Bridging the Gap through Storytelling

When I decided to accept my term of service with the National Health Corps, I knew I had a duty to increase healthcare access for underserved populations. My initial vision revolved around the idea of getting as many patients into the doctor’s office to receive care as possible. However, in the past few months, I’ve realized that this did not necessarily increase the overall quality of care as I listened to the stories that would make up these numbers.
As a Patient Advocate at Health Center 6 under the direction of the Philadelphia Department of Public Health, my main responsibility is to assist patients in obtaining prescription medications through pharmaceutical companies. The patients I see are either uninsured or underinsured deterring them from receiving medications on their own, which aside from being expensive are vital for their disease prevention and management. The process itself is detailed and lengthy requiring collaboration from the patient, health center and pharmaceutical company approval. Given these obstacles I still felt confident in my role not only because my determination to advocate for these patients but also because I felt I was at an advantage when it came to breaking down one of the biggest barriers at our health center.

While there is a portion of patients we see who are English and Albanian speakers, the vast majority are Spanish speakers. On any given day one can walk into the waiting rooms of Health Center 6 and overhear pages for Spanish interpreters every 5-10 minutes.  I am always impressed by their attempts to speak English but nothing beats the smiles on their cheery faces after they hear me respond in Spanish. For me, it is easy to empathize towards someone particularly when they arrive after receiving bad news regarding their health. The real challenge comes when one takes on a paternalistic approach and transitions from helping to rescuing a patient. I have caught myself on both ends of this spectrum. There were times when I thought I knew what was best for the patient; instead of listening to see why they were experiencing difficulties picking up or taking their medication, I would talk “at” them regarding the importance of their medication. I sometimes felt that this rescuing approach was in part due to the connection I had to the culture or an obligation I made up in my mind to bring some sort of immediate relief.

This feeling was better described by Ms. Claire Jones M.Ed , a consultant from the Health Federation of Philadelphia,  who spoke of affinity as “being alike or identifying with a particular ethnic group or biomedical culture based on appearance, language etc.” While discussing the pros and cons associated with affinity in a healthcare environment, she stated that it is natural for humans to feel affinity because people like to associate themselves wherever they see similarities. Incorporating this idea as well as the Trauma-Informed Care training I received during our Pre-Service Orientation which involved understanding, recognizing, and responding to the effects of all types of trauma, I have been able to genuinely welcome the stories of my patients.

It is brilliantly stated by Rachel Maomi Remen MD, Clinical Professor of Family and Community Medicine at UCF School of Medicine that “the most important thing we ever give each other is our attention…A loving silence often has far more power to heal and to connect than the most well-intentioned words.” Therefore, rather than trying to fix problems as soon as possible, I have learned to hear the patient out. Sometimes the healthcare dynamic between patients and doctors places the importance of their interactions on finding out what disease a patient has rather than what type of patient has this disease. As a patient advocate, it is my responsibility to minimize this gap by getting a better understanding of what kinds of stories each individual brings.

Through these changes I’ve noticed that patients have become more comfortable coming to me for unrelated problems and some even stop by the office just to say hello. It’s common for patients to ask me to translate complicated health forms or to call me requesting prescription help/clarification. When an advocate is able to understand the culture as well as the culture of medicine, patients are more trusting of healthcare professionals and more accepting of their recommendations. While these actions seem small, they have actually filled in the cracks where most patients fell and have increased the efficiency of preventative, primary, and specialty health care services by ensuring they know where to go and what to bring. Disease prevention and management also increase their effects when the patient is able to pick up medications and take them as prescribed. I’ve enjoyed the richness and openness of each conversation, which can be simple as holiday plans, bringing in their children to give them advice about their future goals or even receiving encouragement from them about my future career and educational plans.

Although I take pride in the many services the prescription assistance program offers, I believe it is the personal day-to-day interactions that make the most impact and puts us on the path to becoming effective healthcare providers. While solutions to some problems are not always readily available, I think we get closer the more we become aware of each individual’s story and how it plays into the realm of public health.

This blog post was written by NHC Philadelphia member Gerardo Nicolas.
Gerardo serves as a Patient Advocate at Philadelphia Department of Public Health - Ambulatory Health Services: Health Center 6.