During my journey towards a career in health care, I have learned that all patients have various levels of knowledge, self-efficacy, and access. In order to create an effective treatment plan for individual patients, the physician and health care workers must be flexible and mold a plan that perfectly fits the patient’s needs and ensure that it is accomplishable. Socioeconomic status and social determinants of health play an important role in medicine. Socioeconomic status is a measure of a person or family’s economic and social position. Learning inside and outside of the classroom, I have seen socioeconomic status reflect education, income, access to resources, and much more. All of these factors can influence a person’s health status, leading to health disparities. 

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           In Public Health 102: Introduction to Public Health, I first began to realize that there are social determinants of health and how big of an impact that socioeconomic status can have on a person’s health status. In this class, we were assigned a documentary to watch. “Unnatural Causes: In Sickness and in Wealth” is a documentary that follows several hospital employees of different socioeconomic classes and highlights the differences in their opportunities to achieve good health statuses. My WTC artifact is a document with responses I had to the assigned discussion questions, highlighting important take-aways of this video. On my own time, I sat down and watched the documentary and used the provided questions to reflect on what I had just learned. The following morning in class, we had a long debrief of everyone’s reactions to the documentary and how it relates to what we were learning during lecture. In the documentary, one learns about the Whitehall study which revealed that there is a strong correlation between health and wealth. When someone is wealthy and can afford better health care services, their health is significantly better than someone who makes less money and cannot afford the same resources. One of the hospital employees highlighted, Jim Taylor, the hospital’s CEO, says that his stress is significantly less than others because he can afford to leave work at work. He feels safe when exercising throughout his neighborhood and he has the time and money to cook healthy meals for him and his family every night. On the other end of the spectrum, Corey Anderson works as a sanitation worker for the hospital. He has a high demand job with little control. He leaves a stressful job and goes home to a stressful homelife. He does not make a lot of money, lives in an unsafe part of town, and does not have any time for vacation or stress relief. He is stuck in a cycle of stress, ultimately leading to worse health outcomes. Because he does not have the time or money to cook healthy meals, he has to resort to unhealthy food and does not exercise. Social determinants of health are a very real and powerful idea to keep in mind when entering the health care. While everyone deserves the same level of treatment and care, it is not realistic to devise the same treatment plan for every patient that enters through the doors. Before enrolling in Public Health 102, I was naïve to this reality. It never crossed my mind that people may not have control over their health; I always assumed it was the individual’s responsibility. 

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            As Public Health 102 came to an end, I began applying for internships and jobs in the health care field. I ultimately landed an internship with an orthopedic surgeon, Dr. Craig Chebuhar. When I began my internship, I had no idea the amount of knowledge I would take away with me, not just on a clinical level but a social level. For the first time I was able to see, first hand,  how social determinants can effect health. At Carolina Spine and Ortho, we typically only see patients who have a personal injury and have most likely been in a car accident and are being represented by an attorney. We have a wide range of patients every day, and some would not have been able to afford to see an orthopedic physician without going through an attorney, who is handling their case. As a student intern I have a range of responsibilities but first and foremost I am observing and learning. I sit in on every appointment and take notes for Dr. Chebuhar, creating a treatment plan checklist for every patient. Every patient has different needs and so every treatment plan is personalized. If the orthopedic physician recommends physical therapy, but a patient cannot afford to take an afternoon of work off or has no transportation to a different office, the treatment plan has to be revised. Instead of a patient having access to external treatment options, such as physical therapy or chiropractic, the patient will have fewer treatment options, focused on a medication regimen or steroid injections during previously scheduled  appointments. It will be harder to treat these patients adequately because the physician cannot utilize resources that he would normally be able to. When we have a patient who is of higher socioeconomic status, it is easier to create an effective treatment plan because the physician has free rein of what he thinks is the best plan. Below, you can see below a mock up of two treatment plans as my beyond-the-classroom artifacts, one representing a patient with full access and one representing a patient who has limited access and of lower socioeconomic status.  Almost every day we have missed or cancelled appointments, sometimes due to a patient not being able to afford to miss a shift at work or there is a young mom cannot afford the gas to come into the office or cannot afford child care. When a patient does have to bring their child in I often offer to hold the child in my lap so full attention is on what Dr. Chebuhar is saying. You can see the stress on the faces of the young parents who are struggling to be healthy, who are probably missing work when they cannot afford to. Just as the documentary I watched in class showcased, I have seen first-hand how social determinants can determine health outcomes. While genetics always play a hand in health, lifestyle, behaviors, and other social factors affect health more than I could have ever imagined. 

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          Through my within-the-classroom and beyond-the-classroom experiences, I have been able to understand how socioeconomic status can truly affect health. Before taking Public Health 102 and interning at a physician’s office, I was blind to this reality. While everyone deserves the same level of care and treatment, it sometimes is not realistic for patients to be treated the same. This is a harsh reality for anyone planning on entering the health care system and it is something I have become very passionate about changing. As I approach my dream of pursuing a career as a physician’s assistant, I have decided that I want to work in preventative or family medicine. I want to help people help themselves, before damage to their health is done. If a patient doesn’t have access to healthy food, I want to find a way to work within the community to provide healthier options. I want to help people take control of their lives in ways they haven’t had an opportunity to do before. Through my experiences, via professional and civic engagement, I have developed a sense of urgency and passion to help others and I am looking forward to using my platform as a future health care professional to make a change.