Point of View: Ari Johnson, MD

Medicine as an Instrument of Justice

Hometown:
Education:


UCSF Medicine Residency Track:
Areas of Distinction/ Pathways to Discovery:
Washington, D.C.
Brown University: Sc.B., Neuroscience
Harvard Medical School: MD San Francisco General Primary Care
SFGH Primary Care Track
Health and Society: Health Equities Track



  • What drew you to a career in medicine?
  • I came into university thinking I would be a writer or journalist. I became increasingly involved in global health research in some of the world’s poorest communities, and encountered the violence that broken health systems inflict upon the poor. I found myself attending funerals every week for young mothers and children who had died of diseases that we’ve long known how to prevent and cure. For example, one young woman died of a dental abscess because she couldn’t afford access to a few dollars’ worth of antibiotics.

    That instilled in me a great drive to pursue my path in medicine – to develop the skills to both provide medical care for those who don’t have easy access to it, and to design and create health systems that provide access to health care in settings of extreme poverty.

  • Why did you choose UCSF for residency?
  • The SFPC [Internal Medicine Residency Primary Care Program at San Francisco General Hospital] is one of the few residency programs in the country that’s mission-driven. It’s focused around addressing and overcoming injustices in health, and training practitioners, primary care providers and primary care systems leaders for the poor. That mission resonated deeply. I’m most interested in medicine as an instrument of justice. It’s a set of tools that we can deploy to build a more just and equitable world together.

  • What have been some key learnings from residency?
  • One of my co-residents had a primary care patient with weakness in her hand, which is a relatively common complaint. But she was able to pick up that there was something really dangerous going on, and arranged and expedited workup. I witnessed how devoted she was to advocating for a patient, mobilizing two different specialists and the health system as a whole. I have been inspired both by how sharp and insightful my co-residents are as clinicians, and how devoted they are to being advocates and partners for their patients, particularly in settings of great vulnerability.

  • Other memorable experiences?
  • One of my primary care mentors was Dan Wlodarczyk, who is something of a legend in primary care in San Francisco. He keeps me on my toes, because he is so up-to-date on all of the most recent medical literature. At the same time, he has such an incredibly humble and gentle way with patients. The way he sits with patients – who often are stigmatized or isolated because of homelessness, poverty or mental illness – makes them feel comfortable and at home in the clinic, and safe with him. He develops an alliance with patients that allows him to translate state-of-the-art, evidence-based clinical practice into the reality our patients face. That’s something I’ll take with me.

    Also, philosophically, I have benefitted from being part of a community that believes strongly that everyone, even the most vulnerable patients, deserves the highest quality of health care. That’s an ethos that pervades the UCSF community, and a spirit that has nourished me on my path.

  • Could you talk about your work with Muso, the nonprofit based in Mali which you co-founded?
  • Muso (projectmuso.org) partners with the Malian Ministry of Health to design and test new approaches to health systems redesign – how to redefine the way we do health care delivery to the world’s poorest communities, with a focus on improving health outcomes and averting preventable deaths. We’ve worked in Mali for the past nine years on building and testing a new kind of ultra-rapid health system that is focused on reaching patients early in the course of their illness.

    It’s a simple idea, but to pull this off in communities that don’t have roads, addresses, or consistent access to electricity – and where many people have never seen a doctor – is very challenging. We’ve flipped a number of conventions of traditional health systems on their heads. For example, rather than sitting in a clinic and waiting for patients to come, we designed a system that deploys community health workers to proactively search for patients, door-to-door, for hours every day. We remove fees that patients can’t afford, and provide better training for primary care providers.

    An evaluation of the model was recently published by a team of researchers at UCSF, Harvard and the Malian Ministry of Health that showed significant differences in rapid access to care and mortality rates after the rollout of this health system.

  • What are your plans after residency?
  • I’ll devote most of my time to Muso’s health systems work and research, while also continuing to practice medicine in both outpatient and inpatient settings.

  • Any time for outside interests?
  • I enjoy going on runs, cooking and making music with friends.

  • What are your long-term goals?
  • When I’m an old man, I want my grandkids to live in a world where everyone has access to health care – in which we don’t let millions of people die annually because they were born into poverty. I think that is imminently possible.