I UNWRAPPED the blood pressure cuff from the man's arm and took the stethoscope out of my ears. "140 over 100," I said. "Has it ever been that high before?"
"It's always like that," said the patient, a polite, 47-year-old professional driver who had come to the outreach center for a hot lunch and health screening and preferred anonymity. "I'm supposed to take medication, but I don't have insurance. And I'm worried I'll lose my job if they find out about my blood pressure."
The nurse I was shadowing that afternoon suggested the man visit a free clinic that could give him blood pressure medications from its collection of samples. It was a far cry from comprehensive health care, but it was all she could do.
I encountered similar stories every day as an intern with the Soros Service Program for Community Health in Baltimore. My fellow medical students and I learned from doctors and nurses who work with low-income Baltimore residents, and we interviewed clients at outreach centers and free clinics for the Baltimore Safety Net Access-to-Care Survey, which was released Thursday.
Among the 260 people we surveyed for this annual report card of community health indicators, nearly 80 percent have chronic diseases such as high blood pressure, arthritis and asthma. More than half have chronic psychiatric problems, mostly depression. Yet 54 percent have overdue medical bills, and the cost of care frequently prevents them from getting help. Forty percent of those who lacked health insurance said they stopped taking medications or going to the doctor as a result. With poor health and poor credit, they can do little to improve their lives.
But the statistics tell only part of the story. Because I was training to be a doctor, the people I met allowed me a view into the most private details of their lives. I began to see them as neighbors.
At Paul's Place, an outreach center in Pigtown, I helped clients find items in the clothing bank, played with children, served juice and mopped floors. I shared a picnic on Federal Hill with the center's women's group. We unfurled a blanket on the grass and snapped pictures of ourselves smiling in the sun. Another day, I talked with a man about his drug addiction, the abandoned houses where he sleeps and the disrespect he senses from doctors and nurses in emergency rooms. As I stood up, I shook his hand. He smiled broadly, as if nobody had shaken his hand in years.
The stories I heard made me think about the state of the profession I am entering, especially when I heard a Johns Hopkins physician say the only way uninsured patients can see her is if they are hospitalized through the emergency room. If they call for an appointment, they are turned away.
This was news to me. I had changed my plans for a career in journalism and applied to medical school because I wanted to help others directly. I had not realized that if I work at an academic medical center, many people will be excluded from seeing me because they are poor.
At Health Care for the Homeless downtown, I saw a patient who had lacked dental care for so long that two of his teeth had rotted. The doctor peered inside his mouth and without a hint of surprise told him about a dental clinic where he could get them pulled for $5 each.
At Chase Brexton, a Mount Vernon clinic, a woman had massive fibroids, benign growths that had caused her to have daily menstrual bleeding. As a result, she was severely anemic, exhausted and weak. But she lacked insurance and could not afford surgery to remove the tumors. A case manager had helped her apply for benefits, but they were denied.
"Almost everyone is rejected the first time," the doctor told me. "Welcome to our wonderful health care system."
I will always carry with me the stories of the people I met this summer, and I plan to make community medicine a large part of my practice largely because of them. But that is not enough.
I hope policy-makers, who have the power and responsibility to change the system, are listening to their neighbors and learning from their stories, too. Because no one should have to scrape together $5 to get a tooth pulled because he cannot get dental care or stop taking his blood pressure medication because he can't afford it.
Ariel R. Frank Green will be a second-year medical student at the Johns Hopkins School of Medicine this fall.
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