Kaitlyn Greiner

Public Health Determinants Project

1. Social Determinants in Health

The major social determinant that had an influence on the health and medical

services delivered at MUSC was the access to medical care. The promotion of disease

prevention was evident at the hospital, but the use of episodic sick care was used very

often as well. I observed an inequity of access to the services delivered at the university

for many patients. It was clear that some patients were able to take off of work for a week

to visit Charleston for their appointment, while other patients could barely get to their

appointment. There is an inequality regarding access to care at my internship site. For

those who do have access, the care is typically provided by a team of departments that

works together to promote health.

Although MUSC’s GI surgery clinic often times must treat episodic sick care,

health promotion is still emphasized with every patient. There are times when patients

come in with such intense abdominal pain that the only choice is to give them pain

medicine until the time of their surgery. This is an example of the treatment of episodic

sick care. This occurs because many patients already have the issue, which is their chief

complaint of their appointment. This does not mean that episodic sick care is the only

important type of care in this department. It is important to make sure that the patient is

treated and will continue to lead a healthy life after treatment. Health care providers with

GI surgery work together to promote the patient’s health by prevention as well. One

preventative measure that the GI surgery unit utilizes is their connection with behavioral

medicine. Many patients are set up with the behavioral medicine department at MUSC

because the psychological toll of these chronic GI problems and the stress of surgery can

be serious. Patients are linked to behavioral medicine before a problem even arises so that

they can maintain their mental health, while the surgery clinic treats their physical health.

Their mental health is closely monitored through the GI department through surveys

completed at every appointment. These surveys access how they would rate the different

aspects of their physical and mental health and these results are tracked in a database over

the years. Another way that health care professionals work together in health promotion

is through the close association with a certified dietician. A dietician is in the clinic at all

times to advise patients about the best nutrition options based on their problems. This

advice may be needed after a surgery to prevent further pain and to promote the healing

process. The dietician can also keep a patient on a feeding tube if she feels like this will

prevent any complications and if it will keep the patient’s nutrition status where it needs

to be. Other health care professionals who work with the patients along side of the GI

surgery unit in prevention are oncologists and primary care physicians. Working as a

team in prevention is much more effective than remaining isolated in each department.

All of these health care professionals realize that lifestyle is a huge part of health.

Lifestyle choices can have a large impact on the health of the digestive system.

In the GI surgery clinic, I observed many lifestyle interventions between health

professionals and patients in order to promote patient health. My internship preceptor,

Stefanie, talks with each patient who smokes cigarettes and explains the harmful effects

to them. She always says, “The pancreas can’t tell the difference between one cigarette

and a whole pack of cigarettes.” The goal is to encourage patients to stop smoking all

together because the health of the pancreas can worsen for these patients if they continue

to smoke. Stefanie doesn’t just order her patients to stop smoking; rather she suggests

ways for them to quit. Often times she prescribes a patch to help the patients quit. She is

actively working for the patients to help them quit. It is also important to ask each patient

in the GI surgery unit if they drink alcohol. Stefanie also talks with these patients about

their health and the effects of alcohol. The right amount of physical activity and the

motivation to get better are always encouraged after surgery. After a major surgery, the

patient is advised to take it easy but to remain physically active if possible so that the

healing process is faster and easier. The health care providers see that the patients need

the motivation to get better. Some patients don’t try to get on with their normal lives after

surgery and choose to use wheelchairs and stay home. This only hinders the healing

process. Getting back to a normal life is important after these kinds of surgeries.

Therefore, these lifestyle discussions are imperative to have with patients to prevent

worsening health.

In addition to disease prevention, another social determinant that influenced the

services and health of the patients at MUSC is the presence of the services based on the

equity of access. Because MUSC surgeons are some of the top in the world, many people

are traveling from long distances for surgeries or second opinions. The cost of traveling

and staying in hotels can be very difficult for families. Traveling can also be very

difficult for a patient who is in need of surgery or who has just had surgery. Patients can

be in the hospital for weeks depending on their surgery and complications and this can be

very costly for them as well. Many of the patients need a note for work in order to attend

their appointment. For some, the wait time is so long before seeing the doctor that they

feel like they must rush through their appointments in order to get to work. Because not

everyone can afford top-notch care, the access is not equal to everyone. Some patients

simply can’t get to MUSC because of transportation issues, the lack of family or friends

to assist, financial reasons, and the fact that they are too ill to travel. If this is the case,

these patients are subjected to stay in their hometown and may receive care that may not

be the state of the art care that they need. Patients who have better access are receiving

better care than those who do not have access. All patients deserve to receive the best

care possible, yet inequity of access is preventing this care. My internship site should be

more conscientious of this inequity. One solution is to provide a temporary lodging home

for the families of the GI surgery patients who have to undergo extensive medical

treatment. An example of one of these homes is the Ronald McDonald House Charities of

Charleston, which provides lodging for families with sick children undergoing treatment.

Therefore, there are ways to help those who have less access to care than others.

Increasing equity to health services is needed at my internship site. The high

quality of health promotion that the site provides should be available to anyone in need. It

is unlikely that episodic sick care will be eliminated in a department such as GI surgery,

but this does not mean that the department lacks in health promotion and preventative

care. MUSC’s medical services and resulting patient health are heavily influenced by

these social determinants. Making improvements to these determinants can greatly

impact public health today.