He’s a young guy: polite, well-dressed, easy to talk to. He works construction and is here because he’s been getting allergies to dust and pollen. He’s never had insurance, but it doesn’t really matter because he’s always been healthy. He’s the easy slot in my schedule; I ask him a few questions, look in his nose, we chat about the new Avengers movie, and I’m about to send him home with an antihistamine. I ask him a routine question about stress.
“Well, I guess I have had some more stress recently, ever since that guy started controlling my fingers.”
He says it so casually that it takes me a moment to realize how weird it sounds. I shoot him a glance, but he hasn’t changed his expression or posture. “What do you mean?”
“Well, it’s this guy, it just bugs me that he’s controlling my fingers. I know it’s like, not that big a deal, I should just get over it.” He smiles at me, with a look that says “you know how it is.”
I reposition myself on my stool and take a second to mentally organize the questions I’m about to ask, the way I want to ask them. I start probing into his new “stress.” Fifteen minutes later, I leave the room and take a deep breath. He has psychosis. He lives in a world of voices, images, evil organizations, people controlling him. He almost knocked his construction buddy off a 40-foot drop last week, trying to get out of the way of “that guy.” He has never been seen by a doctor, never taken any medications, never been institutionalized; at times he’s wanted to be seen, because the voices were making it hard to work, but he’s never had any access to health care.
The term “medically underserved” can describe any number of health care shortfalls, from the man with sleep apnea whose insurance won’t cover a CPAP machine, to the woman with back pain who’s been on the physical therapy waitlist for six months. But sometimes, it is as simple as my patient: someone with a severe disease who needs help, and who can get it because of a Teaching Health Center.
The Teaching Health Center (THC) where I work is a busy clinic; together with our sister clinics, we see about 70,000 patients throughout Chicago every year. We are part of the answer to the primary care shortage that is facing the country. As the population ages and medical specialization increases, it is harder and harder for Americans to get basic health needs met – especially in rural areas and urban centers. This is coupled with the turmoil of the health insurance marketplaces, which threaten the access of millions to affordable health insurance. THCs are clinics that train the next generation of primary care providers, and emphasize the importance of caring for the underserved in the most resource-poor settings in in the country, providing care for more than 27 million Americans. But Teaching Health Centers are in danger of closing if Congress fails to enact legislation that will allow them to keep going.
Although Congress has passed temporary extensions of Teaching Health Center funding, fixing the THC funding “cliff,” this legislation extends funding for only three months at a time. This funding is vital for 57 THCs across 27 states and DC, and serves to educate 722 primary care medical residents. The three-month budgetary extensions are insufficient and unsustainable; without a guaranteed future, these programs will not be able to recruit new trainees into their programs, and are at grave risk of closing altogether. We need our Senators and Representatives to fix the funding cliff once and for all, to ensure the training of future primary care providers, and to provide care now for our most underserved patients.
It is late by the time my patient leaves, and I’m tired, but I feel good. Many clinics would have sent him away, perhaps escorted by the police on an involuntary mental health hold. But my THC has a full spectrum of services, including a mental health professional who takes him for an immediate hour-long assessment. And we have physicians who prioritize the needs of the patient, and who will bend over backwards to avoid taking away someone’s rights. We spend nearly the entire afternoon getting him the care he needs, but when he leaves for acute treatment, he goes of his own accord, relieved that he might not have to be under the control of the voices in his head anymore.
I can’t imagine training anywhere besides a THC, or where my patients would get their care if we closed. We fill a vital niche that no one else is filling, and we train providers in patient-centered medicine while we do it. Contacting your representative in support of Teaching Health Centers is a crucial step in developing the primary care we need, both now and going forward.
Laura Kahn and Caitlin Farrell are family medicine residents.
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