Nick Vasquez, MD, FACEP, gets to see the impact of social determinants of health every day in the emergency department. Like most in our specialty, he wants to help solve problems. He’s spent 12 years in this place “of inquiry and service,” as he calls it, trying to understand some of the root causes of health inequities. Dr. Vasquez honed in on one piece of the puzzle that he’s now passionate about trying to change: childhood literacy.

“And there’s this critical point [for children] around age eight, age nine, age 10 … somewhere in there, they will either learn to read, or they will not,” Dr. Vasquez said. “If they learn to read and they’re proficient at reading, they gain agency. They gain this idea of, ’I can.’”

He said emergency physicians often care for those who did not develop agency, and it’s led them to believe the world has power and they do not. “They feel like they can’t,” Dr. Vasquez said. “That dividing line is so powerful.”

When confronted with the research regarding the link between literacy and health, Dr. Vasquez said he had a “What the hell are we doing?!” moment of clarity. Ever since, he has been a vocal proponent for improving literacy rates in his Arizona community.

“Everything that I do is about empowering, educating. If you had simply one or two or three more years of primary school, you’d be more likely to wear a seatbelt. You’d be less likely to smoke. You’d be more likely to be successful at the end of the day,” he said.

It Starts with Diversity

“I got to get you to care about you, and you will self-correct,” Dr. Vasquez explained. Of course, it’s not as simple as it sounds. As immediate past chair of ACEP’s Diversity, Inclusion, and Health Equity Section, he’s reflected on the difference among those three things. It starts with diversity, which he says is “changing up the faces around you.” The next step is inclusion, which Dr. Vasquez thinks is harder to achieve because the people in power have to be aware that there’s a problem before we see any positive change.

The hardest to achieve of all is equity, because “equity is sharing power,” Dr. Vasquez said. That’s hard to reach, he explained, when operating in a system where those in power “by nature don’t like to share.”

Rather than get discouraged by the feeling of trudging uphill toward equity, Dr. Vasquez focuses on empowering children to read. “Once they’re able to read, they are self-motivated to help themselves, to be better patients, to be better decision makers, to put themselves first,” he said. “It is this weird thing where you don’t have to fix the world; you just have to teach kids to read. “That extra couple of years of primary school or that extra impact from graduating high school is so powerful. It’s like the best medicine we can get.”

Having Insight into Your Problems

Despite his passion for this work, Dr. Vasquez still gets discouraged when he feels like he’s not making a big enough impact. When that happens, he remembers a book he read that talks about the difference between problems and dilemmas, Stop Physician Burnout.

“There’s this difference between a problem, which is a finite, solvable thing, and a dilemma, which is an eternal unsolvable but must be a managed thing. You have to separate the two,” he said. “[A dilemma is] meant to be managed, and you have to understand what you value most so you can make trade-offs and be okay with what you’re letting go of.”

“I think that we, physicians, especially emergency physicians, try and drive ourselves nuts trying to solve unsolvable things,” Dr. Vasquez said. “You may have insight into the world’s problems, but they’re not yours to solve, because you didn’t create them and therefore you can’t end them.”

“You can advocate,” Dr. Vasquez said. “I can be kind to you right now. I can listen to you right now. I can hear you … I can get to the place where [patients are] regretting losing something, and I can call to them and say, ‘hope better for you. How can I help you to do better?’”

Ms. Grantham was formerly the Senior Communications Manager at ACEP. The ACEP Now Team would like to thank her for her five years of service to the College. She currently works in corporate communications with a national building company.