Breakfast Not Data

We owe a lot to K-12 teachers. They, like others who work in mission critical industries, like sick-care, have to deal with many issues to help their students. In fact, according to a recent survey, the greatest barriers to school success for K-12 students have little to do with anything that goes on in the classroom. The nation’s top teachers say the biggest problems are f amily stress, followed by poverty, and learning and psychological problems. In many ways and in many places, the same is true for doctors helping patients.

Approximately 1.2 billion people in the world live in extreme poverty (less than one dollar per day). Poverty creates ill-health because it forces people to live in environments that make them sick, without decent shelter, clean water or adequate sanitation. While the official US poverty rate is 14.5%, some differ and claim it is as low as 4.5%. Still, a lot of people.

In addition, more than 16 million children in the United States—22% of all children—live in families with incomes below the federal poverty level: $23,550 a year for a family of 4. Research shows that, on average, families need an income of about twice that level to cover basic expenses.

I've worked for many years in "safety net" hospitals—city and county hospitals, university hospitals that take care of a disproportionate share of poor patients, VA patients who are homeless, and native American facilities located on reservations with a culture of poverty. In most instances, health success has little of nothing to do with what goes on in the examining room. Instead, the psycho-social and behavioral health context usually is a predictor of treatment success or failure. In most instances, doctors are ill-prepared to deal with those issues and live at the epicenter of medicine, the legal system, medical sociology and a very dysfunctional mental and behavioral health pseudo-system.

These days, a lot of people are telling doctors what they should be and do. As if practicing state of the art medicine is not enough, clinicians are expected to be experts in health economics, population health, data analytics and business intelligence, spiritual medical sociology, behavioral health, community resource management, law enforcement, addiction medicine, and much more. They are being measured and compensated using measures over which they have little or no control. And we haven't yet gotten to the chief complaint.

I remember in medical school learning about taking a history from a patient. One part was the social history, inquiring about such things as education, occupation, marital status, and a few things that regulators required later on, like being the victim of domestic abuse. I rarely asked about whether the patient had food and shelter for the night.

Population health is more about providing clean water and adequate nutrition than big data. The sick-care system ignores it. However, without seeing care in context, we'll be missing the forest for the trees.