There are four main principles of ethics in medicine: beneficence, non-maleficence, autonomy and distributive justice. Beneficence means to simply do good things, while non-maleficence means doing no harm. Autonomy refers to patient empowerment, giving them the right to choose their course of action in treatment.
Many doctors have no problems following the first three principles, even considering that a lot of very stubborn patients make aggravating and even detrimental health choices. However, the last principle proves to be the most difficult one to accomplish in medicine. Distributive justice reflects our Founding Fathers’ ideals on equality in the same way that autonomy reflects our nation’s independence.
Health disparities are a growing problem in our nation that can only escalate without a few policy and cultural changes. Universal health care is something that we have difficulty “buying into” because of our capitalist thinking… but the way our economy runs should not dictate the level of care that we administer to our citizens. Only recently have I start considering this equality of care as a true, guiding ethical principle alongside “do no harm.”
When I first heard about medical schools offering “free clinics,” I was very excited to be a part of something like that. I did not know what distributive justice was at the time -- I only saw it as an opportunity to get early hands-on clinical experience while being capable of providing a community service in healthcare to an underserved community. In my opinion, this provision is vital in the creation of a bond between students (like myself) and the people we would be seeing in our later years. I have a special interest in Primary Care, so learning how to cultivate this sort of connection was very important to me.
Much to my surprise and delight, My Medical School opened up the “Homeless Outreach and Medical Education (HOME) Project” at the Next Step transitional shelter right next to campus! A few months later, I matriculated. I showed up to the clinic the week before orientation started to get a feel for what we would be doing and I knew at once that this was something I wanted to be a part of. After going through interview after interview with various community health organizations during orientation week, I was selected to be a part of HOME. On my first day as a HOMEy (as we affectionately call ourselves,) I got to draw blood from a family medicine resident, before I even started my curriculum in medical school! I love the sorts of positive experiences and opportunities that HOME provides for us, bridging the gap between the science and clinical aspects of medicine with the art and community aspects.
We learned about community resource mapping and the importance of communicating with various organizations. We learned how to conduct valid surveys which would play into the first phase of our community projects, the needs assessment surveys. Dr. O was very gung ho about involving us in various projects to help the homeless. A few of the projects we are working on involve setting up various clinical services in the areas of dental health and mental health. The project that I am working on involves a mobile clinic that will go out on the road and take health services to the people who need it most. Since the future of the Next Step shelter residents is uncertain next year when the warehouse contract expires, I thought that it was very important for us to be able to go out on the road and see patients.
Last month, we had the opportunity to do just that. HOME set up a tent in a beach park with the “Helping Homeless/Hungry Have Hope” H5 program. We offered blood pressure screenings and first aid alongside the food and entertainment that H5 brought along. We had volunteers to spare, so a bunch of us went roaming through the homeless campsites with needs assessment surveys. The beach residents had a lot of very interesting stories to tell and I left with a sense of sadness and resolve. There were so many children there, just like those at Next Step, who are denied so many things and it is not their fault! The same applies for many of the adults as well, who cannot afford a home or even work at a job. One veteran I met wants to go back to work as a longline fisherman, but he needs surgery before that can be done. As a veteran, he only can get this surgery at an army hospital, but they won’t cover the cost. Another woman I met cannot go to work because she is afraid of losing her government benefits if she tries to raise her income for her family. It is a vicious cycle of poverty, but it is my hope that we can alleviate the problems for a few of these people to make a lasting positive difference in their lives.
We had a Halloween carnival for the kids of Next Step, transitional home to 92 homeless children. It took a lot of planning on the part of the medical students and Dr. O, but we had an incredible amount of support in terms of donations and manpower. I helped organize our volunteers and I also helped make some of the games. The children really enjoyed themselves and a lot of them spent the time cycling through the bouncy castle over and over and over again. Each health-related game came with a set of prizes they could win and their bags already started off with so much toys and candy, it was no wonder that many of them struggled to carry around their big bags of loot around. It was ironic that we had so much candy while we were trying to teach them about healthy habits and perhaps the kids knew that too. One MS-III told me "I asked the kids if they wanted any Reese's Pieces and they just wrinkled their noses... but when I asked them if they wanted pencils, they were really excited about that!"
What I love the most about HOME is the enthusiasm and dedication that everyone involved has and what I admire the most is the way that they excel at the tasks they are put to. Each Tuesday night, we set up clinic and see about two dozen patients in a few hours with just a handful of medical students! The attendings are all very open and friendly with us. It is a good time to get to know the third-years during their family practice rotations and sometimes we get to step beyond doing vitals to perform basic parts of the history and physical examination under their supervision.
I feel that HOME is a great integrating experience that ties in what we learn from clinical skills and basic science lectures with the psychosocial aspects of medicine (the “touchy-feely” stuff) that we discuss in our small group sessions and I am glad to be a part of it!