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Interview with Tracy Jalbuena, MA, MD by Melissa Fry 06-07-2020

Tracy Jalbuena, MA, MD

Preferred pronouns: She/her

Current Occupation: Emergency Physician PenBay Medical Center, Medical Director of Quality PenBay Medical Center, Clinical Lead for MaineHealth Telehealth

Education

Medical Residency in Emergency Medicine, Ohio State University, Columbus, Ohio

MD, University of North Carolina School of Medicine, Chapel Hill, North Carolina

MA Sociology, University of Arizona Department of Sociology, Tucson, Arizona

BA Sociology, Indiana University, Bloomington, Indiana

Tracy Jalbuena is using her sociological research skills to inform quality management and contributions to the emerging field of telehealth. With a Master’s Degree in Sociology and several years of Emergency Medicine under her belt, she identifies how theory and methods both inform her skills in keeping up with current research and in contributing to it.


Emergency Medicine is an endlessly fascinating intersection between clinical medicine, basic human physiology, and sociology.  It is a clear example of “applied sociology”. 


Tell us about your path from an undergraduate major/minor in sociology to your current career. (Probe: what drew you to sociology? From that place, how did you find your way into medicine?)

Growing up, I had always been interested in the biological sciences, and for a long time, I planned on being a basic bench scientist in genetics.  However, in college I realized that I wanted to focus on people; the unit of study in genetics was too small for my tastes.  As the study of human societal structure, sociology grabbed my attention, and I graduated from Indiana University with a BA in sociology.  My subsequent studies in graduate school at the University of Arizona were transformative in my young life, and formed the foundation for everything I did afterward.  However, toward the end of my second year in the sociology program, I realized that I was an extrovert and wanted to be directly engaged with people at the individual level.  Combined with my long-standing love of biology and the fact that my family is steeped in medicine, transitioning to medicine seemed a natural choice.

In what ways do you think your background in sociology informed your career path and the work you do now?

My entire understanding of how humans live in society, namely that social structure shapes and informs virtually every aspect of life, was the filter through which I incorporated all my experiences of medical school and residency.  This view of the world helps me be a better doctor than I would be otherwise, and it also helps me deal with the stresses of a high-pressure profession.

When it came time to choose a specialty, Emergency Medicine was my clear choice.  Emergency Medicine is an endlessly fascinating intersection between clinical medicine, basic human physiology, and sociology.  It is a clear example of “applied sociology”.  The social structures that constrain and limit certain groups of people funnel them into the Emergency Department, resulting in the disadvantaged disproportionately presenting to the ED.  When you don’t have sufficient resources to serve as a buffer, what would have been small bumps in the road turn into real medical emergencies.  For example, a person whose job does not offer health insurance has inadequate treatment for hypertension, leading to heart failure. 

On the other hand, someone whose job offers health insurance may have had good control over their blood pressure, thereby preventing heart damage.  That relationship goes both ways; poor health becomes a constraining and limiting force in a person’s life, exerting downward socioeconomic pressure.


Without understanding and keeping in mind the social structures that constrain an individual patient’s choices, it is easy to become cynical and to come to resent the patients…. My training in sociology helps me fight that current, and to maintain the compassion that is at the core of being a healer.


The Emergency Department is an extremely difficult place to work.  I love it, but the pressures are tremendous, simultaneous demands usually cannot be fulfilled, and it often feels futile.  In the tradition of Taylorism and scientific management, every move is time-stamped, scrutinized, and tracked in order to maximize efficiency.  Long stretches of overly-busy tedium are unpredictably punctuated by sheer terror.  There are rarely enough resources to do what’s being asked, and often there’s not enough time to eat or use the restroom during a shift.  The same patients show up repeatedly with the same problems – over and over again, seemingly after ignoring medical advice and making the same bad choices.  It feels like the pointy end of society’s stick.  Without understanding and keeping in mind the social structures that constrain an individual patient’s choices, it is easy to become cynical and to come to resent the patients.  Many staff in the ED fall prey to this pitfall.  My training in sociology helps me fight that current, and to maintain the compassion that is at the core of being a healer.


[T]he skills I gained in two years of graduate-level statistics are priceless.  I wouldn’t have wanted any other route to medicine.


On an intellectual level, my sociology skills in critical and statistical thinking are called upon almost every single day.  From reading the latest article about a trial for tranexamic acid to stop bleeding, to understanding how to interpret and best use patient satisfaction scores, to designing research projects to understand the clinical impacts of telemedicine, the skills I gained in two years of graduate-level statistics are priceless.  I wouldn’t have wanted any other route to medicine

In thinking specifically about the COVID-19 pandemic, where have you seen social and institutional factors playing the greatest role in experiences and outcomes?

Our system of distributed state governance means that it is difficult to have a large-scale, coordinated, rapid response to events such as the SARS-CoV-2 pandemic without federal intervention.  When combined with our federal government’s inability or unwillingness to exert federal control of testing, tracking of epidemiology, rapid distribution of resources such as test kits and personal protective equipment, and triage of COVID-19 patients, this has resulted in a relatively poor pandemic response.  Morbidity and mortality are almost certainly higher than they would have been with a more organized, rational response.  Of note, while mortality is a terrible outcome, morbidity from having had COVID-19 will also be significant.  COVID-19 has become yet another illness with long-term health consequences that exert a downward socioeconomic pressure on those who have the fewest resources to deal with it.

Please share any other thoughts you have about how sociology combines with your other education and training in ways you find useful or important to your work.

I have always been fascinated with scales and orders of magnitude.  The intersection of emergency medicine and sociology combines three different orders of magnitude: the biochemical and microscopic, the human organism and the structure of human society.  Just as the microscopic and biochemical are crucial to meaningful understanding of the human illness, disease and trauma when one is lying in front of you on a stretcher in the ED, so is the larger scale of societal structure. 

What do you wish had been part of your undergraduate education and training in sociology but was not?

Undergraduate programs in sociology do their students a disservice by glossing over the robust concepts of social structure and the rigorous quantitative and qualitative research methods used at the graduate and professional levels.  

What advice do you have for undergraduate sociology students and/or sociology alumni who may have an interest in health/wellness, healthcare, or medicine?

There are so many interesting opportunities at this intersection!  There’s a lot of creative work waiting to be done!  For example, MaineHealth has a research group that employs statisticians, sociologists, anthropologists, psychologists and others from the social sciences. Their work is used both internally at MaineHealth for leadership to use in strategic decision-making and resource allocation, and also externally for publishing work that contributes to the medical literature.  Many large healthcare organizations have similar initiatives.  In addition, there are innumerable organizations that do not directly deliver healthcare to patients, but that study healthcare delivery, create guidelines, sponsor innovative projects and publish policy recommendations.