Putting ourselves “in the shoes of others” makes a positive difference in healthcare. Names have been changed for privacy.
My husband asked after breakfast, “Why do you have to work today? Weren’t you on call last week?” I was going to help out at the Jackson Free Clinic. Being at the JFC doesn’t feel like work. If you have ever been there, you know what I mean.
On a frigid Saturday morning in January, the parking spaces in a neighborhood encircling a small building where health care is provided to many uninsured clients reveal car tags outside Hinds County. Today would be busy, as are most Saturdays at the Jackson Free Clinic. Walking into the building, I saw a very upbeat group of students sitting at tables discussing their patients prior to presenting them to the resident and/or attending physician. I would be the “Lone Ranger” medical physician that day, with two interns as supervisors of the student-run clinic. The atmosphere was very cheerful and upbeat. One team was ready to present, with team members introducing themselves with “Hi I’m …. a M3, M2, M1 and M0.” When I asked what M0 meant, the student politely informed me that he attends college, majoring in pre-med. He wanted to make sure that I knew his knowledge of history taking, physical examination, and formulating a plan for the patient was nil. We laughed and I invited him to observe the millennial-long process of teaching and learning to provide the best care for our patients. The diverse clinic staff was divided into teams of medical students, pharmacy students, and social service students. The patients were diverse too, some employed without insurance; others retired or unemployed. Black, White, Latino and Asians are our usual clients.
Inclusion in medicine is not just a concept, but observable in action at the free clinic. Just come by one Saturday and you will see firsthand the inclusiveness and equity. There, you will see at work a team approach to providing services such as phlebotomy, performing an ECG, and getting services referred to other facilities for follow-up. Some of our medical students were nurses prior to medical school and have full knowledge of phlebotomy and performing ECGs. They utilize their knowledge of those skills to teach their colleagues. If you recall your own experience in blood drawing, it probably was a bit painful in that the students practiced on each other. Our patients are kind and understand the process. However, after two needle sticks without a red flash of blood in that butterfly, the patients are ready to get the benefit of the attending physician’s experience and expertise.
As I waited for a group to present patients to me, my focus was drawn to a glow of discovery and an “ahha” moment clearly on the face of the senior medical student – Becky – who happened to be an M3. She was excited to present such a challenging patient with a language barrier to us. We used the phone translator to communicate since the patient knew more English compared to my elementary Spanish. The examination revealed an enlarged leg with profound swelling, pain and erythema that was worsening. The patient was sent to JFC for follow-up, with a diagnosis of deep venous thrombosis treated with oral anticoagulation (a DOAC). Becky was excited to present such a challenging case that would require our collective assessment. While one student had the translator on the phone, it became quite clear that a patient’s history is the most important part of the examination. This patient’s history revealed recent travel from South America, history of malignancy one year ago, and an erythematous painful leg and thigh twice the size of her other leg and thigh. This clinched the diagnosis of phlegmasia cerulea dolens. Of course, the patient was referred to our University Hospital for admission and treatment with intravenous anticoagulation. The students, family, and patient were amazed that we took the time for an intensive investigation to determine the severity of the patient’s problem.
Becky knew something was wrong, although a plan and guidance were required to fulfill the best care for the patient. She made sure the patient and family had proper direction to the University with a diagnosis translated in Spanish. As physicians, we are concerned with the physical and mental wellbeing of our patients. Yet, forgetting socioeconomic and other relevant information about our patients would not allow equity in treatment.
Imagine for a moment being in Madrid at a bullfight with an excited crowd. In the excitement, you drop your cell phone and now the service is off. Later, while you’re eating at a local restaurant, you develop abdominal pain with nausea and require hospitalization. Your screams are understood as being due to pain. Albeit you forgot the little Spanish learned in the eighth grade, and now your communication in the native language of the area is poor. You are at the mercy of Spanish colleagues of medicine to determine the diagnosis of your pain. A flood of self-diagnoses flow through your brain: do I have a kidney stone, appendicitis, peptic ulcer? Is this an adequate hospital to take care of my problem?
Fear of the unknown heightens your anxiety. Finally, a bilingual physician enters the room to give the CT scan results and inform you that an emergency appendectomy is required. Your Blue Cross/ Blue Shield is useless in Spain, but you undergo a robotic appendectomy and are discharged from the hospital in 2 days. Our patient presentation is similar to the above scenario. Avoiding biases, stereotypes, and outside influences is important to a physician providing the best, compassionate care possible.
I went to check on our visiting patient with DVT in the hospital. The glow on her face when she saw me was well worth my Saturday off. We communicated through her phone. I discovered that she was a retired businesswoman in the U.S. visiting family. She was very grateful for our prompt treatment and compassionate care. She thanked God for sending us to take care of her.
Days like this remind us that socioeconomic differences are often barriers to good care in our country. The Jackson Free Clinic is one facility where focused attention to level the playing field for equity care is paying off – for the patients, physicians, and the rest of the medical team.