What are the major differences between medicine and public health? What challenges do public health officials frequently ignore?
On Tuesday, I attended a seminar by Dr. Richard Schieber. Dr. Schieber was a practicing pediatrician, however for the last fifteen years he has worked as a medical epidemiologist for the CDC.
One of the major challenges facing the CDC is how to translate public health medical recommendations down to the clinical level. According to Schuster et al. (1998), little of public health care recommendations are preformed in the clinical setting. “Simple averages from a number of studies indicate that 50 percent of people received recommended preventive care; 70 percent, recommended acute care;… 60 percent, recommended chronic care.”
Why are these numbers so low? Well, public health officials have many recommendations. What if a physician is confronted with a patient who has diabetes and is also obese and a smoker. Will they be able to fulfill all the recommendations in the 15-20 minute time slot they have with their patient? Likely not.
A study by Yarnall et al. (2003) finds that “To fully satisfy the USPSTF [US Preventative Services Task Force] recommendations, 1773 hours of a physician’s annual time, or 7.4 hours per working day, is needed for the provision of preventive services. ”
Dr. Schrieber’s main point of the talk is that recommendations in and of themselves are not very useful. They must be “translated” so they are useful and feasible for both the medical provider and the patient. Further, public health programs should be measured by outcomes, not by processes.
Finally, some of the talk was spent on differences between public health and medicine. Some of these differences are listed below.
|Boss||CEO or MD||Bureaucrat|
|Salary||High||Not as high|
|Satisfiers||Positive patient outcome||Vague|
|Language||Very Technical (Greek)||English|
|Funding||Patient (via insurance or gov’t)||Government|
|Unbreakable rule||Primum non nocere||Help underserved|
|View of EBM||Dictatorial||Magically improve patient care|
|Basis of Decision||Patient history, physical, tests||Risk, QALYs, etc.|