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House Calls

The Office of Patient Equity is led by a local physician who created the department after realizing the importance of caring for those who could not afford medical care.  This office was originally created as a part of another provider network, but with the increased national focus on equity, it now has a stronger role as part of our system.  This physician created the ‘Vulnerable Patient Network’ for uninsured and disabled patients who were only being treated in the emergency departments.  With the assistance of nurse practitioners, he visits these patients at their homes.  This was one of the most meaningful experiences of my residency year.  By visiting patients in their homes, you realize the difficulty they have in receiving medical care and the daily challenges that they face.

For example, the first patient we saw was a jovial, 60-year-old lady.  She smiled at us showing her missing tooth, and her hair was unkempt, with a pink comb placed on the side of her head.  She once cared for her 80-year-old mother, but now her 80-year-old mother was caring for her.  The two ladies lived in a cluttered, dark house, and they were praising God that the physician came to visit them.  The patient looked and sounded like she was drunk, however this was due to the fact that she had recently had a stroke.  Now she can’t remember to take her medications, and her mother gives her a sponge bath once a week.  She spends most of her time sitting inside, rarely sees the sun, and easily loses her breath when she walks over 10-15 feet.  Since she can no longer drive and is two years short of having a disability that would qualify for Medicaid, she is left uninsured.  She said that she calls the ambulance quite often just to talk with the paramedics when they arrive at her home.  On top of her recent stroke, she has diabetes and hypertension which require additional care.  At our visit, the physician spent time caring for her and challenging her to increase her physical activity level.  The patient was extremely grateful for the medical supervision.  She has had huge medical bills, and she cannot afford to pay them.  There are many people who face these challenges everyday, and it is important as a health care administrator to walk in the shoes of the people who are uninsured but have many medical needs.  The most saddening part of this visit was that she mentioned that she used to be a nurse at our hospital!  It is hard for me to comprehend that this woman dedicated her entire life to caring for patients but is not allowed to receive care herself because she can’t pay for it.

The next patient we saw lived in the area about a mile away from our main hospital.  This patient has literally cost the hospital millions of dollars because she’s spent so much time at our facilities and at our long-term acute care hospital.  She is a 40-year-old undocumented, uninsured resident who is paralyzed from the waist down from a gunshot wound received at the age of 20.  She was also very grateful to see us, and she gave us all a hug upon arrival.  When we went to her apartment, we found that she lies daily on a bed (given to her by our hospital) in the living room of her 23-year-old son’s apartment.  She stays in her bed all day long with her medications (multiple pain killers, antibiotics, and anti-depressants) sitting beside her.  The 23-year-old son is currently housing and supporting his mother, brother, sister-in-law, and their two small children in a small two-bedroom apartment.  The patient let us know that her son gets very irritated with her and is often rude to her.  Sometimes he is not available to take her to the bathroom or shower.  Since she lies in the bed for so many hours at a time, she’ll get bed sores and have to go back to the hospital.  The last time the physician went to visit her, he and the nurse practitioner noticed that the patient had huge bed sores which she hadn’t even known about since she couldn’t feel them.  The physician informed me that the last time he went to visit her, there was a trail of bodily fluid leading from her bed to the bathroom, because she had literally scooted along the floor to get to the bathroom, bursting open her bed sores on the carpet.  Today, there is a small area of bodily fluid beside her bed where she had thrown up because she was nauseous from pain killers.  The physician said that she was much healthier on this day than the last time he visited her.  The patient complained that she cannot leave her apartment because the landlord will not allow her to have the handicap ramp (courtesy of our hospital) installed on the step right outside of her front door.  The barriers that she has to overcome everyday are very difficult for me to comprehend.  She was a very sweet lady, and she is very clean despite her circumstances.  She gave each of us a hug when we left.  As we got back into the car to return to the hospital, I had a different level of appreciation and understanding for the challenges faced by underprivileged patients who must receive health care but have no means to do so.

The physician says that every administrative resident and administrator should go on house visits with him.  I agree.