2009 National Conference

FPs' Broad Care Best for Homeless, Says 2009 Family Physician of Year

By Barbara Bein
8/7/2009

A number of public figures, including William Shatner, Debbie Reynolds, Jim Carrey, Charlie Chaplin, Ella Fitzgerald and David Letterman, once were homeless. In fact, life circumstances -- including job losses, economic reversals and foreclosures -- can make anyone homeless, according to William Ellert, M.D., of Scottsdale, Ariz. When the homeless have medical needs, family physicians can provide the most comprehensive care, he said.

Photo of William Ellert, M.D., 2009 Family Physician of the Year

The 2009 AAFP Family Physician of the Year, William Ellert, M.D., tells students and residents at the National Conference of Family Medicine Residents and Medical Students about the special health care needs of patients who are homeless.

The 2009 AAFP Family Physician of the Year, Ellert is project director and board chair for Circle the City, a nonprofit organization that helps homeless individuals with health problems in Maricopa County, Ariz. He spoke during "Homeless Healthcare and Family Medicine," a workshop at the 2009 National Conference of Family Medicine Residents and Medical Students, here. Ellert said that unlike subspecialists, family physicians can provide broad-based care for the increasing number of homeless people and their families.

"That's one of the reasons I am an advocate for family physicians practicing the full spectrum of health care," Ellert said. He explained that family members who have lost their homes won't come in for treatment or health care if the adults, the pregnant woman and the children have to go to separate clinics. However, noted Ellert, FPs are trained to take care of the full spectrum of patients.

Ellert made several points related to health care and homeless people:

from 2.3 million to 3.5 million people are homeless at some point during a year, including 1.35 million children and youth;
13.5 million people in the United States have experienced homelessness at least once in their lifetimes;
health care professionals who do outreach to homeless individuals discover that most homeless people became that way recently;
homelessness is increasing -- a survey in Maricopa County showed a 20 percent increase in homelessness between 2008 and 2009, and a 370 percent increase in homeless families living on the streets;
73 percent of the homeless have no health care coverage;
the mean age of death for homeless people is 42-52 years; and
50 percent of homeless people have a current or past drug or alcohol addiction, and 33 percent have a mental illness, such as schizophrenia.

Homeless people have particular health care challenges, said Ellert, describing a 70-year-old Hispanic man brought to a hospital after complaining about abdominal pain and experiencing confusion. Diagnosed with biliary colic and treated, the man then had a challenge getting follow-up care.

"As a physician, what do you do with a patient who is not safe to discharge? What do we do with a patient who no longer meets inpatient criteria, but is not stable enough to live on the streets? Who has the ethical responsibility to care for these patients? Should the hospitals have to keep them?" Ellert asked.

Family physicians have to take into account the circumstance for their patients who are homeless; for example, if a woman is pregnant and living at a homeless shelter, the physician should investigate if she's taking any substances, where she's getting her food, and where she and the baby will live after the baby is born, said Ellert.

With homeless patients, it is even more vital for family physicians to look at the whole person, Ellert said. "Being a family physician is not just going in and seeing the patient and treating a sore throat. We think about the whole psychosocial situation."

Printer-friendly version

Email this page