The Definition and Role of Upstream Doctors. Research Paper Example.

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Sewanee University of the South
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Research paper
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By definition, an Upstream Doctor is a health care profession who is equipped to transform the health care system and the conditions that make people sick. For one to become upstream, he/she should have a passion for seeing social justice. An upstreamist, on the other hand, is someone who is charged with the responsibility of not only seeing and diagnosing them but also finding out and treating social determinants of health. In a similar regard, an upstreamist can be considered as the healthcare provider who is concerned with what is causing the patients to get sick. The individual needs to have specialized training in the healthcare field. Their role is to find out who is throwing people in the water The ER doctor, the ICU nurse and the people at the intensive care are the first responders. They are the people that we look for when were are in dire need (Berkowitz, 2015). They are a vital and necessary part of the healthcare system, while the upstream doctors work at understanding and addressing the social causes of health. Thus, they strive to learn about peoples lives, how they live, where they work and brings that knowledge to the workplace. By understanding these factors, an individual can understand how certain aspect contribute to health issues.

The upstream practitioners play a vital role in the healthcare system as they try to learn what cause the disease. Dr. Rishi Manchanda believes that if doctors are encouraged to look beyond their patient's symptoms, the health care system can be transformed. Dr. Manchanda looks upstream when a patients visit his clinic and at the same time, tries to find out what caused the illness. His questions to the patients include inquiries about their homes and their social backgrounds in relation to the patients physical activity, their diet, and neighborhood (Manchanda, 2013). After writing a prescription to a patient, the doctors dispatches a community health worker to go out and help the patient in determining and eliminate health dangers from their homes. Similarly, Manchanda urges his colleges to help him break the barriers, and he sees a willingness by the practitioners in changing the situation. A 2011 survey indicated that four out of five medical professionals believe the patients environment has a role in his/her illness. However, the research also revealed that most practitioners consider the situation beyond their control. Thus, in a nutshell, regarding the role of an upstreamist, their minds might be considerably helpful in preventing diseases in a social setting, and hence reducing the workload and the fatigue of the downstreamists.

Beliefs and Practices of Upstreamists

Currently, there is increasingly the desire to have upstreamists, who will by default move upstream as their professional practice intended to improve health and also reduce the healthcare costs. For instance, regarding their beliefs and practices, upstreamists believe that they should work to prevent any form of disease before it actually happens. They are, therefore, able to achieve this by primarily addressing both the social and the environmental determinants of health. Besides, Dr. Manchanda contends that with reference to the beliefs of the upstreamists, they usually are those physicians who perceive their work as including the responsibility which does not only involve the prescription of a clinical remedy but which also include the practice of tackling a particular sickness and its source. In the same vein, upstreamists believe that medicine, as a profession could do a lot better if the health practitioners did not have only reason from a clinical setting, which only involves the treatment of a disease. Instead, the upstreamist hold the belief that it is extremely unnecessary to treat people and only send them back to the conditions which made them sick from the very beginning (Manchanda, 2013).

In his book, The Upstream Doctor, Dr. Manchanda suggests that there is a great need for more health professionals to embrace the beliefs and practices of the upstreamist providers. This, in essence, will enable them, as doctors and nurses, to be at the forefront of medical lines, where they are able to see various sicknesses as more than just a mere chemical equation that can be balanced with pills, among other medical prescriptions. Instead, Manchanda says that every medical health profession should be in a position to understand that health begins in our everyday lives; and this includes the health conditions of the places that we live, work, eat, and play.

Also, the beliefs and practices of the upstream doctors revolve around their ability to understand the root cause of a disease not only in the patients body but also concerning the social and environmental factors surrounding the patient. For instance, an upstreamist should understand that asthma, for instance, starts in the air around the patient or even in the mold in the walls of the patients homes. Therefore, as a medical profession, he or she should not only treat asthma in the patient but should also have solutions to rectifying the environment or rather the living conditions of the patient. In the same vein, an upstreamist should understand that obesity, hypertension, and diabetes are not just chronic conditions, but are also a reflection our modern day schedules and our unhealthy food choices. With this put into consideration, the health care professionals will, therefore, be equipped with the necessary knowledge and tools which will be essential in turning the social health knowledge into action. They will also be in a position to translate the acquired knowledge into meaningful action, which will, in turn, transform the care delivery in our clinics and hospitals (Castrucci, 2015).

