Clinician and public health physician

“In clinical medicine, a course of action is a treatment, whereas in population (public health) medicine it is a programme”

Halley S. Faust (2012)

The common question faced by the Public Health Physicians from colleagues, friends and relatives is ‘are you a physician (doctor)? What do you do? Why don’t you practice and treat patients?’ The mainstream clinicians also have a disrespectful attitude towards the Public Health Physicians, in general.

So, what is the reality? Ain’t the PH physicians doctors? On the contrary, they are trained both in the clinical as well as PH medicine. While the clinicians deal wit the individual patients and their well-being, besides clinical skills, the PH physicians deals with broader issues such as epidemiology, health policy, health economics, health management, environment, behavioural sciences etc. which impacts on the health of the population. “Practicing population (public health) medicine is a form of practicing medicine”.

The clinicians and the PH physicians have both similarities and dissimilarities. Both their activities are based on scientific evidence, capacity to identify and address problems, and communicate the risks and benefits of the course of actions taken. While clinicians resort to treatment to manage an individual patient, the PH physician undertake large-scale population-based programmes to address public health problems.

On a different note, the PH physicians uses certain epidemiological and bio-statistical tools to diagnose a problem, analyses data and interprets availing situation to chart out a path to solve the problem in habd. This is done by history taking clinical examination and laboratory tests by the clinicians. Clinicians use medical surgical or rehabilitative means to treat a patient while the PH physicians design new programmes/interventions to treat a defined population group. To the clinician, patient’s interests come first, while to the PH physicians the interest of the population group in question comes first. A moral dilemma may occur while attempting to balance the individual and the population group’s interests.

In our country, there exists no separate ethics for the PH physicians except the one common to all physicians. Recently, American College of Preventive Medicine (ACPM) adopted a code of ethics for the practice of medicine. It provide standards of professional conduct for the preventive (public health) physicians and have 12 principles covering issues such as honesty in dissemination of critical knowledge of interst to the population, respecting the law of the country and beyond, overcome individual biases and reveal conflict of interest, respect of privacy to the data encountered, projecting as health role models, attending to emergencies whatever the level of risks, equitable delivery of services without discrimination, professionally competent and self-monitoring of behaviour where the question of ethics come.

It is high time that Bangladesh codifies similar standards of practice for the preventive healthcare professionals in the country and raise the standards of the profession vis-à-vis the mainstream health establishment!

Source: Faust HS (2012). Impacting the community with population medicine. [http://www.medscape.org/viewarticle/772270]