the bill after the visit! Hospital policies designed to maximize safety, organization, and efficiency dictate what this process looks like at individual institutions. Federal and state policies mandate what services insurance companies must cover, which health issues our country’s expansive but still limited resources are focused on, and who qualifies for public health insurance. In today’s fast-paced political and economic climate, the medications and services that insurance companies cover change frequently and states are constantly adjusting their eligibility criteria for government insurance programs. Losing access to certain (or most) services in these coverage shifts can quickly turn a patient’s prescribed medical protocol into an untenable health plan. Policy plays a role in nearly all aspects of the clinical encounters we are training to navigate one day as medical students, and so it is important for doctors to stay abreast of policy changes in order to more holistically understand their patients’ healthcare experiences and give patients medical advice they can practically adhere to.
While many recognize that certain health policies can be improved or that particular health issues warrant more attention from policymakers, future and current doctors are privileged with a trust from the public on health issues that imbues them with a relatively respected voice with which they can advocate for more effective policies to fellow healthcare providers, hospital administrators, and lawmakers alike. Their “insider” knowledge of healthcare systems also makes them uniquely aware of how certain policies would affect the lives of patients and providers, of whether they are actually improving clinical care, and of which conditions or illnesses impose the largest burdens of disease in our country. Doctors already seek to “do good” for their patients, and they can fight to do even more good by fighting to eliminate policies that make clinical care less beneficial than it could be and working to create changes that elevate patient access to and satisfaction with care.
From primary care to neurosurgery, physicians of all medical specialties have the ability to make meaningful change for their patients through informing policy. Each specialty has its own clinical nuances that give its practitioners unique perspectives on how certain initiatives will play out in daily practice. There is room for any and all physicians to influence policy on hospital, state, and national levels in a wide range of areas and with various levels of involvement.
America is a world leader in producing medical technology that inspires with its ingenuity. It is also a country in which streets surrounding our premier hospitals sometimes house people compelled to beg for money to afford basic healthcare. Hundreds of miles from these streets, residents struggle to have their health needs met in a timely, comprehensive manner as rural hospitals close at alarming rates. Healthcare is a human right that financial and geographical barriers often prevent people from attaining in this country. Exemplary health systems should strike a difficult balance between fueling medical advancements and ensuring that all populations they serve have access to quality care. As future leaders of America’s healthcare organizations, medical students have a unique opportunity to push our health systems to be more equitable, efficacious, and stress-free for patients and providers alike. Both the explanation for and solution to many worrisome barriers to healthcare access lie in health policy. Understanding this field enables future medical providers to recognize areas in which health care systems can be improved, to refine their approach to policies that create barriers for patients in healthcare and give their future patients more manageable clinical advice, and to fight for changes that allow people to have their health be their primary concern when they go to the doctor. Physicians have a unique ability to inform policies, and medical students should be invested in health policy to further empower their future patients to achieve optimal health and well-being.