One Person at a Time
July 22, 2021
by Amy Givler, MD
I have a soft spot for public health. True, I’ve been a family physician for 32 years, and have touched many people’s lives, but decisions made by public health practitioners have an outsized impact on health.
Family medicine is one-on-one. Each individual I treat has a unique personality, family and medical and spiritual history. Public health has a different emphasis, looking at the “big picture” of the health of groups of people and of all of society.
I love seeing people one at a time, but if my goal is to positively affect the health of a maximal number of people, public health has the edge, focusing as it does on prevention rather than treatment. Countless lives have been saved with clean water, vaccination, and identifying and avoiding toxins. How excellent it is to keep someone from getting sick in the first place!
There’s a problem, however. When public health is done well, the people who have most benefited from it are unaware. They don’t know they have been protected from illness. When I am sick, however, fellow human beings treat me with care and medication. To them, then, I can express appreciation. Public health workers toil away in the background, protecting me and all of us from all sorts of menacing threats, and we never know it.
When COVID-19 caused the world to shut down, I couldn’t see patients in person for nearly two months. And so, I pivoted my focus onto public health. I read as much as I could about the virus and then translated that information from medicalese to plain English, posting on Facebook and Medium.com, and making myself available to answer questions. Sixteen months ago, things looked so bleak. Consequently, I followed the development of the vaccines with growing enthusiasm. Here was the way out of the pandemic.
I suspect I’ve answered hundreds, perhaps thousands, of questions from family and friends (and friends of friends) about protecting themselves from infection, navigating through a COVID illness or deciding whether to get a vaccine. I’ve long been familiar with anti-vaccine arguments and knew at the outset that those who oppose all vaccines would come up with all sorts of outlandish objections to these new vaccines, and they would then try to convince others. I have not been disappointed.
But even though vaccination is a public health tool like no other—the foremost disease preventer—the actual process of vaccinating is a very individual, one-on-one experience. Each person I’ve spoken to about vaccines has their own medical situation and their own questions.
Discussing vaccines with my own patients, with whom I have established a trust relationship, is a smoother (and more successful) process than with the friend of a friend of a friend who has never met me.
The difference between the broad scope of public health and the laser focus of primary care has never seemed clearer. Public health authorities have the responsibility of communicating accurate messages that benefit the population, but when a pandemic hits, other sources of information pop up. They bombard that same population with messages that fit their own agendas. Also, in a rapidly-changing medical crisis, such as in the early days of a pandemic, the public health messages shift and change, which confuses people. This erodes trust.
Attentive, sensitive, up-to-date medical professionals are in the best position to influence their patients, one at a time. The problem, of course, is that not every patient has an ongoing relationship with a trusted medical professional. And not every medical professional has ongoing relationships with patients. I’m thinking of critical care physicians, whose ICUs are filling up with COVID-19 patients even now, during the current surge.
Seventeen months into the pandemic, those working on the “frontlines”—caring for seriously-ill COVID patients—are exhausted. I’ve heard several say they are having trouble generating compassion for patients who have chosen to not get vaccinated. Yet, I counter, we still treat alcoholics with alcohol-induced pancreatitis, opioid addicts who overdose and smokers with emphysema and lung cancer. People make choices every day that put their health at risk—heck, I’m one of them—yet we still treat them medically. Still, in the midst of exhaustion, it is hard to care for someone who could have avoided their predicament (and who is exacerbating your exhaustion). I get that.
So what kind of “doctor” is Jesus? What is His focus—public health or primary care? Surely He cares for the whole world. In the familiar words of John 3:16, “For God so loved the world, that He gave His only Son, so that everyone who believes in Him will not perish, but have eternal life” (NASB).
But how exactly did that message for “the world” get communicated while Jesus lived on earth? The gospels record the teachings of Jesus, certainly, but also one-on-one personal encounters with hurting people. Jesus’ heart was filled with compassion: with a personal touch, He healed the blind, conversed with women, raised the dead. He invested three years of side-by-side teaching in the lives of 12 men, 11 of whom would follow Him, regardless of the personal cost, for the rest of their lives.
After Jesus’ resurrection, the gospel spread throughout the known world with remarkable speed, not through mass rallies, but by individual Christians sharing the good news of Jesus, one by one, in their families and communities.
As it was for Jesus and the early church, so it is for us today. How many of us who follow Jesus now point to His direct and loving touch in our own lives as the thing that transformed us? And how was that touch communicated? Almost always, by someone who spoke to us the message of Jesus with love and truth, and our hearts were engaged.
And what does this have to do with public health and primary care? Simply this: I do not have the expertise or resources to develop public water and sewer systems or effective vaccines. I am so grateful for those people who do. But I do have the ability to develop long-term, trusting relationships with my family, my friends and my patients—sharing health information one-on-one.
Do people always take my words to heart when I share how to stay safe or become healthy? No, not always. But more often, I contend, than if they’d heard the same message on television or read it on the internet. How does all of society become convinced of something? One person at a time.