Street Medicine

Recently, I read an article on the ACP internist about a Street Medicine Fellowship program located in University of Pittsburg Medical Center (UPMC). The article is written eloquently and does a phenomenal job explaining what Street Medicine is and what the fellowship pertains. 

Brief Summary of the Fellowship 

Dr. James S. Withers MD founded the Street Medicine institute in 2009 at UPMC at the Mercy Hospital of Pittsburgh and since its inception in 2009, its student coalition represents 35 medical schools in the US & Puerto Rico and over 200 programs have launched across the world. Since then, he has worked with medical students and other physicians to provide medical services to the homeless with his efforts culminating in the first, though nonaccredited, known street medicine fellowship started earlier in 2019. 

The fellowship is a year-long and about 80% of the time is spent clinical, experiential learning work, mostly in the homeless campsites and primary are clinics, but it also consists of hospital consults. The other 20% of the time, the fellows will spend helping define street medicine best practices and next steps. 

The Team 

Each successful street team consists of a multidisciplinary team which include at least one internist, a psychiatrist, a nurse practitioner &/or a physician assistant, a social worker and a recovery coach. The key, in successfully being able to provide care is to have an outreach worker whose experienced homelessness, to guide clinical teams and help solidify trust. 

The Conclusion 

Whether there is a fellowship or not, this is a perfect example of how physicians are finding ways to care for those who have no access to medical care. But why should such organizations be connected to large institutions? Why shouldn’t physicians, themselves, establish such organizations to lead them and provide care to those who are in need. 

We spend time, money and energy doing global missions helping those in need, but what about the half million homeless in our country? Why do we or should we neglect them? 

Unfortunately, the answer is much more complex than it seems. As Dr. O’Connell puts it “If you looked at homelessness as a prism held up to society, what you would see refracted are the weaknesses in all of the sectors, particularly education, welfare, foster care, corrections or justice, housing, and health care”. However, if healthcare itself was to be looked at as a prism, what we would see refracted, are the weaknesses in our recruitment, education, reimbursement, and most important of all protection of physicians from malpractice suits. 

I will continue to write about this refraction that our system exhibits in the upcoming articles and what we, as physicians, can do to take back control and become independent. 

  3 comments for “Street Medicine

  1. Sir Lance-a-lot
    July 14, 2019 at 4:17 pm

    How can they become involved?

    They are involved. It’s what they do.

    Instead of these ivory tower academics deciding that they have invented a new form of medicine, they need to politely and respectfully get themselves involved with the people already providing it.

    I don’t know specifically how Pittsburgh structures its EMS and hospital systems, but these sorts of things tend to work best if the people providing the highfalutin’ medical training and the people providing the EMS care work for the same employer (municipal government, hospital system, whatever). Then what they need to do are two things: First, invite EMS members, during their regular, paid work days, to come in and discuss their insights and understandings with other involved professionals, on an equal basis, and make suggestions for improving the program and the care it provides, and Second, arrange regular ride-alongs with agreeable crews to get a sense of what they do and how they do it.

    These are the most simple and rudimentary ways that one group learns from another group, and if this group has never thought of this, then I am afraid there is little hope for them anyway.

  2. Sir Lance-a-lot
    July 13, 2019 at 6:39 am

    “Each successful street team consists of a multidisciplinary team which include at least one internist, a psychiatrist, a nurse practitioner &/or a physician assistant, a social worker and a recovery coach.”

    No EMTs or Paramedics?

    EMS cares for the homeless all day, every day., and are almost always the only ones caring for them on the street, underground, in the places where they live and die.
    It’s a major, and completely unrecognized, part of their job, and they’re good at it.
    With no inclusion of EMS and their experiences and insights, I have no confidence that these bozos have any idea what they’re doing.

    All I can say to them is “Be well.”

    • Adil
      July 13, 2019 at 2:12 pm

      Ahh, you’re right. Would love to hear your thoughts on how they can become involved.

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