By Allison Martin
At my first general surgery residency interview in the fall of 2012, I sat across from a senior faculty member at a prestigious surgical residency program as he leveled a tough question at me: “Why does a surgeon need a degree in public health?” I had taken time between my third and fourth years of medical school to obtain an MPH from the Harvard T.H. Chan School of Public Health. I was fortunate that many of my mentors in medical and graduate school had regularly incorporated community health principles into their research and clinical endeavors, so my response was easy. This article summarizes some of the reasons that an understanding of public health has proven important to me.
In the past, there was less emphasis on surgeons’ role in outreach policy and prevention, risk reduction, and quality improvement. In recent years, more surgeons are stepping into the roles of advocate, policy adviser, and thought leader regarding how surgical knowledge is shared with providers who have variable access to resources around the world. Examples exist throughout academic surgery. A great example that highlights the use of mobile technology to improve outcomes for post-surgical patients is Assessing Surgical Site Infection Surveillance Technologies (ASSIST). This project was spearheaded by Dr. Heather Evans, a surgeon, surgical infectious disease specialist, and innovator in mobile health (mHealth) technology at the Medical University of South Carolina. Evans and her collaborators created a novel platform for remote assessment of postoperative wounds that may provide earlier detection of infections through electronic information sharing between patients and practitioners.
There are specific barriers to the dissemination of surgical knowledge and access to resources in geographically isolated areas in both the United States and abroad. Surgeons in rural communities cannot easily share information and often do not have the same resources as surgeons in more resource-rich environments. Developing programs that facilitate information exchange for practitioners in isolated domestic and international communities should be prioritized. One example of this practice is the creation of health information exchange (HIE) entities such as the Nebraska Health Information Initiative (NeHII), which was created as an electronic system to facilitate the compilation and organization of clinical information at the point of care. This type of system improves health outcomes and quality of care delivery to rural patients by allowing for any provider within the NeHII system to electronically access patient medical records. This system allows providers in rural areas to track patients when they visit larger referral health systems for specialty care. There are national resources to better understand how HIEs work at HealthIT.gov.
Surgeons at academic medical centers are in a unique position to advocate for better collaboration with surgeons operating at community hospitals and critical access hospitals (CAHs). CAHs are small hospitals with 25 or fewer acute care beds, located greater than 35 miles from another hospital that provide 24/7 access to emergency services. Links must be created between highly-resourced systems and low resource systems. This could be accomplished by, for example,converting underperforming rural hospitals to CAHs and linking them to the nearest academic medical centers via telemedicine or other electronic means. The Rural Health Information Hub (RHIH) is an example of a program that fills this need. It is a valuable online resource supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services for rural hospitals and providers. Advances in telemedicine technology over the last decade have provided money-saving and life-saving links between rural hospitals, like CAHs, and larger urban or teaching hospitals through increased contact with medical specialists.
In an age where pandemics are the new reality, using virtual web platforms and telemedicine to engage with rural practitioners will become even more critical. Issues like maintaining proper personal protective strategies while transferring rural patients to higher levels of care are just one of the novel challenges rural health providers will face in the coming days. Utilizing existing technologies to lessen the burden on rural America will become more imperative as the world gets smaller and rates of chronic and infectious diseases continue to rise. Current programs like the NeHII, RHIH, and ASSIST have shown how surgeons can utilize public health principles and technology to improve health care and outcomes in rural and underserved areas. Moving forward, we surgeons should continue to innovate and apply technology to ensure that quality of healthcare is not limited by a patient’s geographic location.
Allison Martin, MD, MPH, is a general surgery chief resident at the University of Virginia. She completed her MD at Vanderbilt School of Medicine and an MPH at the Harvard T.H. Chan School of Public Health. During residency, she completed a two-year research fellowship in surgical oncology, including a year-long Fogarty fellowship in Rwanda, and will begin a fellowship in Complex General Surgical Oncology at the MD Anderson Cancer Center in August 2020. She currently serves as the AWS Facebook Subcommittee Co-Chair and can be found on Twitter @globalsurgallie.
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