How Best to Provide Care to Patients Living in Poverty
As a health-care provider, imagine that the city you serve is a human body. Would you operate on the heart and ignore the gangrene green creeping up the left leg? Would you remove a mole and dismiss the growing tumor?
Today, Baltimore citizens, all minorities and most living in communities of poverty, spoke via video to a packed room of healthcare providers at the AAMC Annual Meeting. With candid honesty, they responded to questions and suggested to clinicians, medical educators, and administrators what they could do to better prepare for and improve the wellbeing and health in communities like theirs.
“Be more aware of the social aspects that affect our health,” said one Baltimorean. “When you send someone home with a heart monitor, know whether they even have the lights on so it can be plugged in.”
“Know that sometimes we are making the decision between food and medicine,” said another woman, who recalls being in tears while at the hospital not because of her condition but because she was stressed out about the cost of the care she was receiving.
“Don’t be afraid of us,” said a black man. “If you want to build trust with us don’t give us that ‘look’ when you ask questions like, “have you been a drug user? Are you in a methadone program?”
“Some of us can’t read,” said another Baltimorean. “Now how are you going to find a doctor if you can’t read?”
These citizens mentioned again and again the importance of knowing the communities in which your patients live, and better understand the social determinants at play, in order to better care for them. In East Baltimore, for example, life expectancy is 20 years less than it is for those who live five miles away. One young black man emphasized the stress that comes with living in the “hood.” “You have to keep your eyes open 24 hours a day every day . . . don’t sleep. You’re surrounded by drugs, prostitution, violence.” Another young black mother recounted the stress of trying to keep your children safe and recounted how a bullet that exploded through her window almost hit her young child. “Where can our children play and be safe?”
Ask us questions, listen more, be understanding, be open were common refrains. “Get involved in our communities so you can see and understand some of the stressors,” said one Baltimore citizen. If you don’t have the time to visit or be present in our communities, one citizen suggested, get involved in a community program that does have feet on the ground and can help a doctor better understand that community’s reality.
“There is nothing more valuable to learn about the problem than to talk to the people that we are talking about,” said one AAMC attendee. “Patients have much to teach you,” said another doctor from Eastern Virginia Medical School, where medical students have the opportunity to work at a free clinic. “So listen and approach them with that mindset.” Another AAMC attendee emphasized the importance of having people in medicine who have come from such backgrounds. “I grew up in the hood; I’m a child of poverty. And that is where I choose to live today.”
More and more physicians are appreciating that taking care of the health of their communities extends far beyond what they learned in medical school. One doctor talked about the difficulty of easily accessing healthy food.: “If you want to get a stalk of celery or a five-pound. bag of potatoes you’ve got a ways to go.” She decided to do something about it and started a community garden. Ignoring or underserving these communities in need undermines the health of each of those individuals and the entire community. Just as we can’t ignore certain parts of the body when we’re caring for individuals, we also can’t overlook certain communities.
Peta Owens-Liston is a Communications Specialist for University of Utah Health Sciences/ARUP
