Medical Odyssey

adventures, monsters, battles, and maybe a moral here and there

A Divide in Caring for Health

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.


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2 thoughts on “A Divide in Caring for Health

  1. Carolinapuddles on said:

    Okay, I will enlighten you as to why I have had to change dental,surgical and medical appointments in general,but first I will educate you about me,wishing I could say the “old Me”. I am very well educated BHS, and work in HEALTHCARE. I know the risk,various outcomes,and I don’t like being sick[ not able to function at any level] or pain. With that said… I had a job at a hospital where I had most of my medical needs taken care [but not on their insurance ], if I made an appointment with the office staff while there I would get back to schedule the time off just to be told,” You will have to reschedule that due to our scheduling demands” 4 cameras and 4 to 5 patients being prepped by a staff of 4 with 2 staffers having to be with patient and camera off to itself and this would be 2 weeks in advance. My favorite was so and so is on vacation so that is not convient or I think I am going to take off that day. Types of appointments varied from Iron infusions at the Cancer center, to surgeries for kidney stones ,bleeding ulcers and preventive procedures dental, mammagrams,etc. The key was they would refer to the policy manual and say “You should schedule your appointments on your own time” When you are scheduled Mon-Fri 6:30 until , then take call and have to take off when they say because you worked over or got called back in and they book everyday for 5 techs that you don’t have. If I could I would reschedule my appointment myself with the various department instead involving the office staff because of embrassment. Once I was in the ER because a stone was lodged and I overheard one of the nurses saying you will have to call this number and as she dialed my phone rang as she glared at me for having my phone on she heard my voice asking how I could help her. As I am looking her in the face she ask what is my estimated arrival time… I could not help myself laughing I said as soon as you sign me out. I had told her I was on -call could not take anything for pain but I haven’t urinated in over 24 hours and had 40 more hours on-call. I know you are thinking they could have called someone else . Some people would answered their phone when not on-call. Needless to say,after 28 yrs[fired] you are replacable and need to keep that in mind. No job should be worth your health,scrambling to get someone to take care of your children,etc. I always have have the mental attitude that someone else is worst off that me and work thru making sure to wear protective gear if needed to insure patients’ wellbeing. Now, I find jobs when and where I can, co-pays have to come out of somewhere and I got a reminder from the insurance you haven’t had a mammogram in 3 years… only lost my job a year ago. Sad thing my old employer owns nearly everything within a 50 + mile radius
    I do agree we are in these jobs { most of us} from a higher calling and borrowing your quote ” We are here for the patients and we should make sure there are no disparities between races, ethnicities, cultural background, beliefs, or income levels.” May I add they should never be treated in a way to make they feel that you do not believe them and realize that asking them their name and DOB everytime you re-enter the room even if they were in there the whole time or grabbing their arm to recheck their armband can make them irritable.
    RESPECT,LISTENING,OBSERVING EXPLAINING and sometimes RESTATING treating them like you want to be treated or one of your family members goes a long way! I don’t believe that people who go to free ,reduced clinics are that much different from all the patients being seen today everywhere and denial is seen in many.
    May you have a long and rewarding career !

    • Thank you so much for sharing your story; it’s insight like yours that helps bring together the whole picture of healthcare. It also brings up a very important topic: never assume you understand someone’s situation. We, as healthcare professionals (or future healthcare professionals in my case), have an agenda that we try to impose on those around us but we always have to stop and think about what effect that has.

      Thank you very much for the well wishes.

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