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Medical Education
Bridges Curriculum

Alicia Fernandez MD

“I think my life is much richer because I’ve been able to combine research with teaching with clinical work. Those things are very synergistic; they’re not separated in me.”

Dr. Alicia Fernandez is an academic with the heart of an activist. Her passion for social justice grew out of her family’s experience in exile in New York City from a violent dictatorship in Argentina as well as witnessing the early devastation of the HIV epidemic. The decision to go into medicine came after several years of community activism, including working on immigrant rights at the Center for Constitutional Rights. Now, at UCSF and SFGH, she builds on that foundation of community engagement to tackle health disparities and serve vulnerable populations.

What are the current frontiers in your work?

Usually diabetes is framed as an individual’s problem, a choice, rather than a community problem. I want to reframe chronic disease as a community issue, starting with families. We’ve formed a strong partnership with the San Francisco Department of Public Health to create a social marketing program for parents and grandparents to stop the intergenerational transmission of diabetes within families. We’re borrowing from the lessons of the HIV epidemic’s campaign, “HIV stops with me.” That message was so powerful because it took people who are HIV positive and made them the hero of the story: “I care for my community, I take steps to protect others.” In the same way, one of the great strengths of our community is family love and protection. That has yet to be really tapped into for chronic diseases. There’s still a lot of stigma and shame. We can turn it around and say, “I may have diabetes, but diabetes stops with me.”

I have also spent a lot of time reducing language barriers in the clinic, focusing on the physician, the clinical system and technology. But what does the individual patient think? Do they think, “It’s my fault that I don’t speak English, so I shouldn’t ask for an interpreter”? It’s particularly an issue for patients with a chronic illness like diabetes, which is so difficult for our patients no matter how well resourced they are. So why don’t they demand more from the system? I think trying to understand these issues is important and could lead to health systems changes.

How do you draw on multiple lenses of inquiry?

To me, it’s all clinical science. What is clinical science if it isn’t about how we can make our care more effective? How do we talk to our patients? At the end of the day it’s about care. I’ve worked on what happens in the individual patient-doctor relationship to more systems issues to real system reform.

To do that, I collaborate with social scientists. For example, the Russell Sage Foundation (a social science research organization) funded me to study culture and immigration in medicine. We interviewed 700 Latinos, African American and low-income Caucasian people in Chicago and the Bay Area about their experiences in the health care system. That was very rewarding and gave rise to a lot of interesting publications, including some with anthropologists.

Over the last several years, a lot of my work is in education, too. I’m interested in how to teach disparities. Dr. Talmadge King, myself and others have written a textbook, the Medical Management of Vulnerable and Underserved Patients. I’ve also collaborated with the Society for General Internal Medicine to create an online clinical program to teach disparities, which gets downloaded and used all over the country.  At UCSF, I’ve created the Prof-Path program to support medical students interested in health disparities research. In another project that we just started minority faculty will come from all over the country to learn about implementation science. We also work with San Francisco state on faculty development.

I’m also on the board of governors of the Patient Centered Outcomes Research Institute (PCORI), which is a huge leadership opportunity to have a little bit of a say in how research dollars get allocated. PCORI’s core mandate is patient-centered research. It allows us to fund projects that not only ask if drug A better than drug B in terms of mortality, but also, ask about the patient experience. So it’s a fantastic opportunity for me.

What does inquiry mean to you?

It means asking important questions about what we do, how we think about what we do and how we can do it better. 

Inquiry has had personal meaning, allowing me to connect clinical medicine to the social justice work I’ve always done. I think my life is much richer because I’ve been able to combine research with teaching with clinical work. Those things are very synergistic; they’re not separated in me. I love all of those aspects of my job.

What advice would you give a medical student today?

To take full advantage of the opportunities at UCSF to work with people who are performing inquiry. It’s such a special time in your life to be able to do that.

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