Use Different Tools To Help The Underserved

By:  The Generation Y Surgeon (@GenYSurgeon)


Medical School Orientation Taught Me Many Lessons

My medical school orientation was quite the to-do.  There were lectures, dinner, team building exercises, and even a field trip.  The field trip was what had the most impact on me, and not for the reasons you’re thinking.  The impact was all negative for me.

The entire medical school class packed into tour buses and we drove out of the city to a small community hospital teeming with “underserved” patients.  We were taken there for the shock factor: the facility was crumbling, the clientele was poor and unhealthy, the community was violent and drug-ridden yet the community leaders were trying hard to make big changes.  It was terrible and beautiful at the same time and a hundred-and-twenty-some bleeding hearts looked on.  So why was this such a negative experience?  Because I was born at that hospital, that’s why.  Because my family lived in that area, that’s why.  Because the people there recognized my family’s faces in mine without knowing me and it was embarrassing.  I was surrounded by seemingly good-hearted people who, without saying it, felt as though they were better than these “underserved” people.  I was unable to identify with either group because I was clearly no different from these people yet I was not “underserved”.  I had simply found a way around a certain set of barriers.


Reflecting On The Term “Underserved”

Remembering this, I began thinking about what it means to be underserved and now, after 10 years of training, it’s time to re-explore the definition.  In my opinion, to be underserved is not to lack resources, it’s to lack access to resources; to serve the underserved is not to give resources, it’s to eliminate barriers to resources.

Early on in our medical training we are taught to pay attention to the underserved and we are even taught about who they are: black people, poor people, rural people, non-English speaking people, abused women and children.  We are taught to feel for them…but we shouldn’t.  Underserved populations are groups of people who have identifiable barriers to obtaining healthcare, barriers that as physicians, we need to address in order to properly care for people.  How we feel has nothing to do with it.  In fact, you could argue that having feelings towards any group of people clouds your judgement and makes it harder to be objective.  Step back for a moment and think about what it means to be underserved…it’s about barriers to healthcare.  As physicians our job is to eliminate those barriers so that underserved populations have access to care; it’s not our job to just feel for them and give away healthcare.


Think I Lack Empathy?  Read On…

You’re probably sneering at what you perceive to be my complete lack of empathy, but that’s ok.  Let me remind you of all the ways that we are similar: we are doctors, we have sacrificed years to training, we put others before ourselves, we care about people, we want to make a difference in as many people’s lives as possible…


Now let’s think again about being “underserved” really means to us as physicians charged with helping those around us, those dear to us, and those that are hidden from our sight by barriers.  For example, take a look at physicians.  Compared to all American men, male physicians have more than twice the prevalence of hyperlipidemia (12% vs 35%).  Forty-two percent of physicians have hypertension compared to 28% of the general public.  Among female primary care physicians, approximately 20% have a history of depression and suicide continues to be a disproportionate killer of physicians.  Shocking numbers for people who work in hospitals and doctors offices, and this doesn’t even begin to cover all of the gaps in healthcare for healthcare providers.  How many times did you go to the dentist in medical school and residency?  Exactly my point.  Obviously there is some barrier to physicians receiving adequate healthcare…so are we an underserved population too?  We’re not getting what we need, not following advice, or have some other barrier…


Why Does This Fit On This Blog?

You may be wondering why I’m writing about this in a business and innovation blog.  The point is to highlight a set of skills that already exist in the business world–skills that you are likely overlooking in your process improvement and safety lectures/meetings.  Tools like root cause analysis or Ishikawa diagrams can help you identify the right problem.  Process improvement exercises could streamline your practice and extend your abilities to see patients.  Pulling data from your very own practice and analyzing it may identify barriers that exist in your very own office.  Taking this knowledge base into the community and using it to maximize the efficiency of hospitals, like the hospital I was born in, has the potential to touch more patients than you could ever dream of seeing in your own practice.  To be “underserved” isn’t about being poor or black or beaten or far away from a hospital; it’s about being stuck behind barriers.  As physicians, we can help more people by identifying and breaking down barriers than by simply stepping over them, because at the end of the day the barriers will still exist.

If you really want to make a difference and extend your influence as a healthcare provider, then use some tools from business world.  We don’t get paid to feel bad for people, we get paid to help people and the best way to do that is to be objective and remove barriers so that we can see who really needs us. I challenge you to start thinking of the “underserved” in a different way and begin tackling their barriers to healthcare in a strategic manner.  If you can correctly identify what stands between you and your patients (or colleagues!) then you will have a much better shot in removing that barrier.  Take a closer look at David’s blog entries for more information…the tools he describes can be used for much more than business if YOU apply them correctly.