The Population-Centered Medical Model: A Theory of Practice for Public Health and Preventive Medicine
Abstract
Introduction
Public health physicians occupy a unique place in the fields of both medicine and public health. Trained in each field, and often holding positions of authority in public health systems, public health physicians are sometimes challenged to identify their roles in either field of practice. Public health physicians work to achieve population health, but there has been limited theoretical development in this field of practice.
Objectives
The objective of this research was to develop an empirical theory of practice for public health physicians.
Methods
A literature review of current practice models applicable to public health physicians was performed. A discourse analysis of Chief Medical Officer of Health (CMOH) media briefings during the COVID-19 pandemic was conducted to understand the socially constructed public-facing identities of public health physicians. A Grounded Theory study of practice was conducted by interviewing public health physician participants.
Findings
Current practice models for medicine do not account for the work of public health physicians, whose ‘patients’ are populations. Practice models for public health do not account for the unique roles and responsibilities of physicians in public health. The literature review affirmed that there are no published models of practice that are specific to public health physician practice. From the discourse analysis, it was found that Chief Medical Officers of Health (CMOHs) construct a social identity that is recognizably medical by virtue of its technical and relational aspects. The implication of this social identity is that CMOHs view themselves as physicians, and further that they also view populations as patients. The findings of the grounded theory study led to the development of a theory of practice for public health physicians, the Population-Centered Medical Model (POP-CMM). In this model, public health physicians bring values, knowledge, and stances into the practice of public health medicine. Public health physicians view populations as their patients, and the method of practice involves diagnosis and intervention that is focused on systems and prevention. This process of practice relies on knowledge sharing and relationship building between public health physicians and populations.
Conclusion
The POP-CMM forms a theoretical grounding for the training and practice of public health medicine in Canada. Taken with the findings of the discourse analysis, this inquiry reveals that the practice of public health medicine (and perhaps medicine in general) is constituted by a set of core processes that are enacted across a range of discursive settings. These findings have implications for conceptualizing competence in medical training and practice, as well as for progress toward a general model of medical practice across a spectrum of patients from n=1 to n=N. Further research could demonstrate its transferability to the practice of public health physicians in other countries, to the practice of other professionals in public health, and to the practice of medicine in general.
Keywords (alphabetical order)
Discourse Analysis, Grounded Theory, Medical Practice, Medicine, Model, Physicians, Population Health, Public Health, Public Health Practice, Theory