Upstream Doctors - Rishi Manchanda Flashcards
What is the common Public Health allegory relating downstream and upstream care?
3 friends come upon a river where children have become caught in its current and are being swept to their deaths.
1 friend starts pulling kids out downstream.
1 friend begins building a net midstream to catch more kids.
1 friend swims upstream to find ou why kids are falling in to the water.
All 3 friends have very important jobs.
What do we call health providers that seek to treat individuals at the root social determinants of health?
Upstreamists
What is one method by which physicians can gain much more information about patients without using much more time?
Medical assistants asking questions about the patients living/working/socioeconomic conditions.
These questions should be tailored to the needs of the specific community. Information regarding disease concentrations and clusters in the community can be found using GIS. Cultural needs should also be taken into account.
To whom can an upstreamist refer his patients in need of environmental justice and aid in modifying their living conditions?
Tenants’ rights advocates Community health workers GED tutoring Job training Rehabilitation Psychiatric care
How much of the variation in health outcomes results from medical care disparities?
A 2007 study in The New England Journal of Medicine found that health care accounts for 10% of the variation
What are the 5 main drivers of health outcomes?
Social environment Physical environment Behavior Genes and biology Medical services
If a pregnant mother is stressed and abused during the pregnancy, what is the effect on the child?
Increased sensitivity to stress hormones
Is the current standard of care acceptable?
No. 18% of our GDP and $9,000 per capita per year are buying us significantly lower health outcomes than other high-income countries.
What are two effects of the ACA that are not very well-known?
A large expansion of community health centers
Mandated coverage of preventative services
What proportion of physicians think social problems are as important as physical health problems?
What proportion feel capable in addressing social needs?
(According to a 2011 RWJF study)
4/5
1/5
What is the annual U.S healthcare cost?
Nearly $3 trillion per year
What are the effects of our fee-for-service system?
Overcharging Over service An abundance of highly paid specialists Procedure-heavy practices A lack of focus on social aspects An increase in lucrative tests, high-tech diagnostics, and brand name medications
What are the three main types of barriers upstreamists are facing today?
Regulatory, cultural, and financial
How do regulations inhibit upstream approaches?
They prevent easy sharing of geographic information regarding disease spread and living conditions through medical and housing records.
What should upstreamists know about the communities they serve?
They should be aware of disease clusters, violence rates, and housing conditions throughout the geographic boundaries they serve.
