Student-run free clinics: A pure form of medicine

The culture of medicine has changed and a new generation of medical students has noticed this insidious path to disgruntlement. Reimbursement rates dominate conversations among health care professionals. Physicians are slowly burning out while younger faces are tempted away from humanitarianism by lucrative lifestyle specialties. Bureaucrats, technology, and increasing health-care costs have transformed the doctor-patient relationship, and students pick up on the increasing frustration in the profession.

The few oases of “pure” medicine are dwindling. Outside of a handful of rural family docs, the culture at most clinics and hospitals now focuses on efficiency and cost-effectiveness. The constant escalation of health-care costs and the numerous opportunities to profit have shaped the new business of medicine, making it less of an Oslerian public service and more an industry analyzed on CNBC and Bloomberg.

Like many medical students around the nation, I have been fortunate enough to volunteer at a student-run free clinic, a place without billing codes or collection experts. Such charitable clinics exist only to serve, not to profit. Our patients are often the most vulnerable and most forgotten by the health care system. The clinic’s greatest successes are not the result of prescribed antibiotics. Instead, they come from a sympathetic ear and a compassionate touch.

For many of us — students and physicians alike — financial gains were not the reasons we entered the field of medicine. We’re here to help, to heal, and to listen to our patients in need.

Charitable clinics offer a venue to practice medicine this way. They serve not only the patients, but also the health-care providers. They remind students (and physicians) of the joys of patient care. In a community-clinic setting, the focus returns to the patient, her hardships, and building relationships. Patients aren’t just charts, illnesses, or ICD-9 diagnoses. They’re the humanistic story of why we became doctors.

At the student-run Lubbock Impact/TTUHSC Free Clinic, my education was not convoluted by health-care reform or reimbursement codes. It was the place where I heard my first breath sounds, caught my first murmur, and wrote my first progress note. The clinic provides much more than education. Most importantly, it provides inspiration. Our experiences there serve as regular reminders of the reasons we spend our twenties nose-in-book. We’re not just learning about treatment protocols; we’re learning about the doctors we hope to become and the medicine we hope to practice.

My experience is not unique. At least 50 medical schools have student-run clinics, where students engage in patient care early in their careers. But student-run free clinics are in a permanently precarious position.

Whether a physician, a student, a donor, or a community member with a voice, each of us can make an effort to encourage an environment that centers on the patient. Student-run free clinics shape the future of medicine for the better and provide health care to those most in need.

Within these clinics, medical students, nurses, physicians, and patients alike constantly see the humanitarian reasons for joining the medical field. The dream of public service trumps the dream of big houses. Here, we still have an oasis: a pure form of medicine.

Justin Berk is a medical student. This article originally appeared in Texas Medicine.

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  • Duncan Cross

    This is so transparently a response to the essay, “Texas’s Other Death Penalty”, that it’s creepy the author doesn’t mention it. It’s deeply troubling that he views charitable clinics in terms of their benefits to med. students, without paying any attention to how his patients became “the most vulnerable and most forgotten by the health care system”. Here’s the Observer piece:

  • John C. Key MD

    There are many descriptive terms that you can use to describe such clinics, but I don’t believe “a pure form of medicine” is one of them I’m sure that everyone’s heart is in the right place and have only the best of intentions, but the quality of the medical care and the efficacy of the efforts would also be determinants or “performance measures”.

    I read that a road to somewhere is paved with good intentions. Good intentions go a long way but alone they are not enough.

    • querywoman

      In life, everybody uses everybody. Those clinics exist to train students. Their eyes are looking for certain conditions.
      I don’t know what a “pure form of medicine” is.

  • Duncan Cross

    Well… don’t I look like a dum-dum? My apologies, Mr. Berk. I definitely appreciate your enthusiasm for medicine, and your concern for patients.

    • Justin Berk

      No not at all! The Texas Observer piece really is fantastic and definitely worth sharing. The systemic issues that have led to people in such desperate need of healthcare is a story that goes untold too often.

      • Duncan Cross

        You are too kind, sir.

  • GT

    Well, in just two weeks, thanks to the PPACA, no American anywhere will have any excuse not to have insurance.

