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Monday May 08, 2017

Free Clinics Need Our Help to Heal Patients, Communities

"What do you normally have for breakfast?" I asked the 30-something woman sitting before me.

"Oh, whatever they have left over at the gas station," she replied.

"The gas station?" I asked.

"Yes, they give me the leftovers from the hot dog machine when I get finished sweeping the parking lot," she replied.

The young lady in question appeared to be 20 years older than her actual age, was living in a tent and had no income. She didn't want to bother anybody with her problems, but she had attended a health screening at a local church, where she was found to have hypertension. That led to an appointment at the free clinic where I saw her.

Hers is one of the hundreds of stories we could tell about our patients. No matter what legislation is ultimately passed in Washington, unless the forgotten people of this country are taken care of, they will continue hiding in the shadows and living unnecessarily shortened lives.

Free clinics across this country have been trying to take care of patients who have no other place to go for years. The challenges we face in doing this job continue to grow daily.

The clinic where I work is fortunate to have volunteer support from physicians who see it as our duty to give back to the community. It is difficult to have a patient seen by anyone else because physicians are often too busy just meeting the needs of their office to see someone gratis. And without the support of others in the community, it would be a huge challenge just to keep the rent paid and the power on.

Why should we take care of the less fortunate?

Morally, it is the right thing to do. Most of the world's religions advise us to take care of one another. That desire to help others is the reason most of us went into the field of medicine in the first place.

And it makes financial sense! We all know preventive care is less costly than curative care and saves money in the long run by keeping patients out of the ER and out of the hospital. Keeping a patient's blood pressure under control will prevent heart attack, stroke and renal failure (just to name a few issues).

By giving to a free clinic and supporting its mission, you save the money that is then not needed for more costly services down the road.

Who pays for those services? We all do. The cost of indigent care is factored into hospital bills and helps explain those $15 acetaminophen tablets. Insurance pays for that, you might argue. True, but who pays for your insurance? You do.

Looking back in history, we realize there have always been those who were considered the "unfortunate." In her book White Trash: the 400-year Untold History of Class in America(www.nytimes.com), Nancy Isenberg calls them "the waste people." Today we talk about social determinants of health. Either way you look at it, there are those who -- sometimes due to circumstances out of their control -- are economically, educationally and physically challenged. Don't they deserve good health care?

The population we see in our free clinic has changed over the years. There are more homeless people. There also are a lot of 50-somethings who lost their jobs in the economic downturn and have not found new employment. And there are some who are recent immigrants to our great nation, seeking what we used to call the American Dream.

They all find themselves in the unenviable position of asking for help. This may be the first time many of them have had to ask for assistance. Just like the homeless young woman at the start of this blog post, they did not want to be takers instead of makers in the system. Georgia, where I practice, did not expand Medicaid, and those who fall outside of that safety net are in drastic need

The free clinics of our communities help these people. Most, like the one where I work, depend on the generosity of the community. That generosity, unfortunately, seems to wax and wane, and it is hard to develop a budget when you have no idea whether the money will come in.

For those who can, I urge you to volunteer at your local free clinic. If you can't give of your time, perhaps you can give money or supplies to keep their mission going. Your support will help us all in the long run by saving lives and saving our communities money.

So what happened to that young woman? When we heard her story at the free clinic, we helped her get in touch with community resources. She joined a nearby church and met a fellow member who needed someone to help with his aging mother. She no longer lives in a tent, has a bed to sleep in and has found a family that cares about her.

It is the kind of result that keeps me working at the free clinic.

Leonard Reeves, M.D., is a member of the AAFP Board of Directors.

Posted at 07:00AM May 08, 2017 by Leonard Reeves, M.D.

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