Primary and Community-Engaged Healthcare at the Frontline of Medicine


Image result for shailendra prasadDr. Prasad is the kind of doctor you want treating your family and community.

His story began in South India. In 1992, there was a cholera epidemic in the entire district but no one died from the infectious water-borne disease. This was due to the fact that for the past three years, the community had been talking about and working towards water hygiene. Prevention, according to Dr. Prasad, is not very “sexy”. It does not require any high tech magic-bullet solutions. In this community, the life-or-death intervention was finding where people collect water and wash their clothes.

“What is primary care?” Dr. Prasad asked us, and we gave the usual responses: treating basic health issues, providing vaccinations and treating families and communities. He introduced us to the model of the “five C’s” of primary care: first contact, continuity, comprehensive, coordination, and community. Primary care professionals are at the frontline of medicine. They are often the first person both the sick and the well encounter, and as we all know, first impressions are very important. The patient’s first interaction with a physician can determine their future relationship with the whole field of medicine. If patients feel misunderstood, disrespected or fearful, they will be much less likely to come back for future checkups or to seek care for serious health conditions. This is where continuity comes into play. Primary physicians are there for the long term – for the vaccinations, height measurements, yearly checkups, sexual health education, chronic diseases and beyond. Our bodies exist in and interact with our social worlds. Only physicians who know who you are, not only your family history but your healthy and unhealthy habits and all the social determinants that affect your unique health and body, are equipped to treat you with the dignity and knowledge that all people deserve. Comprehensive and coordinated health care requires this contextual understanding, so that diabetics, for example, not only receive a prescription for medicine, but are also referred to a nutritionist, psychiatrist, shelter, or any necessary financial resources. The final “C”, community, is how individual health becomes part of a greater and healthier whole. As the final piece of the puzzle, this is where long-term changes in overall health can occur.

The current U.S. healthcare system excels at treating illness. Promoting wellness, on the other hand, is not a political or financial priority. Following the Neo-Darwin organism theory, interventions only occur after the absence of health and manifestation of illness. The success of a system based on curing rather than preventing is much easier to quantify and evaluate, but at what cost (pun intended)? Hospitals and clinics lack the metrics to determine wellness and evaluate preventative measures. Dr. Prasad, however, has his own “grand slam” metrics: questions like, “how are you doing today?” “how are things with your family?” and “do you feel like you are being taken care of here?”

Dr. Prasad showed us a quote: “Our concept of health is to make social change”. His advice? Get involved in family medicine. Following that statement, he told us he may or may not be biased on the matter.

An innovator in primary care, Dr. Prasad is a practicing physician and lecturer working at the intersections of medicine and public health, including training providers on issues of racism and inequality, improving quality of healthcare in rural areas, and conceptualizing ways that medicine can address wider social determinants of health—issues that can only be addressed outside the clinic.

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