fantastic, thanks so much! it's a preliminary draft, so I'm hoping for pretty broad feedback along the lines of "add more xyz" or "that anecdote is meh/fine/boring/etc," though if you have more specific suggestions, that is totally welcome! I'll just paste it below, let me know if a link to a Google Doc is preferable. Thank you again!
Sam’s first visit to a primary care doctor since his release from prison and the HIV diagnosis that soon followed felt like a new beginning, at least to me. Insulin scripts sent, a shiny new glucometer tucked in the pocket of a beat-up jacket, and a follow-up visit with an infectious disease specialist on the horizon. Within a few days, the scripts went unfilled, the jacket had been stolen and the glucometer with it, and the appointment was missed due to a last-minute meeting with a parole officer. I had started my year of AmeriCorps service in Camden, NJ, with the naïve expectation that improving healthcare for individuals in underserved areas was simply a matter making resources available. As I quickly learned, life too often got in the way.
Like many of the patients I worked with as an AmeriCorps health coach, Sam had multiple chronic conditions, a burden compounded by the stress of homelessness and his untreated depression. One of my primary goals as a health coach was reconnecting Sam to the healthcare system, but his priorities were understandably elsewhere; making sure he had a space in the shelter that night took came before attending a doctor's appointment. Nearly every day from December to May I took the walk from my stately office to the run-down church turned homeless day shelter to meet with Sam. Though his presence was unpredictable, I made it a goal to be a lunchtime fixture at the shelter, ready to launch into action when the opportunity struck. Weeks of planning with Sam over ramen and baloney sandwiches eventually got him into a day program with behavioral health support, and soon after, connected to a program that would help him find housing. With greater stability on the horizon, it finally felt like Sam was ready to tackle his health issues.
My two years in Camden have given me an in-depth look into two very different sides of the healthcare coin: The experience of complex patients navigating the healthcare system, and that of the providers delivering the care. Following my patient-centered year as a health coach, I did an about-face and took a position working with primary care providers in a newly developed Accountable Care Organization. Our organization was responsible for effectively coordinating the care of 20,000 lives covered by two major Medicaid HMOs. I communicated with our 13 primary care practices about recently hospitalized patients and ensured that necessary follow up care was received. In a city where too many faced a daily reality similar to Sam's, providers I worked with were often frustrated by the seeming non-compliance of these patients. Consistent no-shows led to double booking, causing long wait times and compromising the quality of care for all patients. When I fielded a call from a physician inquiring about discharging a “non-compliant” patient from his practice, I couldn’t help but think of Sam. What he needed most from his provider was to be heard, to be understood, not be denied care.
The role of a physician lies at the intersection of science and humanities. Fusing the precision and critical thinking of an engineer with the compassion of a counselor and the patience of an educator, the best physicians wear many hats at once. As access to care continues to expand, effectively applying the science of medicine will require an ever deeper understanding of the human side, along with the willingness to learn. Curiosity about how living things function at a molecular level drew me to the biological sciences as an undergraduate, but a desire to connect with people, not just study them, has since drawn me to medicine. My time in Camden has strengthened my commitment to becoming the type of compassionate and socially conscious physician patients like Sam need.