At visits to medical schools during the application process last year, every school mentioned that they had free clinics. These clinics were touted as places of learning, offering medical students clinical experience dealing with a tough patient population. No one took a patient-centered approach to describing the clinics' benefits, which made me wonder just how great the clinics were for the uninsured.
The exception to this was one very frank conversation I had with a resident interviewer. He had started the free clinic at the school as a medical student there, and when I asked about how they operated he shared with me its benefits and draw backs. The organizational structure of the clinic was thoughtfully done and seemed to maximize good: the clinic had connections with local hospitals and could easily refer patients for specialty treatment as needed, and they had the resources to set eligible patients up with health insurance. But we both agreed that the need for free clinics in the first place was a problem.
I chose the medical school I now attend for many reasons, one of which was the student involvement in service projects. Virtually everyone volunteers at a free clinic, which I saw as an indication of student engagement with the needs of the community. During orientation all the first years went through an orientation program for volunteering at the clinics where we learned how to take a patient history, measure blood pressure, and administer a vaccine, and soon afterward my classmates began volunteering.
However, again the approach was medical student centered: we were encouraged to volunteer in order to learn, a reasoning that surely has truth but also conceives of the patients as practice specimens. Rather than the clinics being places of service, where students dedicated themselves to caring for the Chicago community, they felt like an extension of the curriculum.
I soon realized that I wasn't alone in having trepidations about volunteering at the clinics. One of my classmates expressed a similar discomfort, and we soon had a class-wide discussion about the ethics of the clinics. Those who had already volunteered expressed concerns: it's difficult to find doctors to volunteer so there isn't always adequate supervision; and our training wasn't sufficient to make us comfortable dealing with patients' multi-faceted medical problems. Others were more certain of the clinic's benefits: some care is better than no care; supervision is typically adequate; no one feels totally comfortable meeting with patients at first regardless of circumstance; medical students can't offer healthcare but we can listen, and that makes a positive difference; and we can be educators for patients who are misinformed.
My initial qualms were related to how the clinics were approached, but once the perspective shifted to a patient-centered one, I still didn't feel comfortable with the rationale being used to justify our involvement. Is discovering patients' health problems beneficial without the capacity to appropriately respond to their subsequent needs? (I don't think so.) Though listening is indeed therapeutic, are we using this reasoning to justify our involvement in a system that perpetuates inequality? (To a certain extent, yes.) Are all the student volunteers knowledgable enough to educate patients on relevant topics? (I know I'm not.)
Despite all this, I still see a role for free clinics in our current healthcare system. Whatever the status quo may be, it is certainly possible to create a clinic that offers excellent care to the uninsured. A place where patients eligible for Medicare and Medicaid are aided in applying for and accessing services, where patients can find educational programs and assistance with psychosocial issues, and where diagnoses are follow up with high quality medical treatment. Until these same patients can access the same services as everyone else, that's the best we can offer.
Ultimately this is about a person's right to healthcare -- something that I didn't feel the true importance of until recently. Being poor, or homeless, or undocumented -- these are circumstances that no one would wish for; circumstances that often occur despite someone's best efforts to avoid them. And when anyone in our community is suffering, everyone suffers. When one person is too sick to work, but shows up anyway because they can't afford not to, her fellow employees and customers get sick. When one person is too downtrodden to keep a consistent job, our economy suffers. And when one person is ignored, his troubles accumulate until we are forced to contend with them -- and at that point, it's often too late.
Offering someone healthcare doesn't mean getting them access to prescriptions and medical treatment -- although that's part of it. It means offering everyone the chance to lead a healthy life. As we work to find a successful model of healthcare delivery, I hope that we will avoid using our energy to make judgements on who is deserving of our care, and instead focus on how to best foster a healthy, vibrant community.
