by Kelsey Caffy, UTHSC College of Medicine, Class of 2017
At the end of last week’s Serving the Underserved session, several members in the course voiced questions that centered on how can we as healthcare providers find practical and sustainable solutions to healthcare disparities that our patients face. While these questions were invigorating and emboldening, they were also somewhat frustrating because it can be difficult to know where to start when you want to change outcomes at a systems level.
I am on the Admissions Committee for UTHSC and this question, of how we can actually change healthcare disparities, was asked to an applicant who was interviewing for a scholarship. She thoughtfully alluded to the fact that healthcare providers still aren’t where they need to be in their understanding of healthcare disparities. I full heartedly agree with her. We still make assumptions about what is best for our patients. We presume to know what they need, value, and want for their own future, rather than simply asking them.
About a year ago, I was on my Internal Medicine rotation and my team was taking care of a young woman that was repeatedly admitted to the hospital for asthma exacerbations which were secondary to crack cocaine use. She was caught in this cycle of being admitted to the hospital, treated for her asthma symptoms, and then returning a week later. To make matters worse, she was homeless. One morning, after she was admitted the prior evening, our new attending sat at her bedside and asked what it was like to be homeless. She shared her experiences from where she slept and what she ate, to what it was like to ask people for money. Our attending also asked her about her hopes and goals for the future. She shared that she wanted to reach out to her family in a different state so that she could have support for getting off of drugs and getting off the streets.
I was touched and moved by this conversation with our patient. How easy it could have been to think we knew what was best for her in that encounter. By hearing her story, we were better able to understand the challenges she faced and to provide support and encouragement in her personal goals.
I have frequently contemplated how I can let my patients know that I am an ally. Often, I encounter patients who must wonder how we will possibly relate to one another. Whether it’s a veteran with PTSD, a victim of sexual assault, or a young woman who is living on the streets, sometimes the divide seems too wide to overcome. However, my experience on my Internal Medicine rotation, as well as countless other interactions with patients have taught me that human experiences, such as joy, guilt, shame, loneliness, love, and forgiveness, transcend basic constructs of society such as gender, race, socioeconomic status, and educational background. To change outcomes on a systems level, we have to continue initiatives like Serving the Underserved and incorporate more medical school programming geared toward helping us become better allies with our patients. We also have to learn to trust that that our patients know what is best for themselves, and oftentimes it’s a matter of asking to find out how we can create shared goals for their future.