Thursday, August 18, 2011

Sex and Gender Medicine - A Lens for Evaluating Sociocultural Determinants of Disease


It used to be good enough to be smart - good in science; good at figuring things out. When you only have penicillin or sulfa, then just making the right diagnosis was pretty impressive. But times of have changed - we have PET scans and PCRs; we have minimally invasive surgery and a vast (if not overwhelming array) of medications and interventions at our disposal.

So today our gold standard has migrated past being smart and finding the disease 'in' a patient - now we are expected to influence health outcomes.

When acute injury and infections were a major cause of death (and we had limited tools) we had challenges. Now, most diseases are chronic and the ability to influence runs over a longer timeframe. Diabetes, Obesity, Hypertension, Heart Disease, Cancer - not 'quick in- quick out' challenges and certainly not the easiest to impact on outcomes. Yet, it is do-able.

We just need to get all of the data - scrutinize the biomedical, be clinically and scientifically curious and obtain data about the person in her world. One of the ways we can impact health disparities (and therefore move care closer to excellent for all) is to see the whole picture. The whole person.

In understanding the whole person, we need their story - who lives with them? who helps them? who do they help? what do they think or fear is going on? how do they define a good outcome?
Just today, a short essay on the social history was published in NEJM

Complicated Lives — Taking the Social History  R. Srivastava  N Engl J Med 365:587, August 18, 2011.   I highly recommend that   you read it, as it is written by an Oncologist and gives an interesting perspective on what we need to know to care for patients.  Now worries, it's a quick read!

McGinnis, J.M. 2002;21:78-93
Sociocultural determinants of health issues need to be lenses that we use to evaluate our patients. 
Dr Schroeder from UCSF delivered the Shattuck lecture about this. (We Can Do Better - Improving the Health of American People. Schroeder SA. New England Journal of Medicine. 357(12):1221-8, 2007 Sep 20. ) Access HERE courtesy of Pubmed and NEJM.

As physicians, we need to zoom in and zoom out on the pathophysiology and the life of our patients in order to best understand what is going on and how we can best help them lead healthier lives.

For a review on our discussion about sex and gender health disparities, check out this blog entry - click on Sex and Gender Resources as well as check out our other blog entries.


Culture, Gender, Health
Our second blog is Culture Gender Health and it reviews some of the definitions we discussed. It is available on the left side of the blog


Our third blog is a patient health blog Philadelphia Ujima and is a useful place to find plain language (aka health literacy and culturally appropriate) health education info and resources.






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