By Natalia V. Galarza, MD and Kristina Diaz, MD
Global health has been identified as an increasing field of interest in medicine. As Koplan et al, mention, it can be thought as a notion, depending on current events. A definition for global health has never really been reached by consensus, and so it seems that global health can be adapted to the necessities of the location and time.
Many definitions touch on the fact that global health should improve health and achieve equity for all people and protect against global threats that disregard national borders.(1,2) It has deep connections with public health, blurring the boundaries between public health and global health. Within these connections, we have “border health” as a unique part of public health, with many characteristics being shared with the broader “global health.” For family medicine residency programs that are geographically located near the United States-Mexico border, the teaching of border health is embedded seamlessly in the medical resident education, so much that we tend to diminish its importance and gravitate toward other subjects of public and global health. It is easy to overlook the unique populations that we have in our own communities and focus on those that are more conventional and shared with other residency program or educational goals.
Richard F. Mitchell, MD,
For many clinicians, the path of medicine is a comfortable one—well-worn, made by many feet before your own. From college to residency and beyond, the courses to take, exams to pass, and applications to fill out have been laid out for us in a nice, orderly path. There is some room for brief excursions off the path, but the route to our prescribed life of clinic medicine, hospital medicine, specialty care like sports med, OB, or geriatrics, or some combination thereof is a well-marked trail with lighted signs to guide us all the way.
Until the day you decide to teach. I recall talking to our program director on the first day I had administrative time and asked, “What should I do?” His response: “I don’t care.”
Kathleen Rowland, MD, MS
Change is here, and more is coming. In medicine, we often perceive change, especially external change from hospital systems or payers, to be a threat. We feel a loss of control, which can lead to anger, resentment, and burnout.1 A survey of 3,000 US physicians done by a staffing company found that 58% of physicians who left medicine in 2013 reported doing so because they didn’t want to practice in an era of health care reform. This is more than stated they left because of economic factors such as malpractice insurance or reimbursement concerns (50%).2 The changes we face can feel overwhelming, and we have to take measures to make the changes less daunting.
Being resilient does not mean that we become pushovers. The goal of teaching resilience to change is to increase the sense that we are able to react to, triage, and adapt to changes while maintaining the core of who we are: physician teachers and healers. We can fight unwinnable battles or choose good ones. We can hold out on changing until the demand to do so is punitive, or we can adopt the change at a comfortable pace. We often do not choose the changes we face, but can choose the way we respond. As we restore that independence, we can reduce our risk of burnout and increase our satisfaction with practice.