Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Doctor of Philosophy

Program

Family Medicine

Supervisor

Brown, Judith Belle

2nd Supervisor

Thind, Amardeep

Co-Supervisor

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

Summary for Lay Audience

Public health physicians are doctors who work to achieve health for the whole population. They have one foot in the world of medicine and one foot in the world of public health. This means they can have difficulty explaining their work to other doctors, to people in public health, and to the public. This project aims to build our understanding of how public health physicians practice public health medicine. First, looking at the available literature there are no frameworks or theories that public health physicians can use to describe their own work. Next, looking at how public health physicians present themselves publicly in the media, it appears that they construct an identity as physicians who see populations as their patients. Finally, asking public health physicians about the processes they use to care for populations led to the development of a model or theory of practice for public health medicine, the Population-Centered Medical Model (POP-CMM). In this model, public health physicians bring values, knowledge and stances to their practice. They consider populations as patients, and diagnose and intervene on public health issues with a focus on systems and prevention. This practice relies on knowledge sharing and relationship building between public health physicians and the population. The POP-CMM can be used to help describe what public health physicians do, to set the stage for training public health physicians, and to build better practice in public health medicine. Taken together, the findings from both studies suggest a new way to think about competence in medical practice – as a set of core processes that are enacted by discourse in different settings or genres.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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