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Building A Fund of Knowledge for Community Medicine

Building A Fund of Knowledge for Community Medicine. It is a safe rule to have no teaching without a patient for a text, and the best teaching is that taught by the patient himself. - Sir William Osler. Mattie. 67-year-old African American female Long history of type 2 diabetes

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Building A Fund of Knowledge for Community Medicine

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  1. Building A Fund of Knowledge for Community Medicine

  2. It is a safe rule to have no teaching without a patient for a text, and the best teaching is that taught by the patient himself. - Sir William Osler

  3. Mattie • 67-year-old African American female • Long history of type 2 diabetes • Admitted with progressive shortness of breath • Evaluated appropriately with history, physical exam, lab, x-ray, echocardiogram • Silent myocardial infarction and congestive heart failure

  4. Mattie, continued • From a CV standpoint, she did well • Blood sugars were poorly controlled • “Non-compliant”

  5. Mattie’s Vices

  6. ADA Diet, Board Exam Prep • Which of the following would NOT be considered the most healthful food choices for an individual with type 2 diabetes? A. Fresh fruits and vegetables B. Dried beans C. Fatback and buttermilk D. Whole grain foods

  7. The Truth We don’t always tell the truth. We don’t always know the truth.

  8. ABCs of Preventive Cardiology • A – Aspirin/antiplatelet; ACE • B – Beta blocker • C – Cholesterol; cigarettes • D – Diabetes; • E – Vitamin E; Estrogen; Exercise

  9. ABCs of Preventive Cardiology • A – Aspirin/antiplatelet; ACE/ARB • B – Beta blocker • C – Cholesterol; cigarettes • D – Diabetes; • E – Vitamin E; Estrogen; Exercise

  10. The Truth We don’t always tell the truth. We don’t always know the truth... Yet!

  11. Aristotle’s Intellectual VirtuesWays of Knowing • Techne • Sophia • Episteme • Phronesis • Nous

  12. Quality of Evidence • Level I: Evidence obtained from at least one properly designed randomized controlled trial. • Level II-1: Evidence obtained from well-designed controlled trials without randomization. • Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group. • Level II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. • Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees

  13. The Scientific Method • Experience: start from observation • Conjecture: formulate hypothesis • Prediction: reasoning from hypotheses • Experiment: testing these elements

  14. Characteristics • External • Third person • Dispassionate • I-It

  15. Classic Experimental Design

  16. Challenges of Communities • Complex organisms • Chaotic • Non-linear

  17. People are Messy!

  18. Rigorous ? Simple Complex Not so much

  19. How do we embrace a broader range of ways to generate new knowledge, while still retaining rigor?

  20. Anxiety about “Community” • Focus? • Primary care • Indigent • Imagery • Content • Community college?

  21. The “Honors College”A Value-Added Curriculum • Traditional biomedical curriculum • Biopsychosocial model • Public health themes/content

  22. Community MedicineFrom Molecule to Culture Molecule

  23. Public Health Disciplines • Biostatistics • Epidemiology • Health Administration and Policy • Health Promotion Sciences • Occupational and Environmental Health

  24. Certificate in Public Health • Biostatistics • Epidemiology • Social and Behavioral Sciences in PH • US Health Care Systems • Environmental Health • Integrated Public Health Practice

  25. Epidemiology Biostatistics Environmental health Health services administration Social and behavioral sciences Informatics Genomics Communication Cultural competence Community-based participatory research Global health Policy and law Ethics Who Will Keep the Public Healthy?

  26. Training Physicians forPublic Health Careers • Leadership • Public health emergency preparedness • Clinical and community preventive service provision • Across contiunuum of medical education • Regardless of specialty

  27. Medicine is the most humane of sciences, the most empiric of arts, and the most scientific of humanities. - Edmund Pellegrino Humanism and the Physician

  28. Re-visiting Mattie • How would the perspective of a provider trained in community medicine enhance her care? • How have or can public policy and public health practice impact her care?

  29. Outside the doctor-patient relationship there is a wider place filled with community. And it calls to us through the voice of public health. - Author unknown

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