Some of the most dreaded types of medical school MMI stations are those concerning questions of public health in Australia. After all, if your passion is for clinical science, and treating individual people, then why should you care for politics and policy?
The answer is deceptively simple – medical care exists in the real world, which unlike its picture-perfect textbook analogue, is a world of deficit. The unfortunate reality is that there is simply not enough time, expertise, and available resources to be spent on conversation with patients and analysis of every intricacy of their medical condition. It should also be mentioned that the average person would prefer to avoid hospital altogether. Accordingly, in addition to the many patient--centric responsibilities of a doctor, allocation and management of healthcare resources emerges as an unexpected yet significant priority.
In this brief article, we will delve into the specifics of the doctor’s role in public health, and what you (the MMI candidate) have to consider when responding to this type of station.
First Things First: What Are The Responsibilities Of A Doctor?
Over the past few decades, there has been a shift in perspective as to what the role of the doctor actually entails. We no longer think of physicians as men wearing stethoscopes, sitting behind great oak desks. The contemporary doctor looks beyond treating the disease, to actually treat the person. The goal is no longer to ‘fix’ the person according to a standard template, but to work with the individual to help them achieve a desired health outcome or prevent illness altogether. These ideas are vague because they depend on context, so here are a few examples:
- End of Life Care: a whole field of medicine dedicated to helping a patient achieve the most from their remaining time. The field of medicine is not curative but focuses on treatment to improve other aspects of health and wellbeing. These include mental health and pain management.
- eHealth: a novel concept where a specialist doctor can reach out, across hundreds of kilometres, and provide remote advice to other patients or even physicians.
- Mental Healthcare: a huge area of growth, especially in the general practice sector. This idea encompasses everything from the creation of a safe space within the clinic, to asking a broader range of lifestyle questions during the interview.
It is evident that these concepts are a far cry from the narrow and prescriptive style of healthcare of the past century.
But How Do These Relate To Public Health?
At this point, it is very reasonable to ask why it is so valuable to spend time on tasks which appear so tangential to clinical medicine. The answer to this question is central to responding to the MMI station appropriately. In the second half of the 20th century, researchers began to realise that most diseases do not occur by chance. In fact, some of the biggest culprits of hospitalisations, such as heart disease, are a direct result of the lifestyle that a person leads.
Many studies were conducted on the matter and the idea of a Bio-Psycho-Social model of healthcare was born. Decoding this cryptic title, what this essentially means is that of course disease is a biological problem, but a person’s psychological state, and socioeconomic circumstances are key precipitating factors.
For example, if you had a tough time at home, or your boss at work treated you poorly, you may be much more inclined to reward yourself with fast food to lift your mood. If this becomes a habit, you increase your risk of obesity and diabetes, relative to someone living under more fulfilling, positive circumstances. The logic now goes, that if a doctor is responsible for treating obesity and diabetes in the hospital, why wait that long? There is no ethical reason to wait for a health crisis if it is possible to tackle the underlying mental health or social problems at their root. After all, this saves the health system money. More importantly, it saves a patient from a trip to the hospital.
What Issues Does Australia Face?
Usually, the MMI interview questions are focused on the pertinent Australian public health issues. This is why it’s useful to be aware of the current political discussions, at least at a superficial level, so that you have some context for your interview. While nobody expects you to be an expert in policy, a good medical candidate will at least be able to give an outline of the issue at hand. To help you along the way, let’s discuss some of the public health dilemmas of the Australian healthcare landscape.
- Aging Population: this issue is two-fold. On the one hand, innovation in medical technology means that people are living longer. This, in turn, means that the health and lifestyle challenges facing our hospitals and staff are greater.
- Obesity: our highly commercialised society has created an incredible diversity of fast food chains. There are saturated with fats and sugars, which make for a tempting meal, especially after a long, boring day of sitting in an office in front of a computer screen. This combination of sedentary lifestyle and unhealthy diet has created an obesity and diabetes epidemic across Australia.
- Mental Health: tragic and misunderstood, we are only now coming to terms with the poor identification and management of depression and anxiety in our society. This issue is particularly pertinent in the healthcare community.
What Are The Solutions?
Approaching a public health MMI station is a challenge. The first step is to outline the problem as you understand it. The solutions are largely up to you, but it is a good idea to be informed of official government strategies already in place to address these issues. A good example of a scheme in this sector is the NDIS – the National Disability Insurance Scheme.
This is a funding program that assists individuals with disabilities address their lifestyle needs, ranging from taxis for mobility, to modifications to their home such as the addition of railings in the bathrooms. This funding allows for a safer lifestyle, and one where the social and professional aspirations of people with disabilities are less limited. Public health literacy schemes are also a useful tool to bring up during the MMI. The list of solutions is limited only by your imagination - just remember to be informed, reasonable and pragmatic!
