Social determinants of health (SDOH) such as a patient’s home community and economic status are well recognized in many medical specialties, but the surgical field has been slower to embrace social concerns. Now, an organization of surgical educators and medical students is trying to change that paradigm.
Socially Responsible Surgery (SRS) was founded at Boston University Medical Center (BUMC) in 2014. Through research, education, and advocacy, the group aims to establish social responsibility as a core value of surgical practice and raise attention to SDOH in surgical training and care.
“Factors like nutrition, access to care, and insurance status play major roles in how a patient will recover from surgery,” said Diane Haddad, M.D., a general surgery resident at Vanderbilt University Medical Center. “Social determinants of health are intrinsic to effectively caring for surgery patients.” Haddad attended medical school at BUMC, was a founding member of SRS, and co-authored a paper in Frontiers in Surgery that defined the group’s core concepts and goals.
Changing Surgical Education
As a movement led by surgical residents and educators, SRS has a strong focus on medical training. SRS leaders hope to integrate its principles into the formal medical school curriculum, create more service-learning projects and help surgery residents build careers that incorporate these values.
“We don’t always think about these things in surgical training,” Haddad said. “But we know that your health coverage and social support dictate your outcomes in trauma and cancer care, which are fundamentally treated by surgeons. SRS aims to merge the unmet needs of patients with early clinical experience for medical students, exposing them to how social determinants of health affect care.”
“Social determinants of health are intrinsic to effectively caring for surgery patients.”
Understanding Disparities
SRS also has a research agenda. Haddad explains that surgery as a field has lacked a strong body of research exploring disparities in surgical care and access. This has made it hard for community minded surgeons to design interventions to address inequalities. “[SRS is] trying to identify the gaps and formalize the process in order to improve our ability to intervene,” Haddad said.
Haddad is focusing her research on public health and health policy, including barriers, access points, and payment systems that affect access to surgical care in underserved populations. At her former BUMC, surgery residents and faculty advisers are studying SDOH-related topics including the impact of food insecurity on surgery, the link between primary language and surgery outcomes, and hospital recidivism rates among victims of violence.
Advocating for Change
As a philosophy, SRS is focused on expanding the surgeon’s service beyond the hospital or clinic. It seeks to involve surgeons in developing interventions and policies that address inequalities, and to be leaders in establishing team-based strategies to engage with patient communities.
“Surgeons must learn how to engage in political and social platforms. We need to encourage the allocation of resources towards addressing surgical inequalities and participate in developing health care policies that address the social determinants of health,” Haddad said.
Building a Movement
In its short history, SRS has established two national chapters and has implemented a two-year fellowship at BUMC. At Vanderbilt, Haddad has collaborated with the Social Mission Committee, General Surgery Interest Group, and other surgery interest groups to host a discussion panel on social mission in surgery on Thursday, December 5. The discussion will highlight current efforts of Vanderbilt surgeons to promote health equity in areas including work with underserved populations, research, community service, diversity recruitment and mentorship, and political advocacy.
“We hope to initiate these types of conversations at academic medical centers across the country,” said Haddad. “We’re trying to build a movement.”