The Pros and Cons of Upstream Doctors

Like any other medical practice, the upstreamist therapeutic approach has both its advantages and disadvantages which are attributed to the health benefits as well as the shortcomings which are brought about by this approach. The following are some of the benefits of having upstream doctors;

The Pros of Upstream Doctors

As clinicians and healthcare providers, through their societal and environmental approach, the upstream doctors can adequately address the social determinants of a patients health. These upstreamists are able to achieve this through the use of crucial tools which primarily assess the patients environmental conditions, and their community conditions, at large.

Through their beliefs and practices, upstream doctors effectively include non-medical providers as part of the healthcare team. By so doing they bring about the necessary evolution in the healthcare practice which seeks to improve the overall patient care.

The social approach taken by the upstreamists does not only benefit the ailing patient but also positively impacts many other people in the society (Gottlieb et al., 2015).

The Cons of Upstream Doctors

While upstream doctors are characterized by a vast range of benefits to both the patient and the health care sector as a whole, their practice does not go without any disadvantages. Some of the common disadvantages related to the upstreamist approach are attributed to the barriers which hinder the achievement of various health goals by the upstream doctors. These barriers include:

Lack of diversity among the healthcare professionals

Unlike the current healthcare professionals, upstreamists are expected to have a social, economic, as well as a cultural relation with their patients. This kind of relations help the upstream doctors in coming up with ways that can be used to address the root cause of the patient's condition effectively. However, in the case of America today, the health care sector lacks diversity due to the drastic underrepresentation of health care practitioners in various minority groups and cultural backgrounds. Healthcare professionals, or rather the upstreamists who share the same culture with their patients are more likely to identify the root cause issues of the patients condition in their society.

Lack of enough training

One of the common limitations of the upstreamist medical approach is that the healthcare professional, doctor or nurse, is expected to have the necessary knowledge on the social determinants of health. This, however, faces the lack of education and training barrier since a majority of the healthcare training programs fail to include the required courses on the social determinants of health.

Actionable data

This is also a common barrier which substantially leads to the limitations of the upstream doctors. Based on this context, the lack of enough information regarding public health approaches or even the patients way of living substantiates this disadvantage. For instance, the upstream doctors lack actionable data relating to different health approaches which have, in the past, managed to treat diseases that are characterized by a strong environmental component.

How Upstream Doctors are Related to Current Healthcare Practices in America

With the modern day environmentally related health issues, the upstream doctors have a significant relation with the present day practices in America. With the help of the upstream doctors, who seek to identify the root causes of various health conditions, doctors in the current American health care sector perfect their profession. For instance, with their social and environmental knowledge, upstream doctors help doctors in the clinical settings to make inferences relating to susceptibility as well as monitor various symptoms for geo-specific health conditions such as lung disease. Additionally, in the current American healthcare setting, clinical healthcare practitioners fail to understand larger environmental and societal risks and trends responsible for some rare kinds of diseases. However, upstream doctors present in the healthcare work with the clinical health professionals, hence helping them in combating both the environmental and societal disease causing risks which eventually contributes to improving the overall health conditions of all the people (In King & In Wheeler, 2016).

In conclusion, reflecting on the roles, beliefs, and practices of upstream doctors, we can conclude that it is professionally accepted that healthcare professionals, find and treat the root cause of an ailment or a disease. Thus, in this regard, Dr. Manchanda emphasizes that there is a need for our modern day medical professionals to embrace the upstream style in our hospitals and clinics. By so doing the medical sector and the society as a whole, will be in a position to more appropriately address health issues, if they are looked from a societal perspective which addresses the matters right from their root cause.


Berkowitz, S. A., Hulberg, A. C., Hong, C., Stowell, B. J., Tirozzi, K. J., Traore, C. Y., & Atlas, S. J. (2015). Addressing basic resource needs to improve primary care quality: a community collaboration programme. BMJ Quality & Safety, 25(3), 164-172. doi:10.1136/bmjqs-2015-004521

Castrucci, B. (2014, April 23). Rowing Together: How Public Health Supports the 'Upstream' Doctor | The Huffington Post. Retrieved from

Gottlieb, L. M., Tirozzi, K. J., Manchanda, R., Burns, A. R., & Sandel, M. T. (2015). Moving Electronic Medical Records Upstream. American Journal of Preventive Medicine, 48(2), 215-218. doi:10.1016/j.amepre.2014.07.009

In King, T. E., & In Wheeler, M. B. (2016). Medical management of vulnerable and underserved patients: Principles, practice, and populations (2nd ed.). McGraw Hill Professional.

Manchanda, R. (2013). The Upstream Doctors: Medical Innovators Track Sickn...

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