In my first post, I'd like to introduce a point that I've discovered during my internship experience, something that I've learned from my supervisor there. As I am still in the process of earning my Masters degree, there is much left for me to learn about health care. I have no conclusive opinion yet to offer on this topic, so that's why I say I am only bringing this to your attention. Actually, some students who already went through an internship praticum might agree with me already.

With that said...

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The practice of public health often does not mirror the public health theory we are exposed to in academic settings.

Especially at well-endowed universities, we the students are trained in our courses to strive for optimal care for our patients. We aren't aware of it when we are being schooled, but we are shielded from the real world by the luxuries in our home institutions. It is my opinion that the rift between academic health research and health delivered in practice is here, in the discrepancy between the "Ideal" and the "Next Best Option."

Studies must always be planned out thoroughly. Before we even propose the study, we must read all of the literature already present on the topic and make sure, through and through, that this will be a promising study. We must get a massive sample, and leave little room for error. A difficult situation, an unexpected problem that is out of your area of expertise--no problem, contact a specialist, hire a biostatician, call your lifeline.

It's a common exercise in my public health classes to create hypothetical research studies or intervention programs. Although we are presented with challenges, many times we brush them off by using the excuse "this is just a hypothetical study." In this hypothetical setting, we have lots of money and time and all the resources we need, so why should we bother thinking further?

Now, graduate and you've got the degree. Come the real world, and this is what you might really see....

Shortages in supplies (such as ink for the fax machine) that seem most trivial at first, but end up halting the entire process. Workers retiring/getting laid off, nurses taking week-long vacations at all the wrong timings. Deadlines for grant applications that leave no time for you to consult the previous literature. Software that won't stop crashing on you. And will you ever, ever have enough money?

When I worked at my summer internship at a correctional facility, I realized that we were constrained like this (I won't go into excruciating detail). Jail inmates are a unique population in every sense. The most important limitation on our screening and treatment programs was that many inmates didn't stay in our facility long enough for us to give them treatment. Infected patients were released back into society, free to spread whatever they might have been carrying. All it took was maybe a little delay in getting laboratory test results back because of lazy workers forgetting to fax us the paperwork. Just like that, we'd lose the opportunity to treat several sick patients. Not to mention, if we conducted research evaluations, the sample size was never ideal, there were human mistakes and data were often incomplete (we lost entire sets of answers to certain questions because someone copied the survey questionnaires and didn't notice the bottom was cut off!).

Ideally, we'd screen everyone for every reportable disease and treat all the positives properly. But taxpayers' money just didn't give us enough resource to do so. And that is only one of a million other limits we faced. I imagine this tight situation does not apply only to the place I worked in. The economy, the special population, the political situation...whatever the reason, health care workers everywhere on the planet must be facing such difficult decisions as to "What is the Next Best Option available to us for our patients and the public?"

We need to learn to be opportunistic, flexible, and resourceful. The main point of my account here is that we must be ready. Not only for crises, but for little holes in our planning that can cause the whole boat to sink.

And so, from this point forward, I intend to learn how to really think when I practice public health.