A proposal to incorporate a public health perspective into clinical teaching

Background: In medicine today the 'whole person with an illness' struggles for attention in a health system dominated by a specific focus on disease. A reductionist approach alone is inadequate.

Context: Efforts to broaden the medical curriculum through integrating public health into clinical practice have been numerous, yet the clinical application of a broad public health perspective in medical education has been frustrated by a number of factors.

Innovation: This paper is a proposal to incorporate a public health perspective into clinical decision making, in order to assist the student to develop a comprehensive approach to clinical assessment. The proposed framework formalises the assessment of the patient's personal and social context, which is used to complement disease assessment and diagnosis. My suggestion is to use the SOAP format (subjective, objective, assessment and plan) as the framework for clinically processing a public health perspective of the patient. I have classified the public health perspective in terms of seven categories of the patient's context (cultural, social context, psychological context, population health context, social determinants, health services context and the information context). Within each of these categories the student clinician gathers subjective and objective public health data, which is used in combination with diagnostic clinical data to formulate the whole-patient assessment and plan.

Implications: The next step is to trial and evaluate the effectiveness of the proposal in promoting the assessment of the whole person with an illness.