The Challenge of Urban Family Medicine


After an eye-opening move to a new community, one physician discovers she is more than just a doctor to her patients.

Fam Pract Manag. 2003 Apr;10(4):18.

“Why do you think my son needs to see a psychiatrist?” asked a genuinely concerned mother.

“Because he tried to commit suicide,” I replied. “He was depressed about the murder of his brother and the accidental shooting of his best friend.”

“But don’t teenagers grow out of this stage?” the stepfather retorted.

Imagine this as your first encounter of the day. Can you picture yourself trying to convince caring but clueless parents that their son needs help? All the evidence is there: failing grades, marijuana and alcohol abuse, and promiscuity. This teenager had seen more in his 16 years than I in my 31.

Worlds apart

Traditional medical training provides a very narrow view of the world. Although college, medical school and residency are institutions of higher learning, they are also controlled environments. They reflect a somewhat diverse population but, on average, do not expose students to the harsh realities of urban environments.

In college, for example, students of varying economic backgrounds may meet and interact on superficial levels but rarely do these relationships mature past that. Middle-class, small-town students experience little of the lifestyles of their inner-city colleagues. For instance, does the middle-class student know what it is like to have to walk or catch public transportation to the nearest grocery store? Would this middle-class student be surprised to see that these city grocery stores carry fewer varieties of fresh fruits and vegetables and more processed foods that are high in calories and fat?

Reality check

Before moving to St. Louis, I had never really experienced an urban environment. I was born in a mid-size Southern town. My parents were educated and quite involved in my education and upbringing. All of my friends had similar backgrounds. Working in an urban health center has provided a major dose of culture shock.

Here at my new job I face teenage pregnancy, young grandparents, drug abuse, domestic violence, lack of education – and the list goes on. Probably the worst situation I face daily is dealing with the poor parenting skills that my young patients exhibit. If a mother can barely read, do I sincerely believe she will be reading to her infant or encouraging her teenager to improve his grades?

It suffices to say I have grown up pretty fast! I now laugh when I hear politicians speak about the ills of our society. Do they really know what is going on? Do they truly have an intimate relationship with our urban communities? Do they ever weep at the fact that some children face an uphill battle from conception? Are these leaders aware of the staggering illiteracy rate and how it impacts the choices people make regarding their health? Sitting behind a desk, surrounded by people who look like them, talk like them and live in their neighborhoods does not give them an adequate picture of the global community.

Making a difference

On a daily basis I see families struggling – financially, spiritually and medically. I see grandmothers adopting children so that the family can stay together. Later I see these same grandmothers coming in with fatigue and depression. I see children removed from their homes and placed in custody of the Division of Family Services for a variety of reasons. I see adults who have severe hypertension but cannot afford their medications. It is a constant challenge to find ways to help my patients cope.

Some days, therapeutic medicine may assume many forms: hugging an 8-year-old for making good grades, providing letters of support to a mother needing respite care for her autistic daughter, encouraging a young woman to free herself from her abusive relationship or supplying an elderly man with medication from the sample closet to prevent him from having to choose between basic necessities and medicine.

I am not only a physician; I am a counselor, teacher and motivational speaker. Occasionally, the plight of my patients’ lives can cause quite a bit of weariness, but I continue the struggle. I am planting seeds and praying that my fellow colleagues are providing the water. Maybe one day we will reap the fruits of our labor.

Dr. Hooks-Anderson is associate medical director at Family Care Health Centers in St. Louis, Mo.

Conflicts of interest: none reported.

Send comments to fpmedit@aafp.org.


Copyright © 2003 by the American Academy of Family Physicians.
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