Archive

Perspectives in Primary Care features writing from practitioners, activists, and community members representing organizations, practices, and institutions across the United States and around the world.

Promoting Health Equity through Voter Registration & Mobilization

It’s a warm September day. I neatly arrange my voter registration materials at a small table outside of the Somerville Urgent Care entrance. Sitting on a cool granite bench, I watch as a young girl and her mother approach. They are linked arm-in-arm, speaking Portuguese. “Hello! Are you registered to vote?!” They can’t see it, but I’m smiling behind my mask. The young girl’s face lights up, and, like many who visited my table before her, she begins to share her story. In just five days, she’ll turn 18. She’s finally old enough to vote ...

My Patient Anna, and Millions of Others Like Her, Are on the Ballot in November

Meet Anna. She’s a 47-year-old woman with diabetes and high blood pressure—that is, hypertension. When I first met Anna three years ago, she’d recently moved to Massachusetts and obtained health insurance for the first time in two decades. During her first clinic visit, Anna’s blood sugar was wildly uncontrolled—a clear indication of diabetes. She felt dizzy and fatigued, but this was her baseline. We spent over an hour, during a visit scheduled for 20 minutes, working with the pharmacist and health insurance company to find an insulin prescription for which she could ...

Child Care and Early Education is a Social Determinant of Health—For Children and Adults

More than six months into the COVID-19 pandemic, child care solutions for families remain scarce. A high-stakes problem typically confined to parents with children younger than five, lack of child care has now become a near-universal challenge, with remote K-12 learning upending care infrastructure for families with school-aged children as well. Consistent failure to provide public funding to the child care and early education sector—both traditionally and in this moment of crisis—is taking a heavy toll:

Don Berwick's Moral Determinants of Health

Donald M. Berwick, MD, MPP, is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement (IHI), an organization that Dr. Berwick co-founded and led as President and CEO for 19 years. He is one of the nation’s leading authorities on healthcare quality and improvement. In July 2010, President Obama appointed Dr. Berwick to the position of Administrator of the Centers for Medicare and Medicaid Services (CMS), which he held until December 2011. A pediatrician by training, ...

Situating the Continuum of Overdose Risk in the Social Determinants of Health

The United States remains in the throes of an escalating drug overdose crisis. Data show that overdoses increased yet again in 2019, and are now soaring amid the COVID-19 pandemic, which ...

In the US West Scorched by Wildfires, We Can Barely Breathe. It’s Going to Get Worse.

In California, we’ve counted ourselves among the lucky this past week if the worst we’ve had to cope with is a thick layer of smoke transforming our daytime skies into eerie orange hellscapes. Compared with the trauma of losing a home or loved one, having to

Precision Medicine & the Pivotal Role of Primary Care to Shape the Future of Healthcare

"My dear, here we must run as fast as we can, just to stay in place. And if you wish to go anywhere, you must run twice as fast as that." - Lewis Carroll, Alice in Wonderland This is the only quote which I clearly recall from my early childhood, and it took me several years to fully understand its meaning. It is truly universally applicable, and physicians are not exempt—I believe most of us are undeniably permanently running at least twice as fast, attempting to contribute to the (r)evolution of medicine, and also not lag behind. ...

Food Access via Small Stores on Navajo Nation: COVID-19 & Beyond

It’s a calm sunny day as I sit with John McCulloch in front of his store in Teec Nos Pos, Arizona. The store has served his community since 1905. The English name Teec Nos Pos is derived from the Navajo T'iisnasbas, a name inspired by a grove of trees growing in a circle in the area. As we sit and talk, community members file in and out of the store. They’re greeted with large florescent posters asking customers to wear a mask while in the store, to stay home if they feel sick, and to respect the maximum occupancy level of eight people in the store at one time. ...

African Americans Are Disproportionately Exposed to Extreme Heat

Climate change is a threat multiplier. This is a fact I know to be true. I also know that our most vulnerable populations, particularly environmental justice communities—people of color and/or low socioeconomic status—are suffering and will continue to suffer first and worst from the adverse effects of climate change. Case in point? Extreme heat. After reading the Killer Heat Report, most people probably used ...

Racial and Ethnic Disparities in COVID-19 Mortality Among Children and Teens

Due to early misconceptions that COVID-19 didn’t lead to severe disease or death in children, US state surveillance dashboards were not set up to track the course of the pandemic among age-specific groups. Over time, state reporting for children has gradually improved, and The COVKID Project has been synthesizing and sharing data for children and teens since late April 2020. Although 49 of 50 states now report COVID-19 case counts by age (with New York being the exception), only 2 ...

The Inner Bully and the Burden of Charting: A Dose of Self-Compassion May Be the Best Medicine

If you are a physician, this may sound familiar: I can feel that old resentment bubbling up as I sit down to chart on a beautiful summer Saturday afternoon. Seventy-two hours and I have to get all the charts done or they will close themselves automatically, and my name is added to the departmental “late charts” email list. My daughter is waiting for me to take her to her mall. It’s always hanging over me, and I can’t stand the stress. The minute I login, I hear the familiar self-critical voice and internal task master who whips me to get the job ...