From Practice to Policy: A Medical Student’s Perspective
By David E. Myles

When I was considering applying to medical school I learned that the word “doctor” translates to “teacher” in Latin. Although my medical school curriculum had no formal classes in which we learned how to teach, I spent many Friday afternoons and weekends mentoring and teaching local public elementary, middle, and high school students. Midway through our half mile walks from their school to the medical school I would notice that several of the students lagged behind. It became apparent to me that it was not lack of interest but rather that too many of my students had excessive weight gain and asthma which likely made this mild form of exercise intolerable. Working with these students and providing services for the adult and pediatric patients during my clerkships significantly shaped my vision for the type of medical career I will pursue. I plan to intentionally execute a multilevel approach to prevent the diseases from which my patients and students suffer. To do this, I need to continue learning how to provide anticipatory guidance and vaccinations to, advocate for, treat, and address the social situations of my future patients. Prevention is at the core of the practice of pediatrics and is an effective way to provide healthcare at a societal level and to achieve the goal of my life’s work on a personal level. It is my aim to implement the optimal biological, psychological, and social conditions that will allow each of my patients to realize their full potential. By extension, changing the social conditions that lead to the poor health and educational outcomes of my patients and students has become of increasing interest to me.

Why would the families of my patients and students continue to consume unhealthy food and fail to get enough exercise when many members of those families are overweight and are suffering from a variety of interrelated diseases (e.g. obesity, diabetes, hypertension, etc)? If those children are not outside getting exercise, why is it that they don’t spend relatively more time preparing for school? I was drawn to the field of social psychology because of its ability to provide explanations for these seemingly paradoxical observations. As a rule, social psychology makes salient the influence that contexts and conditions have in shaping thoughts and behaviors. My thesis work in that field outlined how a 15-minute intervention reduced the interethnic achievement gap by 40% among middle school students over the course of an academic year. I found that there may exist conditions that allow a person to increase her or his ability to perform well in a challenging domain by self-affirming in that same domain—a hypothesis that was not previously supported in the literature. One of the logical next steps is to use similar social psychological interventions to those I investigated for my thesis to enable such populations to realize that more beneficial outcomes in other domains (e.g. health) exist and are attainable.

While I was in graduate school it became increasingly clear to me that we have reasonable solutions to solve many of the health and educational challenges that children face in this country and abroad. I contended that what is lacking is the political will to implement those feasible solutions. Realizing how powerful political contexts are in shaping thoughts, behaviors, and outcomes, I sought to learn the extent to which changing those contexts influences outcomes in the lives of children. It was at that time that I decided to work as a Deputy Field Organizer for the Obama Presidential campaign in Charlotte, NC. In just two weeks after taking office, President Obama signed legislation that expanded State Children’s Health Insurance Program (SCHIP) eligibility. This expansion provides health insurance for an additional four million children. More recently, President Obama signed the Patient Protection and Affordable Care Act, which should provide insurance coverage to millions of uninsured or underinsured Americans.

After the campaign was over, I continued to learn how to shift political will in support of reasonable solutions to address the challenges that children face. I had the opportunity to serve as a Science and Technology Policy Fellow at the National Academy of Science (NAS) on the Board of Children Youth and Families. One of the primary functions of the NAS is to produce consensus reports about a given topic and make recommendations to Congress. I spent my time briefing key Congressional staff about a report entitled, “Prevention of Mental, Emotional, and Behavioral Disorders Among Young People” in addition to working on revisions of a recently released report entitled, “Depression in Parents, Parenting, and Children.”

My experiences with children have spanned a continuum including education, the provision of individual patient care, hypothesis generation, and policy implementation. It is clear to me from my time on the wards that I derive a great deal of gratification from directly addressing the health care needs of individual children and their families. However, I have increasingly realized the significance of the decisions made in Washington and how they affect the doctor-patient relationships of which I have been a part. It is for that reason that I hope to continue working at the intersection of policy and the practice of medicine.