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Caring for the underserved: Identifying the benefits for patients, families, and ourselves

Posted By Lauren DeCaporale-Ryan, Wednesday, April 20, 2016

 

About 90% of my clinical practice is focused on caring for the underserved:


The young,

The old,

Those suffering from chronic medical illness, now unemployed,

Those without a home to go to at the end of the day,

Those with a home but without any furniture or food,

Racially diverse individuals,

Refugees,

LGBT individuals often afraid to walk down the city streets that lead to our clinic,

& Medicare and Medicaid beneficiaries.

 

This list doesn’t even fully capture who might be labeled as "underserved,” but reflects many vulnerable populations that turn to primary care settings seeking behavioral health treatment. I work with patients in a family medicine practice that serves over 20,000 individuals annually, most of whom are from underserved backgrounds. These are families with low SES, who frequently have experienced poly-trauma, chronic loss, and environmental stressors. Often, they do not trust the medical system… and sometimes… when they first meet me, I’m sure they don’t trust me… The evaluation of the healthcare system as untrustworthy and unfair is not universally true, but it is also not unjustified. Bias and discrimination exist – just watch one political commentary these days and you’re bound to hear something about these very populations and assumptions about individuals from such backgrounds.


But what do I know about these things? I am privileged: my skin tone, my education, my SES, & my life experience make me different from every patient who walks through my door. There are other factors that distinguish us. And then there are commonalities: the most obvious for many is gender or age, but there are my own family experiences of aging and illness that provide me with a shared understanding. Some patients ask to explore our differences immediately. Others wait, reflecting as treatment ends that they weren’t "sure about” me but gave therapy a chance and that they are grateful that they did. Others explore the subject when someone throws privilege in their face: Questions are posed like, "can you believe this white lady,” "that doctor doesn’t care about me, he’s just in it for the money, right?” And suddenly, with these questions, we are processing that I too am a white woman and doctor. How am I the same as those who have acted from a space of privilege and how am I different?

 

Often, I cannot fathom what it is that these families have been through. Their narratives are burdened by unending stressors that often lead to pain and anger. They are estranged from family, have limited supports, and the practicalities of their stressors are real. So…what do I have to offer?

 

I have learned over time that I can very rarely fix the actual problems: the bed bugs, the lack of food, the violence in a neighborhood. I am aware that these factors will cause continued suffering, but there may not be the resources in my community to address the practical, environmental needs of each individual. What I can give instead is empathy, warmth, and compassion. I can provide a safe space that allows for processing an acute stressor or remote hurt that has only furthered an individual’s vulnerability. I can provide human contact that demonstrates that the patient is someone valued and that even when they feel no one else cares, their treatment team does. I can help them develop problem solving skills and work with their team to identify community resources (when they exist) that will help them overcome the limits that exist in their lives. I can simply be present, listen, and hear their stories. I can advocate for change with them. I can push myself to continuously learn about the value in what makes us each different. And I can educate others to have better knowledge, tolerance, and acceptance of differences.

 

I often end my days feeling drained, but then I remind myself of how fortunate I am and turn to gratitude. Of course, there is gratitude for my own upbringing and family, for the many gifts and opportunities I was granted… but it is more than that. I am grateful for patients’ wisdom and insight. As they battle obstacles in their everyday lives, I am motivated to make change in my own and hopeful that I can make even the slightest bit of difference in improving equality.

 

I leave work every day feeling lucky that families have had enough faith, hope, and trust to show up at my door and share their stories with me: that is privilege.



Lauren DeCaporale-Ryan, PhD is a Family Geropsychologist and Assistant Professor of Psychiatry, Medicine & Surgery at the University of Rochester Medical Center. In addition to clinical work, she provides coaching on patient-family centered communication skills and team-effectiveness to physicians and interprofessional teams in Internal Medicine and General Surgery. She is the Associate Track Director of the Primary Care Family Psychology Fellowship at URMC and serves as the Early Career Representative to CFHA’s Board of Directors. 

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