Day #63: There is a vastly growing divide between the healthcare we advocate and the healthcare that’s sought by lower-income minorities. Is it cultural, economic, or social? An enlightening observation while volunteering at an innercity clinic.
What, you think I can’t make my own appointment? You don’t trust me?
No, no. I’m just doing that to make it easier for you!
It was after a short exchange between a patient and me at a Student Run Free Clinic that really made me think, “why aren’t you more concerned about your condition?!”
Today from 8:30am to 12:30pm I volunteered at a local Student Run Free Clinic established and run by students from my school. As a training co-chair of referrals, my job was to absorb as much information as I can about how to properly fulfill patient referrals that our care teams deem necessary. Now, these particular (and unfortunately limited) referrals are all sent out to partnering organizations that provide free or low cost services that we at the free clinic in turn provide to our patients at no cost. Referrals stem from annual mammograms to biopsies of potential cancers; however, we’re limited in scope because of the difficulty to find free or affordable health care establishments that are willing to work with us (that’s a blog topic in and of itself).
The day was running smoothly until a returning patient decided to show up for a general visit. Now this patient, let’s call her Mrs. Doe, has been to the clinic several times before and has been told that she needs to go have her menorrhagia looked at by specialists. Luckily for us Michiganders, this is done easily through the BCCCP program. The problem, however, is that she refuses to go through with making and appointment and actually showing up–always presenting to us with a new excuse as to why she hasn’t been to see a specialist. So, following the same routine they have before, the student care team diagnosed her with menorrhagia and irregular cycle along with recommending she gets a pap smear, mammogram, and a biopsy on a worrisome tissue–knowing full well that she most likely won’t get any of those things done.
Enter me and my co-chair.
The reason we were selected for this new position of Referral Co-Chairs is simply because many patients the clinic sees–all low income, uninsured minorities–simply do not follow through on their appointments to the clinic or to their referrals. Now, this is a multifaceted problem: they may not have had transportation, they may be afraid of going, they may have been too under the influence to remember to go, etc etc. However, it’s become evident that these patients time and time again do not follow through on their health plans. Therefore, my co-chair and I were tasked with setting up referral appointments for them, hoping that if we do all the work for them, they will show up to their appointments.
That’s when I had my encounter with Mrs. Doe. After receiving her medical chart from the care team, I decided to go see her in the waiting room to tell her I’ll be calling BCCCP to make an appointment for her and that I would like to know which days work best for her. My decision to go see her was simply to make sure she doesn’t leave the clinic before getting a copy of her referral but also so that she can see that we’re all working hard to make sure she actually goes to her appointments; a little bit of cognitive dissonance never hurt anybody, right?
So I approach her in the waiting room, introduce myself, shake her hand, and tell her I’ll be making an appointment for her and ask which days and times work best. Her response was a sly smile before quipping back: “What, you think I can’t make my own appointment? You don’t trust me?” Then she broke out into laughter while shaking her head. Knowing that she is notorious for not showing up for her appointments, it’s clear that, yes, that’s precisely why I’m here. But could I simply say that? Of course not (at least I don’t think that’s the right approach).
But reflecting on it on my drive home, it really struck me that “why is it that, even though these services are free, the patients are failing to follow through on their medical conditions?”
As I mentioned before, there’s probably no easy answer to this, but it seems like there’s a big disconnect between these poor minorities and any real interest in their health. When you think of your generic suburbanite, they see their family physician quite frequently and most of the time have done a little bit of research before their appointment in order to ask educated questions about their symptoms or medical conditions. If that suburbanite is told they may have some disorder and should get it checked by a specialist, they are usually on top of it. Not something you see from the patients at the free clinic. Is it possible that it’s a cultural or social issue like the fact that they weren’t raised in a household that could afford (financially or temporally) to stay on top of their health? Could these minorities feel ashamed or uncomfortable to visit these places? Or is it simply just a lack of basic education the severity of turning a blind eye to their health?
This is an issue that is developing and evolving in urban centers like Detroit and, with the current political and economic climate, this is an issue that seems to unfortunately be one that will only get worse.
Lesson learned: The baseline cognitive ability or educational foundation should never be assumed in patients. Every patient should be treated like a toddler who needs to be talked to slowly and clearly in order to really understand their current condition and what needs to be done in order to palliate or prevent certain conditions. This shouldn’t be done from a paternalistic position of “I know what’s good for you and you don’t, so shut up and listen” but from a “I have the education that can save/prolong/enhance your life, so tell me where you’re coming from and we’ll work together to make sure you get what you need and what’s best for you.” We are here for the patients and we should make sure there are no disparities between races, ethnicities, cultural background, beliefs, or income levels.