Guest Opinion

Rediscover the Joy of Medicine While Caring for the Uninsured

August 09, 2010 02:50 pm Ed Weisbart, M.D., of Olivette, Mo.

I recently had an experience that reminded me why I went into medicine in the first place. For two days, I took care of patients with no artificial bureaucratic frustrations, no maze of insurance forms to complete, and no evaluation and management "bullets" to code against. I didn't even have to worry about malpractice insurance. My only concern was to take the best care I could of my patients given the resources available to me and to them.

Ed Weisbart, M.D., peers into the ear of Justin Jones, 12, as his sister Rhema, 10, watches during a free mobile medical clinic in Washington.

If that sounds good to you, do what I did: Volunteer at a mobile free medical clinic for the uninsured sponsored by the National Association of Free Clinics(www.freeclinics.us), or NAFC.

A nonprofit organization, the NAFC supports free bricks-and-mortar clinics across the United States, but it also has begun sponsoring one- and two-day free mobile clinics to draw attention to the needs of the uninsured. The NAFC doesn't have a political agenda -- it's not Republican, Democratic or Libertarian. Instead, the organization firmly believes that bringing people face-to-face with the problem of the uninsured in these massive clinics will help them think creatively about how to solve our health care problems.

Several months ago, I learned that such a mobile clinic would be held in my state in Kansas City, Mo., so I volunteered. I liked it so much that I signed up for another mobile clinic in Atlanta. Both were astonishing experiences that I wouldn't trade for anything.

A Clear Focus

Volunteering at these clinics brings the uninsured and their needs into clear focus. It's one thing to read the statistic that there are about 47 million uninsured Americans. It's another thing entirely to see more than 1,000 people patiently waiting in line for free care -- neatly dressed people like you and me, ethnically diverse, humbled by needing to be there but thankful for the opportunity. More than 80 percent of the patients at these clinics have jobs, but they don't have insurance -- a uniquely American crisis.

At my first mobile clinic, I treated a cook who worked full time for the U.S. Department of Agriculture. As you know, Congress has mandated that all federal employees have health benefits -- but since the USDA outsourced this woman's job, she was working as a contractor with no benefits. She hadn't seen a doctor for years because she couldn't afford to.

Another patient's migraines made her miss days of work each month. A doctor once diagnosed her problem and gave her a free sample of a triptan that worked with the first dose, but she didn't have enough money to fill the brand-name prescription. Since then, she'd been treating her headaches the best she could with OTC remedies.

She just about cried when I handed her a prescription because she was sure that, once again, she couldn't afford the medicine. She was amazed when I showed her how reasonable the cost of the generic would be.

I also saw people with sky-high blood pressure almost dance with joy when they learned that for $20 at the patient assistance program Rx Outreach(www.rxoutreach.org), they could get a six-month supply of a drug that would likely work as well as the $200-a-month prescription they never could afford to fill.

A few others needed pre-employment physicals so they could apply for a job. I was happy to help them escape their own personal Catch-22.

As a volunteer, I wasn't expected to schedule or provide aftercare for the patients I saw. However, a key focus of the NAFC-sponsored mobile clinics is to be sure that community resources have a large presence. After seeing a provider at the clinic, patients are guided through a wealth of booths to help them tap into aftercare and other resources. Several of these local groups reserved a few acute-care appointment slots for patients who needed follow-up more quickly than a routine process would support.

Although the surroundings weren't cushy, I had my own curtained exam room, supplies and equipment, a medical record to write on, and a nurse to bring a screened patient to me whenever I was ready. I tried to be relatively quick because there was a jam-packed waiting room, but I was encouraged to spend as long as I needed with each patient. What a golden way to practice!

Want to Volunteer?

The National Association of Free Clinics' next mobile clinic will be in New Orleans, Aug. 31-Sept. 1. The organization has purchased occurrence-based malpractice coverage for the event. At press time, the deadline had not yet passed for getting a limited temporary medical license in Louisiana.

The NAFC also is planning a mobile clinic on the East Coast in the next few months.

In addition to practicing physicians of all specialties, residents and medical students are welcomed to volunteer. The NAFC also needs mid-level practitioners, nurses and everyone else who can help, clinically or nonclinically.

Visit the NAFC website(www.freeclinics.us) for more information on the New Orleans clinic and to volunteer. Information on the East Coast clinic will be posted on the site as soon as plans are complete.

My second mobile clinic experience was different because I hadn't signed up in time to get an expedited temporary medical license in Georgia. So I worked out front as part of the team that registered patients. The good news is that we registered more than 1,000 people to see a doctor that day. Unfortunately, we turned away 700 more who had been politely waiting in line, simply because we didn't have enough physician volunteers to accommodate them. It just broke my heart, and I vowed to start helping recruit more physician volunteers so it wouldn't happen again. That's why I wrote the guest opinion you're reading right now.

My Next Steps -- and Yours

A few weeks ago, I retired after three decades in practice and a seven-year stint as chief medical officer of medical affairs at Express Scripts, a large pharmacy benefits management company. My retirement has freed me up to volunteer as chief medical officer for Rx Outreach, the patient assistance program that Express Scripts currently is spinning off to become an independent charitable organization. As Rx Outreach grows, we hope to find ways to better support NAFC-sponsored clinics and the uninsured individuals they serve.

My retirement also has given me time to reach out to organizations such as the AAFP, looking for ways to encourage more practicing physicians (and residents and medical students) to volunteer at these mobile clinics. That's my passion these days -- that, and playing the ukulele.

I hope this guest opinion will inspire you to volunteer at an upcoming clinic for a few hours or a few days. Just sign up, show up and remember the experience for the rest of your life. (See "Want to Volunteer?" sidebar for more on volunteering.)

The reasons you wanted to become a doctor might come flooding back as you take care of these incredibly thankful patients. Their gratitude will be the finest form of reimbursement you'll ever know.