I wanted to become a doctor because I wanted to be a superhero. As a kid, I was inspired by the unparalleled heroism and comedic genius of Captain Underpants. After reading tales of Captain Underpants using his superpowers to single-handedly eliminate all of society’s evils (talking toilets, giant dandelions, zombies), I was convinced — his was the path that I needed to follow in life. Soon, I realized that, as tempting as it sounds, it wouldn’t be an acceptable career choice for me to run around and fight crime in only my underwear…even if I had a cool cape. So, I looked at my other options. I didn’t have to look far to realize that the path that I really wanted to follow wasn’t Captain Underpants’. It was my dad’s. At the time, we were living in a small town in New Mexico. The town lacked luxury, but it had the essentials: a school, market, and a clinic. My dad was a physician at the clinic and, to me, it seemed that everyone looked up to him. In many ways, he was the town celebrity. Everyone knew his name, stopped to say hello and chat. Even my friends knew him as ‘the doctor’. I didn’t fully realize my dad’s impact on the community until we heard a knock on our door one evening. We answered it, and a visibly distraught woman stood before us. She told my dad that one of her family members had a big, deep gash in his leg after an accident. He was bleeding in the back of their pick-up, which was parked just outside our house. She asked my dad if they could go to the clinic together, so that he could treat him. My dad had seen many patients at the clinic, but this was the first time someone had come directly to our house to see him. I don’t remember what my dad said to her. I imagine he probably wanted to spend time with his family after a long day at work. But, he went with her, and he only came back after treating her relative with the gashed leg. Often times, people say they want to be a doctor because they want to help people. It’s a pretty generic explanation, and we’re often advised not to use it, but why? Being a doctor is not only about helping. It’s also about feeling a natural obligation to do so — to be completely selfless even when you want to be selfish. That’s what my dad embodies. To me, he’s the real superhero. Captain Underpants has nothing on him. I’ve let the memory of my dad guide me through my pre-med years, and it influenced me to become a fellow for Pittsburgh’s Birmingham Free Clinic’s Health Links program. The Birmingham Free Clinic is the result of a partnership between the Salvation Army and the University of Pittsburgh’s Program for Health Care to Underserved Populations. Part of the clinic’s mission is to provide free health care. Five days a week, a volunteer group of physicians, nurses, and other clinicians provide primary and acute care, physical exams, vaccines, and consult services to uninsured individuals who are vulnerable to falling through the gaps. In addition to providing free health care, the Birmingham Free Clinic also recognizes the social influences that affect their patients. Some of the patients that come to the clinic may need help looking for employment, food, rental assistance, new furniture, among other things. That’s where myself and the other Health Links fellows come in. We meet with patients at the clinic one-on-one, find out what needs they want addressed, and then work with them to find organizations and services that may help meet their needs. As someone who hopes to be a physician, it’s been great to be able to actually talk to patients about what’s going on in their lives. One thing I’ve learned as a fellow is the importance of listening to others. It seems pretty basic and intuitive, but listening goes a long way. Often times, we use the term ‘low socioeconomic status’ to describe underserved patients. It makes sense to label groups at times, but it can also be dehumanizing. The patients that come into clinic are more than ‘low SES’ — they’re ‘real’ people who have ‘real’ people problems, just like you and me. Actively listening to others makes you realize that. When I started as a fellow at the clinic, I had somewhat of a narrow view of what I would be doing. I thought I would be seeing patients and helping each of them with their individual needs. What I’ve realized now is that, as you start to help patients look for services, whether it’s for housing, employment, utilities, etc., you get an understanding of the large structural forces that cause people to fall through the gaps in the first place. Let me give you an example. Recently, I was seeing a patient (let’s call him John) who needed help paying his medical bills. John was uninsured and was suffering from a mental illness. He had visited the Birmingham Clinic in the past but, after an emergency, he received treatment from a hospital. The treatment seemed to help John, but the amount of money it cost was both astonishing and unexpected. John found out that he would have to pay thousands of dollars in medical bills, putting him in an even greater hole than the one he started in. John isn’t alone when it comes to this problem. According to a recent Gallup poll, 11.4% of individuals in the United States are uninsured. This number is steadily decreasing, likely due to the implementation of the Affordable Care Act. Nonetheless, even under the ACA, many are still uninsured due to the high costs of coverage. In 2014, 48% of uninsured individuals cited costs as a major reason they were uninsured. Also, many remain uninsured in states that haven’t expanded Medicaid (a healthcare program for low income individuals) due to the high costs of public insurance. Without health insurance, John and others seek treatment at clinics like the Birmingham Free Clinic. Otherwise, they can seek treatment at a hospital and risk falling into huge debt — according to a recent study, many hospitals in the U.S. charge the uninsured 10 times the cost of care. Studies have also shown that the same group of low income, uninsured individuals are also those that are the most vulnerable to poor health. With that said, a clear and unfortunate disparity exists. Those that need health care the most face the greatest barriers to accessing it. Where do you even start with a case like John’s? There are a few organizations that provide small grants to help individuals pay for medical bills. These grants often require an application process, paperwork, and a wait time. It’s stressful enough to be in thousands of dollars of debt, and I can only imagine how mentally taxing it is to have to wait. Some applications also require a permanent address. At the time, John didn’t have a permanent address — instead, he was living with a friend. So, rather than looking at the small grants, I started to talk to John about applying to Medicaid. Well, it turns out that you need a permanent address to apply to Medicaid too, which only further complicated things for John. Some hospitals provide financial assistance programs to patients like John who are having trouble paying medical bills. But wait, you guessed it, there’s another barrier. To apply to financial assistance, you need a letter that explains that you aren’t eligible for Medicaid. Not only would this entire process take a lot of time, but it’s also difficult for John because he can’t apply to Medicaid to begin with. John is just one of many in the U.S. that are already slipping through the cracks because they’re uninsured. To make matters worse, the current system further complicates things so that people like John fall through the gaps and end up in a tangled web of paperwork, paperwork, and more paperwork. Our system has created what seems to be a hopeless situation for many. This is something that we absolutely need to change, and I’ve only realized this through my experiences as a fellow. I’ve recently started to look back at the memory of my dad. It’s no longer just about being selfless and helping others in times of need, although they are important aspects of being a physician. The part that really sticks out to me now is the tremendous amount of trust my dad earned with the people of the small, underserved community we lived in. He was able to earn peoples’ trust because he listened to them. He understood what his patients were going through and, more importantly, he cared. As a fellow, I’ve realized that myself — and other future physicians — should do the same. Treating a patient is more than remedying an ailment and providing medication. Instead, we need to have the mind of a physician and a social worker. We need to gain a better understanding of the patients we treat, as well as the workings of the healthcare system that affects us and complicates treatment for many. As physicians, we have a voice that others will listen to. It’s important for us to take advantage of that and advocate for the underrepresented because, often times, these are the individuals that need treatment the most. I’ll always cherish the childhood memories I have of my dad treating patients. At the time, he really was like a real-life superhero. But, the power isn’t necessarily in healing wounds. Instead it’s in establishing a connection with the patient. In today’s age, it’s very easy to be cynical about the shortcomings of our health care system, and it can be even more difficult to rise above it. But, it’s important that we do. There are so many individuals who fall through the gaps of today’s system. As physicians, it’s not only important to realize them, but it’s imperative that we work to close them too. Source
