A Clinical Approach to Preventing Death on the Streets

An article, A Clinical Approach to Preventing Death on the Streets, published in JAMA Internal Medicine seeks to solve the riddle of why doctors don’t stop and treat the mentally ill homeless people that inhabit our city streets.

Every day in cities around the globe, men and women experiencing homelessness lie sick or injured on sidewalks, often inches away from potentially lifesaving help. Yet passersby, even health care professionals, routinely walk past as if they are worlds apart…When fellow human beings are in need, clinicians typically jump to respond. Most (69%) physicians report they would definitely help a restaurant diner clutching his chest. Most (54%) would definitely respond to an airline passenger in need. Only 2%, however, report definite willingness to help a disheveled person lying on the sidewalk.

Why don’t doctors stop and treat random homeless people on the street? Here is Harvard educated Psychiatrist Dr Koh’s answer. 

“…there is another reason that may help explain the low likelihood of clinicians intervening for a person on the street: the lack of a clinical framework to guide action.”

Then, she presents her elaborate algorithm which she hopes will propel physicians into action. I had to stop and double check the reference. Was this The Onion Medical Journal or a real peer-reviewed article? 

Earth to Harvard. There are many reasons doctors don’t stop. It’s not because there isn’t a treatment algorithm to follow. We aren’t waiting for a new page in UpToDate before leaping into action. My guess is that the number one reason is self-preservation. Here are a few headlines one day alone:

Bystanders rescue Asian police officer attacked by homeless man in San Francisco

Homeless man who was arrested multiple times last year charged in NYC Asian attack

De Blasio needs to face the growing wave of assaults by the mentally ill

Elderly man dies after random attack in Anaheim

If Dr. Koh wants prevent death, she should advise passersby not to approach unknown people on our city streets. Any other advice is irresponsible.

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