1st essay

1. Kaitlyn Greiner
Public Health Determinants Project
1. Social Determinants in Health
The major social determinant that had an influence on the health and medical
services delivered at MUSC was the access to medical care. The promotion of disease
prevention was evident at the hospital, but the use of episodic sick care was used very
often as well. I observed an inequity of access to the services delivered at the university
for many patients. It was clear that some patients were able to take off of work for a week
to visit Charleston for their appointment, while other patients could barely get to their
appointment. There is an inequality regarding access to care at my internship site. For
those who do have access, the care is typically provided by a team of departments that
works together to promote health.
Although MUSC’s GI surgery clinic often times must treat episodic sick care,
health promotion is still emphasized with every patient. There are times when patients
come in with such intense abdominal pain that the only choice is to give them pain
medicine until the time of their surgery. This is an example of the treatment of episodic
sick care. This occurs because many patients already have the issue, which is their chief
complaint of their appointment. This does not mean that episodic sick care is the only
important type of care in this department. It is important to make sure that the patient is
treated and will continue to lead a healthy life after treatment. Health care providers with
GI surgery work together to promote the patient’s health by prevention as well. One
preventative measure that the GI surgery unit utilizes is their connection with behavioral
medicine. Many patients are set up with the behavioral medicine department at MUSC

2. because the psychological toll of these chronic GI problems and the stress of surgery can
be serious. Patients are linked to behavioral medicine before a problem even arises so that
they can maintain their mental health, while the surgery clinic treats their physical health.
Their mental health is closely monitored through the GI department through surveys
completed at every appointment. These surveys access how they would rate the different
aspects of their physical and mental health and these results are tracked in a database over
the years. Another way that health care professionals work together in health promotion
is through the close association with a certified dietician. A dietician is in the clinic at all
times to advise patients about the best nutrition options based on their problems. This
advice may be needed after a surgery to prevent further pain and to promote the healing
process. The dietician can also keep a patient on a feeding tube if she feels like this will
prevent any complications and if it will keep the patient’s nutrition status where it needs
to be. Other health care professionals who work with the patients along side of the GI
surgery unit in prevention are oncologists and primary care physicians. Working as a
team in prevention is much more effective than remaining isolated in each department.
All of these health care professionals realize that lifestyle is a huge part of health.
Lifestyle choices can have a large impact on the health of the digestive system.
In the GI surgery clinic, I observed many lifestyle interventions between health
professionals and patients in order to promote patient health. My internship preceptor,
Stefanie, talks with each patient who smokes cigarettes and explains the harmful effects
to them. She always says, “The pancreas can’t tell the difference between one cigarette
and a whole pack of cigarettes.” The goal is to encourage patients to stop smoking all
together because the health of the pancreas can worsen for these patients if they continue

3. to smoke. Stefanie doesn’t just order her patients to stop smoking; rather she suggests
ways for them to quit. Often times she prescribes a patch to help the patients quit. She is
actively working for the patients to help them quit. It is also important to ask each patient
in the GI surgery unit if they drink alcohol. Stefanie also talks with these patients about
their health and the effects of alcohol. The right amount of physical activity and the
motivation to get better are always encouraged after surgery. After a major surgery, the
patient is advised to take it easy but to remain physically active if possible so that the
healing process is faster and easier. The health care providers see that the patients need
the motivation to get better. Some patients don’t try to get on with their normal lives after
surgery and choose to use wheelchairs and stay home. This only hinders the healing
process. Getting back to a normal life is important after these kinds of surgeries.
Therefore, these lifestyle discussions are imperative to have with patients to prevent
worsening health.
In addition to disease prevention, another social determinant that influenced the
services and health of the patients at MUSC is the presence of the services based on the
equity of access. Because MUSC surgeons are some of the top in the world, many people
are traveling from long distances for surgeries or second opinions. The cost of traveling
and staying in hotels can be very difficult for families. Traveling can also be very
difficult for a patient who is in need of surgery or who has just had surgery. Patients can
be in the hospital for weeks depending on their surgery and complications and this can be
very costly for them as well. Many of the patients need a note for work in order to attend
their appointment. For some, the wait time is so long before seeing the doctor that they
feel like they must rush through their appointments in order to get to work. Because not

4. everyone can afford top-notch care, the access is not equal to everyone. Some patients
simply can’t get to MUSC because of transportation issues, the lack of family or friends
to assist, financial reasons, and the fact that they are too ill to travel. If this is the case,
these patients are subjected to stay in their hometown and may receive care that may not
be the state of the art care that they need. Patients who have better access are receiving
better care than those who do not have access. All patients deserve to receive the best
care possible, yet inequity of access is preventing this care. My internship site should be
more conscientious of this inequity. One solution is to provide a temporary lodging home
for the families of the GI surgery patients who have to undergo extensive medical
treatment. An example of one of these homes is the Ronald McDonald House Charities of
Charleston, which provides lodging for families with sick children undergoing treatment.
Therefore, there are ways to help those who have less access to care than others.
Increasing equity to health services is needed at my internship site. The high
quality of health promotion that the site provides should be available to anyone in need. It
is unlikely that episodic sick care will be eliminated in a department such as GI surgery,
but this does not mean that the department lacks in health promotion and preventative
care. MUSC’s medical services and resulting patient health are heavily influenced by
these social determinants. Making improvements to these determinants can greatly
impact public health today.