Where’s The Street Cred?

Posted: July 27, 2014 in Uncategorized
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The first clinic that Brett and I worked to open was the DeSales Free Clinic (check the Where Are We page for more information) in 2007. To the credit of the DeSales University faculty (long before I was a member), they made attending the Clinic a required part of the curriculum. This is no small feat and did not come without it’s share of controversy. In fact, many medical institutions who offer a homeless clinic experience do not require it but rather just make it available. There are a million reasons stated to take this approach- it is better to have people who really want to be there, the students are already so busy, it is really more of a club-type activity and the list goes on. However, academic research has shown that in the medical school and residency model, the greatest impact on the attitudes of students and fledgling practitioners about this population is seen in programs that require participation in the experience.

Early on in the life of the DeSales Free Clinic, I was going about my business of coaching students and seeing patients. One student in particular looked very uncomfortable. At first I thought it was just nerves. The clinic requires a team of first and second year PA students to see a patient as a team. This expectation is both exciting and obnoxiously intimidating for the students. This usually causes GI distress for 48 hours before the Clinic night in anticipation and 48 hours after the Clinic night as they ponder if they know anything at all. I assumed that student was panicking about repeatedly putting their stethoscope in their ears backwards.

I was wrong.

After the student continued to sweat uncontrollably for over an hour and looked as if they were on the verge of passing out, I pulled them aside and asked them if they were ok. Reluctantly, they told me they were terrified of being at the clinic with ‘these’ patients and had no idea how to relate to “them”.  They wanted to be helpful and they wanted to connect but in the students eyes, there was no common ground. They didn’t look the same, they didn’t act the same, they seemed to share no common experiences. Even their dentition was different. As the night had progressed, this young student had generalized this experience to mean they could never relate to any patient. Ever. The whole night was on the verge of catastrophe.

In my experience working with the homeless (and talking the ear off about homelessness of anyone who doesn’t have the good sense to stop me) I think this is a common feeling that becomes a barrier for getting involved at any level.  I have asked myself the question before too.

I grew up mostly in Kansas and Indiana. I am more familiar with tornados, farm land and suburbia than the inner city. I listen mostly to country music.  I don’t have a history of addiction or incarceration or abandonment. I say ya’ll and when I am tired, tend to sound more like a hillbilly than a college professor. I have parents that are still married after 41 years and always had plenty of love. It is not to say that there were never hardships and difficult times but a big difference is those struggles were conquered with the support of a loving environment. So, simply put, how do I relate? Where is the ‘street cred’?

Respect. Dignity. Humility. Authenticity.

It is really very simple.  When we treat people with respect and dignity, they appreciate it. They may not show it right away but they see it, they hear it and they feel it.  Often, in medicine we are told that the homeless are a ‘difficult population’ who never follow up and never follow through (usually accompanied by an eye roll or heavy sigh). This has not been our experience. In fact, one way our patients show us that they have felt the respect and have been treated with dignity is that they either come back to the Clinic or invite us back to their encampment- their home.

There are certain things in life that are exceedingly difficult to fake. Humility and authenticity are two of them. Most of my patients have experienced things that are unspeakable. I don’t know how they have walked on this Earth for all these years bearing these burdens of emotional (and often physical) trauma. And certainly, sometimes they are suffering the consequences of their own actions. But often, no one listens to them. They don’t listen to how they ended up sleeping on a friends couch. They don’t listen to how they ended up sleeping in their car, the woods or in a shelter. They don’t ask why they never took any of the medications they were discharged home on. They simply determine- by way of a sideways glance- that a persons homelessness is the rightful consequence of a mistake and simply cannot be helped.

Dr. Jim Withers (seriously, if you don’t know how he is- Google him) always says that we have to suspend our reality and step into our patients reality in order to truly understand how to help them.  Suspending reality takes some courage. Once you see the world through different glasses, it can be hard to ever see it any other way. Like the former lifeguard in me that cannot go to a swimming pool without constantly scanning the water for someone in trouble. However, if you are willing to take a journey into someone else’s life, you will be enlightened and only the can you really know how to help.


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  1. Tammy says:

    Love reading these!! So well written! I can feel what you are saying.


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