Partnering with communities: why and how?

To enhance the impact medicine can have in addressing healthcare disparities, it is often necessary to work outside of the clinical space.  One-on-one clinical care is critically important for the individual, but can only address the individual's need at that point in time.  Although this is the core of medicine--the doctor/patient relationship--it is not sufficient to address broader issues.

I believe that physicians' roles in leadership and community focus require us to look beyond the clinic to bring necessary change.  At the minimum, I believe that  physicians need to be advocates for necessary change: at the organizational and/or at the political level, we must be pushing for policies that will improve the health of our communities.

At the same time, it can often very valuable to develop partnerships in the community itself.  However one defines community, the community's members will have a strong sense of the community's strengths, needs, and challenges.  However, in many cases forming a productive and effective relationship with underserved communities can be challenging.  Many times, these communities may feel isolated and marginalized.  In some cases, they may actively distrust medical institutions based on past experiences.

Every community is unique, and effective community partnerships will all differ in some way.  However, there are some general themes that can guide the process in developing community partnerships:

• Demonstrate genuine commitment
• Have a long time horizon--things will move slower than you would prefer
• Assess the communities needs and values, and respect them
• Expect challenges and strife: pre-empt them if you can, address them when needed
• Understand that all decisions carry political consequences
• Good intentions are dangerous things: consider the ethics of your intervention
   Identify and engage the community's leadership (official and unofficial)
• Inspiration and interest on our part can help generate an idea, but need community guidance for any intervention
• Listen, think, talk...then act
• Tolerate of uncertainty
• Know that communities are heterogeneous, even if there are not any apparent differences on the surface
• Align incentives: look for space where your interests/motivations/rewards align with the community's

By approaching a community guided by these principles, the resulting partnerships will be more robust, more beneficial, and more respectful.