OU’s new School of Community Medicine aims to get to the roots of community health problems and find solutions that will improve not just the health of individual patients but of the state as a whole.
Perhaps no one understands the concept of community medicine better than Breanna Brumley.
The 24-year-old grew up in Stilwell, going to Indian clinics for her own health care. Later, she worked in the cardiac care unit of Tahlequah City Hospital, where she learned about the special needs of the elderly.
Now, she’s a student at a new school that focuses on community medicine — the OU School of Community Medicine.
When she finishes in two years as a physician assistant, she intends to go to work right back in a rural Indian clinic. That, she says, is where she can do the most good for the community.
“The most important thing is going to your job every day and loving what you do,” Brumley says. “Money can’t beat that. In a large hospital, you might see a patient once, prescribe medicine and never see them again. But in a rural clinic, you build relationships. You see people grow up and eventually treat their kids.”
The community approach to medical education trains doctors, physician assistants, nurses, pharmacists and social workers to treat patients while appreciating the fundamental causes of disease.
The diagnoses in community medicine remain the same. What is different is that with the community-medicine philosophy, a multidisciplinary team analyzes how occurrences in the community around the patient contribute to the illness. What emerges is more effective health care that involves more than just a doctor, patient and bottle of pills.
The concept became reality in February, when the George Kaiser Family Foundation gave a $50 million gift to the University of Oklahoma — the largest gift in the university’s history — to create the OU School of Community Medicine.
It is the first formally named school of community medicine in the nation.
The School of Community Medicine’s goal is to leverage leadership, education, research and clinical service resources to improve the health of individual patients and entire communities. The program is a statewide initiative that allows graduates to go into any community in the state and make a difference in the lives of those people. This includes all demographics: children, adults, seniors, pregnant women and people with special needs.
Doctors will receive additional training in public health and preventive medicine concepts, and all the disciplines taught at OU — medicine, physician assistance, pharmacy, social work and nursing — learn to work together.
The Kaiser Foundation gift includes $35 million to endow 35 faculty chairs, $7.5 million for faculty recruitment and other startup costs and $7.5 million for a scholarship and loan-forgiveness program for students who agree to work in underserved areas in Oklahoma.
Seeing a need
The program arose out of some startling health statistics on Oklahoma: It ranks 50th among the states for overall health because of the high number of children and adults without insurance, the low rate of children and adults who seek preventive care, the high number of avoidable hospital visits, the high rates of untreated mental illness and the skyrocketing level of unhealthy living, according to the Commonwealth Fund State Scorecard on Health System Performance.
Additionally, Oklahoma is the only state where the average lifespan has declined during the last 25 years.
The inequities of access to care and low life expectancy are directly related to poverty, social status and where people live, the OU team determined.
Heart patients in north Tulsa, for example, might not be able to buy fresh produce because they don’t have a grocery store. So a doctor telling a patient to replace high-sodium canned vegetables with fresh vegetables may not understand how difficult a change in diet would be. Patients in west Tulsa may not be able to walk for exercise if they don’t have sidewalks in their neighborhood.
Some of Breanna Brumley’s patients may speak only Cherokee and need the assistance of a pharmacist who speaks the language, too, she says. Her diabetic patients may need to be connected to a walking group instead of sent out the clinic door with instructions to exercise, but no one to encourage them to keep up the routine.
“One of the things I’ve learned the most is to learn your resources,” Brumley says. “What I’ll do is prescribe them medicine. But it takes a whole team to really help with all the issues.”
The team formed and involved many community members other than just those dedicated to medical care.
“The first thing we had to realize is that medicine is not just about doctors,” says Dr. Daniel Duffy, senior associate dean for academic programs. “It’s about people who build neighborhoods and roads. It’s about the people who own grocery stores. It’s about teachers and churches.”
The next step in starting the School of Community Medicine was to study the issues in Tulsa and meet people who had stories to tell about health care. This was undertaken during a weeklong summer institute — a meeting of new students, faculty and the community. After a brief morning lecture, the participants went out in teams to interview community members such as police officers, firefighters, workers at a homeless shelter, teachers, prison employees, ministers and even a single mother with multiple sclerosis who had no health insurance. All of them shared their ideas for making Tulsa and Oklahoma healthier. Later in the week, students accompanied vulnerable patients as they visited a clinic.
The nine interest groups during the summer institute returned with several suggestions for solutions to community health-related problems. To improve health education, one group recommended a program in which medical students would mentor high-schoolers so that the high-schoolers could then mentor middle-schoolers.
Another group wanted to start a clinic at a north Tulsa school, thereby bringing health care to families instead of expecting families to come to the doctor’s office.
A third group, after visiting St. Simeon’s Episcopal Home and a church, decided that social interaction as a treatment for the early stages of Alzheimer’s disease should be undertaken by churches.
Brumley’s group, which also focused on the elderly, recommended placing medical information for seniors in unlikely places, such as beauty shops, because those are the places seniors often frequent and where they feel comfortable.
“It is our expectation that these students will think differently,” Duffy says. “We think this is going to change the attitude of the city and state about health. It will help us continue to find new and innovative ways of delivering care.”
The old way of thinking
The concept of community medicine sounds lofty, but how is it different from conventional medicine?
Julie Miller-Cribbs, assistant director of the School of Social Work at OU-Tulsa, describes the difference this way: A child might come to the doctor and be diagnosed as obese and with early diabetes. A year later, the child may be worse, not better.
An individual doctor might take the blaming approach. Exasperated, he’d wonder, “Why can’t that mother control her kid’s diabetes?”
In the community-medicine approach, a team would find plenty of reasons why the family isn’t succeeding in overcoming the weight and the disease.
The mom may be single and work at a job where she has no insurance. She worries about how she’ll pay for the child’s medical supplies. She may have limited literacy and not be able to read the pamphlets the doctor gave her. She may not have the math skills to calculate blood sugar levels.
On top of that, the child may go to a school that cut back on physical education. The neighborhood may not be safe enough for the child to play outside alone.
The solution, then, for a team versed in community medicine, would involve changing policies at the school to provide healthier lunches and more P.E. It would include lobbying the city to build more parks in the area. It would involve enhancing literacy, helping pay for medications and supplies and even starting a community garden.
“We know it’s complicated,” Miller-Cribbs says. “But the traditional system treats it as if it’s not that complicated. We’re thinking broadly, past the individual blame.”
Goals for the program
The immediate goal for the OU School of Community Medicine is to build a specialty clinic in north Tulsa that will focus on heart health, cancer and urgent care, says the school’s dean, Dr. Gerard Clancy.
He also plans to expand overall class size. A long-term consideration for the School of Community Medicine is to increase enrollment. When implemented, the goals will be increasing third- and fourth-year medical student enrollment from 80 to 140, and the resident physician enrollment from 201 to 251.
In the next five years, the school’s goals are:
Ensuring that 80 percent of graduates establish practices in Oklahoma and work with underserved populations.
Expanding clinical services in Oklahoma.
Developing interdisciplinary research and more than tripling the grant funding for research.
Achieving recognition for the school nationally.
Creating an $85 million annual impact for the region and adding 1,600 new jobs for northeastern Oklahoma.
While the OU School of Community Medicine is improving, the faculty and students hope that the overall health in Oklahoma will, too.
“It’s doable,” Duffy says. “We don’t know exactly how. But if we’re all focused on it, we can do it.”