    So I’m sure this will all be a thing of the past.

    • Justin Berk

      Unfortunately this won’t be the case in Texas. Without Medicaid expansion, the vast majority of the patients we serve will still not have insurance. The poorest of the poor will not qualify for Medicaid (you must be pregnant or disabled in Texas to qualify) and they ironically will not have enough income to qualify for ACA subsidies. They will be waived from the individual mandate (because no affordable options exist at their income level) and they will remain uninsured, without health care access.

      • J.L. Creighton

        It’s a shame they rammed the bill through without reading it, or they might have seen that loophole before it was too late.

      • querywoman

        In my large urban Texas county, the county health district’s program covers the uninsured working people well, at least under 200% of the federal poverty level. My friends have been terrified they would be forced into Obamacare and have to pay monthly premiums.
        The county told one a few weeks ago that she would have to show proof she applied. I know a tad about her finances – she works 5 part-time jobs. She probably doesn’t make enough in any for the advance tax credits to be workable.
        I have found out, through an official inquiry, that the county will continue its program. I know them, and I know how they operate. I’m sure they will have peonic clerks at the bottom telling them they have to get Obamacare,
        So what’s going on in the majority of Texas’ counties without Medicaid expansion? Business as usual? County clinics and a bus trip to John Sealy in Galveston for the more costly stuff>

  • querywoman

    Ha! I went to a sort of semipublic dental clinic which was staffed by dental school students and dentists. The med techs claimed the “dentist” would see me soon.
    The dentist stated she was a “volunteer” from the dental school. She was a dental student doing part of her rotation that day.
    I never saw the supervising dentist, which violated state law.
    I talked to a dental faculty supervisor in a couple days, who I assume took action.
    I have an ongoing complaint with the state dental board. I do not know how the clinic is covering for itself, but it may be very hard, since the clinic director refunded my money.

  • querywoman

    I was just mad about the state law violations. I don’t know about the care since I didn’t have anything done there.

    All I got was X-rays, an exam, and a recommendation for an alveoplasty after all my teeth were pulled and before I got dentures. The student was not allowed by state law to make a full recommendation for a comprehensive plan.
    The director of the clinic told me about the student, “She had her instructor down the hall.” So? My dermatologist is a teaching doctor, and he never abdicates his full responsibility to anyone. I’m not supposed to see his PA unless he is in the office.
    The private dentist who finished pulling my teeth told me that my mouth would conform to the dentures in about six months and that he didn’t do many alveoplasties. He said the student was just going by her book.

    They told me I had to get the county hospital to pull my remaining teeth since I have diabetes. Then, they said their dentists could pull my teeth if I had my internist okay it.
    Though I have umpteen health problems, I used to have excellent teeth. My skin disease went inside my mouth and around my gums, and helped rot them. I’ve never had a problem with having a tooth pulled, and barely take narcotics afterwards. My personal history of no problems after a tooth pulled was irrelevant.
    This cost me about $80, which was loosely comparable to a private dentist, though many of them run specials around here for like $25 for an initial exam and X-rays. Supposedly, this was on a sliding scale at a clinic that receives United Way Funding.
    They have a special plan for people over 60, which I am not. I later sent a friend there who was around 80 for a new bridge. They said they didn’t have any grant money at the time, so to come back. He died without a new bridge.
    I think as long as they get enough Chips and Medicaid money for children and fill their chairs, they won’t dip into the grant money.
    I would never donate money to this dental clinic. I keep looking for a dental charity that helps adults. If I donated money for an adult to this clinic, it would not reduce the upfront fees for an adult no matter how much I gave. In a perfect world, I would start a dental charity fund that accepted donations for adults and served only adults. The funds would be paid out of the charity, like insurance, without a clinic first directing it to children. Similarly, states have been in trouble for only using Medicaid funds for children’s organ transplants.

    There is no low cost dental for adults in Texas.

  • querywoman

    Nonprofit hospitals are in business to make money. The clinics don’t make as much, but they still need money. They’ll do everything they can to find another payee source for the patient other than their own funds.

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