The Physician’s Calling and Science Promote Health Equity and Outcomes

Abstract

To the Editor The article by Prussien and colleagues 1 presents an updated Social-Ecological Model of Adolescent and Young Adult Readiness for Transition to Promote Health Equity (SMART-E) that challenges the physician to address a wide range of broadly defined effectors of health, well-being, and readiness to transition from pediatric to adult care and the spectrum of disparities that influence health equity and lifelong health outcomes. The article and associated Editorial 2 raise profound questions at the heart of the physician's calling and the practice of medicine and science.Most physicians have read Hamlet or similar works and have developed the commitment to respond to the "slings and arrows of outrageous fortune" to which humans are subject. As physicians, they experience these disparities in real time. Response to the human condition with compassion, diagnosis, and treatment of the individual patient is the physician's calling. But the article, which includes feedback from interviews with 20 patients, offers a diverging path. The physician is directed to consider how "practitioner readiness factors might be impacting patient success and health equity" and to target "institutional and interpersonal drivers of disparities, such as limited practitioner cultural humility and implicit bias." Physicians are challenged to divert their focus from the patient to the ills of society and into the depths of their own subconscious. No, the physician must not become a Hamlet, futilely battling the "sea of troubles." Advances in precision medicine demonstrate that awareness, questioning, and compassion are at the origin, but are not the end point of medical care.Next comes the question as to whether physicians and scientists promote equity. The reply begins by saying thank you to the countless health care professionals and scientists who serve to advance humanity. Thank you for medications, vaccines, gene editing treatment of sickle cell disease, instant access to patient records, and instant sharing of knowledge. We now have the tools to provide precision care and continuity of care. Medicine and science do promote equity, 3 but the contributions of a wide range of professionals are needed to bridge the remaining gaps in the delivery of optimal treatment modalities to all patients. 4 A remaining concern is the perceived encroachment of ideology into medicine and science. The view of the physician through the lens of intersectionality, racism, systems of power, and implicit bias is disheartening and counterproductive. This concern has been critically and comprehensively evaluated by a group of scientists who advocate for adherence to scientific methodology as the path forward to advance equity, 3 resolve barriers to care, and uphold the physician's calling.