At a moment of increasing isolationism and xenophobia and -- for physicians – burnout, in a highly bureaucratic and profit driven health system, service in low resource high needs settings can be an antidote for what ails America and American medicine, at least for the individual clinician. John Lawrence has spent decades serving all over the globe as a pediatric surgeon, most recently in war torn Gaza and South Sudan. He explains how he headed to college with plans to become a mathematician and then got diverted from that career trajectory while teaching math to Native American youth in Montana and seeing the consequences of poor access to needed healthcare. As cliched as it may sound, physicians are supposed to serve humanity rather than just the well insured, and John exemplifies that point of view on a global scale.

In can be confusing and even demoralizing for a medical student or resident to understand what’s expected of them when caring for patients with social needs. They already feel overwhelmed. Are they supposed to now also screen for housing insecurity? Is it their job to intervene to address social needs? And if someone else is doing the screening, what’s their role? And are they also supposed to be advocating for changes to social policies? Finally, what’s special about social needs as opposed to all the other reasons that, for instance, a patient can’t control their diabetes? A patient may not be able to store their insulin because they are poor. Or they may not be able to administer it because they can’t read the bottle or their fingers are arthritic.

Our guest, Emily Murphy MD, an academic hospitalist, provides her perspective on teaching medical students and residents about SDOH. Co-host Saul Weiner, expresses concern that messages to trainees about their roles are confusing, that the SDOH movement is just the latest buzzword in medicine, like “patient-centered care,”, and that while getting a huge amount of attention the movement could ultimately have little impact on patient wellbeing. He, Dr. Murphy, and co-host Stefan Kertesz discuss these questions and concerns and consider what needs to change.

To commemorate the start of our fifth season, we revisit a conversation we had almost two years ago about the wisdom of Simon Auster, MD.

Simon was a family physician and psychiatrist who inspired the conversations we’ve been having with each other and with guests on every episode.

“Simonisms” embody Simon’s insights: pithy observations about the practice of medicine that are never cliché, challenge commonly held assumptions and offer fresh perspectives.

We share -- and reflect on -- these pearls because we believe they can help many doctors, those in training, and those who train them, find joy and meaning in their work.

You can learn about Simon, who died in 2020, in an online (open access) essay about his life, published in The Pharos, the journal of the AOA medical honor society.