The Fifth C: Why Context Matters in Patient Care
On September 9, 2026, students in the Conversations in Health: Global to Local class had the opportunity to hear from Michelle Roett, M.D. Dr. Roett is the current clinical chief at MedStar Georgetown University Hospital and a professor and chair in the Department of Family Medicine at Georgetown University Medical Center. The discussion began with Dr. Roett presenting about family medicine, social determinants of health, and health equity and was followed by a Q&A session where students were able to ask questions about her work and perspective on the current climate of health care.
Throughout the conversation, Dr. Roett reflected on what drives her in her career, highlighting her curiosity as a trait that has led her to pursue many different roles within health care. Her work spans clinical practice, research, and education, sharing her story and knowledge with high school to medical school students. Showcasing her duality as an educator, clinician, and researcher, she stressed the importance of the shortage of family medicine practitioners. She highlighted that family medicine reduces the risk of hospitalizations and, in the long-term, lowers health care cost because of the preventative care it provides.
An important theme that emerged during the discussion was social determinants of health, specifically, how a patient’s environment and access to resources shape their health. Dr. Roett described the “four C’s” of family medicine: (first) contact, continuous, comprehensive, and coordinated care. She emphasized the importance of the specialty in coordinating care, acting as a case manager, as the average adult over the age of 65 sees five or more doctors. Family medicine practitioners are critical in overseeing the care to ensure the best outcomes possible.
Dr. Roett added a fifth “C” to her list: context in care. She defines context in care as an attention to the factors that contribute to being healthy.
As a class, we discussed the impact of different social determinants of health, including the historical implications of redlining and how they manifest in our community today. Other highlighted social determinants of health included geographical location, food and water accessibility, access to public transportation, and politics. Dr. Roett believes quality patient-centered care requires a comprehensive understanding of their circumstances and environment. Her commitment to curiosity and asking intentional questions drives her research and efforts to bring awareness to how the social determinants of health affect her patients and others. She highlighted her goal of getting patients independent and invested in their own health journey, as, in her words, “no one likes being told what to do.” With a holistic approach to health care, she can get a fuller profile of the patient, learn about the environment that surrounds the patient, and increase outcomes due to patients feeling supported and prepared to take charge of their health.
Reflecting on Dr. Roett’s advice and story, I am inspired by her drive for eliminating barriers to health care and multifaceted ways she works for health equity. As a student looking to pursue a clinical career in nursing, I hope to carry Dr. Roett’s curiosity with me in my commitment to supporting the whole person.
Ava Gonnella (N’30) is an undergraduate student majoring in nursing at Georgetown University.