March 18, 2010

Insured Need Not Apply

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B.L. drives a taxicab in New York City for a living. He is 54 years old, is married with two children and his customers often tell him he should go see a doctor for that hacking cough he’s had for the past couple of months.

If it were only that simple. B.L. doesn’t have health insurance.

Among large urban areas in the United States, New York City has one of the largest groups of uninsured residents, comprising a growing number of individuals whose health care needs are simply not being met. Recognizing this tremendous gap in the delivery of medical care, the Weill Cornell Community Clinic (WCCC) was established six years ago by a group of medical students concerned about the barriers to health care faced by uninsured individuals. WCCC is a student-led initiative that provides high quality, free health care for this vulnerable population for which a safety net does not exist.

On Monday evenings at 5 p.m., as the regular shift comes to a close at a large group practice on the Upper East Side and the last paying patient leaves, medical students man the front desk, ready to see the uninsured, stethoscope in hand. But on any given night, the WCCC doesn’t just dispense care. It screens its patients for free or low-cost health insurance. It makes sure each new patient sees a social worker. It puts each patient through the rigors of the most comprehensive history and physical exam that first-year medical students can muster. And it exposes its cadre of volunteer students and physicians to the unique psychosocial aspects and competing social priorities that affect delivery of care to at-risk, underserved populations: If B.L. comes to the Clinic, he isn’t driving his taxi. If he isn’t driving his taxi, he isn’t making what he needs to afford his blood pressure drugs. B.L. is the lucky one, however — he gets top-notch care and even some of his drugs for free. But for every B.L., there are countless others who can’t get an appointment.

With national unemployment hovering around 10 percent, the number of uninsured has ballooned to nearly 50 million. While historic health care legislation may very well be passed by the time this article goes to print, the need for such safety nets will continue for the foreseeable future. By the most optimistic estimates, it will still leave student-run free clinics with a potential patient load of 20 million. That probably doesn’t include undocumented workers, who seem to get sick just like the rest of us!

Because of this tremendous need, we’ve realized that seeing patients once a week is not enough. Rather than bring the community to the Clinic, WCCC has embarked on an innovative program to bring the Clinic into the community. Over the next year, the Clinic’s “Heart to Heart” community outreach initiative will screen 1,000 patrons for cardiovascular disease (CVD) by assessing lifestyle (diet, smoking, exercise) and by using rapid, on-the-spot testing equipment for the most common CVD risk factors: blood pressure, body mass index, cholesterol, blood sugar and hemoglobin A1C — a measure to assess long-term blood sugar control. By providing on-site test results, education and counseling by a health care professional, the campaign empowers patrons with the knowledge needed to live a healthier life.

One Saturday morning each month, the Clinic packs into five plastic bins all its supplies (along with a few sleep-deprived medical, nursing and physicians assistant students — not in the bins, mind you) and sets up shop at sites such as a church in Queens, at an adult daycare center in Brooklyn or at a community health center in the South Bronx to provide 100 individuals with a chance to discuss their vital signs with a physician. Truly vital, because for many, this is the only time they will see a doctor in the coming year.

Are we really bending the cost curve from $150 to see a physician (plus another $200 for all the lab tests) to about as much as B.L.’s average cab fare ($18)? Not exactly. Even if all free clinics started such programs, this would be a drop in the bucket. Visits to primary care physicians entail more than just a blood pressure and some lab values. And it does not count as preventative care — something truly necessary to bend the curve — if we see our patrons at community health fairs only once.

But for the next few Saturdays and for the 1,000 patrons we plan to see, it will have to do.

J.D.M. and S.H.P. are fellows of the Medical Scientist Training Program at the Weill Cornell / Rockefeller / Sloan-Kettering Tri-Intuitional MD-PhD Program, and are Executive Directors of the Weill Cornell Community Clinic. They may be reached at jom2036@med.cornell.edu and sup2011@med.cornell.edu respectively. What’s Up, Doc? appears alternate Fridays this semester.

Original Author: Suchit H. Patel