Outreach: Trust in Medical Care

It is a cold drizzling night. Four of us—two medical students, a social worker and myself—cram ourselves into a jeep packed with water, sandwiches, boots, tents, and clothing. If we had more square footage, we could be mistaken for an REI. Our plan tonight is to provide resources, information and medical care to the homeless, where they live. Our primary mission is to foster trusting relationships so that we can better serve them.

Cultural and circumstantial barriers often restrict communication when a doctor is providing medical care. If “white-coat syndrome” is any indication, even the average patient experiences anxiety when visiting a doctor’s office. If a patient is too anxious or does not trust their physician, the most beneficial conversation they could have had is compromised, and consequently the patient’s access to care is greatly reduced.

At Pittsburgh Mercy Family Health Center, we celebrate patient-centered care. We meet patients where they are, and through dialogues develop individualized medical plans. As part of an outreach team, relationships are built where homeless feel most comfortable—on the streets. On an average night of street outreach, I engage with 20-30 people who are homeless. Of those, virtually all will accept food, water, or clothing, some will need medical care, and few (initially) will express interest in treatment at the Health Center. Most recently, an older gentleman with advanced COPD, who had declined medical care for several years, suddenly requested treatment. His decision to address his medical needs would not occurred had we not fostered a trustworthy relationship.

Once engaged with the Health Center, the relationships continue to grow. Culturally many in this community view emergency room visits as normal, routine means of accessing medical care, which can be partly attributed to a lack of insurance coverage. However, most medical concerns could better be addressed in a primary care setting where care is more easily managed and coordinated between providers.

In my role as the Mobile Medical Unit Coordinator, I am able to direct patients to make better healthcare decisions. Before I worked with one patient, he utilized the Emergency Room every week. I worked with the doctor to schedule this patient on a weekly basis. Whenever he called the Health Center seeking advice, I discussed his concerns with him, and asked if they could be addressed at his next appointment. Now he is seen monthly and has not utilized the Emergency Room in 3 months. More exciting than his foregoing of seeking emergency care for routine issues is that his blood pressure is now under control.  By actively listening to his concerns and fostering a relationship, we led him to better health outcomes and changed his perspective on what constituted accessing healthcare.

Too often the importance of creating and maintaining relationships is overlooked in the medical world. The paradigm of healthcare becomes “I (the doctor) have pills to treat your problems, take them and you will be fixed.” Within this model the patient lacks a voice and is indeterminable from all other patients. Conversely, as a Health Corps member, I am able to meet patients where they are (often where they live), and strive to understand their concerns from their perspective. By creating a familiar, relaxed environment, I ultimately am their access to quality healthcare.