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At the Intersection of Health Policy and Patient Care

A conversation with David Fink, PhD

By Janice Hur
4 Minute Read

Healthcare is shaped not only by what happens in the clinician’s office but also by the policies, systems, and evidence that determine how patients access care. For David Fink, PhD, assistant professor of medicine (general medicine) at Yale School of Medicine, those connections have led to a career researching pain and substance use, with a focus on how health policies and care delivery models affect patients. His recent review examines the association between state cannabis laws and opioid outcomes.

Fink’s path into health policy and substance use research began when he saw firsthand how policy could affect the care available to people trying to reduce the risk of substance use or enter recovery. He later trained in epidemiology, worked in veterans and military health, and studied the effects of policies such as prescription drug monitoring programs and cannabis legalization on drug-related outcomes.

In a Q&A, Fink discusses the interacting pieces that shape health, what drives his work, and how research can better reflect the outcomes that matter to patients.

Your work sits at the intersection of medicine, public health, policy, and data. Tell us more about that intersection.

I see those areas as part of the same system. Health is shaped by many interacting pieces, from individual clinical encounters to institutional, state, and federal policies.

Even when there are only two people in the room—a clinician and a patient—policies are still shaping that interaction. Guidelines, regulations, treatment availability, and institutional practices all affect what clinicians and patients are able to do. That is why policies need to be designed in ways that are practical, adaptable, and able to help clinicians do their jobs better.

What kinds of questions drive your work?

There are many ways to improve health. Some happen one-on-one between a patient and clinician, and those interactions can be incredibly meaningful. My work often focuses on policies and systems that affect entire states or large populations. Even a small effect, when spread across many people, can have a large impact on health.

How has being at Yale School of Medicine shaped the questions you ask or the collaborations you pursue?

Before coming to Yale, I primarily worked in schools of public health. Yale is my first position in a school of medicine, and that has been valuable because it has brought me into closer contact with clinicians and providers.

I have enjoyed interacting with clinicians who have direct, on-the-ground experience with the populations affected by the questions I study. Being at Yale School of Medicine has brought me closer to patient populations and provider perspectives, which is extremely helpful in making sure the questions we ask make sense.

When you study policies that affect millions of people, what does it mean to produce evidence responsibly?

For me, producing evidence responsibly means understanding the full body of literature and being careful not to overstate findings.

One way I approach that is through systematic reviews. I tend to publish systematic reviews regularly, often on topics that I also study in my own research. They help me understand where the evidence is strong, where it is mixed, and where important gaps remain. That broader understanding matters because we should not make major policy claims based on one study alone.

The second part is humility. Each study is incremental. A single finding needs to be understood within the larger literature. Systematic reviews and meta-analyses are especially useful when thinking about policy because they synthesize the evidence and show where we can have more confidence.

What has your work taught you about translating research findings into practice?

There is a long distance between producing evidence and changing practice or policy. That distance includes many people, institutions, and stakeholders, each with different priorities.

Evidence has to move through multiple levels before it affects what happens in practice. Clinicians have to implement changes on the ground. Hospital administrators may need to change systems or workflows. Policymakers have to consider many competing pressures.

Research is most useful when relevant groups are involved from the beginning. That includes affected populations, clinicians, administrators, and other stakeholders. If those groups are part of the process early, the questions are more likely to be meaningful, and the answers are more likely to be useful.

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Author

Janice Hur
Communications Intern, Internal Medicine

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