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January 2010 Issue

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'Community' Important Element of Comprehensive Family Medicine

By Katie Pence
Published January 2010

The definition of a trip to the family doctor is all in the name: comprehensive care for the whole family.
However, at the University of Cincinnati, the reach of care spans beyond mom, dad and the kids.

Jeffrey Susman, MD, wanted to reflect that by redefining “family medicine” with an addition that emphasized an important mission.

“Our physicians are known regionally for their work with the homeless and other vulnerable members of the Cincinnati community, as well as for our international work with underserved populations,” says Susman, chair of the newly named family and community medicine department. “We wanted to show our passion for continuing to support and expand these goals.”

The name change became official at the Nov. 17, 2009, UC Board of Trustees meeting. Although the name has changed by adding “community,” Susman says the idea remains the same.

“This name better reflects the department’s mission,” Susman says. “It embodies what we’ve already been doing for years. We strive to not only provide care for those we see in the hospital and clinic, but also those who are underserved or at risk in the community.

“The new name reflects the attitude and temperament of our doctors; we are truly concerned with justice and equality for every individual, and we make every effort to provide the resources necessary to help all populations achieve maximum health.”

Doctors in the department are involved in a wide array of health care-based projects as diverse as the patient groups they see, Susman says.

“The ‘community’ of which we speak is not just underserved. It’s not just Cincinnati,” he continues. “It’s multi-dimensional.”

Doug Smucker, MD, an adjunct associate professor and researcher in the department who focuses on end-of-life care, says physicians and researchers address all social determinants of health.

“We look at whether patients are receiving adequate housing, have access to good nutrition and other social determinants that influence their health status,” he says.

“Health care is rarely the sole solution to improving health. We have to look at the person as a whole, and in the context of their family and community, in order to help them achieve a healthy, happy life,” he says.

“We’re not improving health if all we do is focus on health care needs,” Susman adds. “It’s like an onion: We peel away all the layers to see the underlying issues that exist and work on fixing those first.”

This idea of “holistic” health and an emphasis on the community is reflected in the way residents in the department are trained, in the practice-based research that is conducted by physicians, in the education of medical students and in the care for the elderly, done through the office of geriatric medicine.

Susman says the department coordinates learning experiences for students and residents in community-based health sites, including the homeless health care van and the racetrack clinic at River Downs for migrant workers. He says physicians also conduct studies on these vulnerable populations—including the elderly—to help discover new, more efficient treatments.

“Even in our international outreach we don’t limit our care to health services,” he adds. “We look at culture and beliefs and incorporate these factors into our practice to make the biggest impact. This philosophy aids in our goal to help our patients build better, more fulfilling lives.”

Susman says preventative care is also a community-based philosophy that he sees making a difference.
Currently, the department is involved in a Patient-Centered Medical Home pilot, supported by the Greater Cincinnati Aligning Forces for Quality (AF4Q), an initiative of the Health Improve-ment Collaborative of Greater Cincinnati, which focuses on disease prevention and maintenance of good health while tailoring care to patients’ specific needs.

“Currently, the health care system waits until people are at their sickest to intervene,” he says. “We look at ourselves as the antithesis of that. We try to work upstream and keep preventative medicine at the core of what we do.

“In some cases, changing lifestyles is where the cure lies, not in medicine.”

Susman says the new department name is simply a better description for the diverse program and the dedication to public health in place at UC.

Smucker agrees.

“As a department, we’ll continue to reach out to those around us with the hope of making an impact on health care regionally and nationally,” he says. “This change is just a helpful way to describe the true connection between community, family, and health care and the ways we strive to make it successful.” 

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