Saturday, October 16, 2010

Guest Blog: Advocating for change at community health centers

Dr. Keisa Bennett is a family physician in Lexington, Kentucky who previously saw patients at a community health center in Washington, DC while completing a fellowship in primary care health policy. The following piece was originally posted on her blog, Ruminations of a Family Doctor.


I had a bright spot listening to the head of DC Primary Care Association criticize community health centers, the very entities her organization exists to support (in a way). Sharon Baskerville's beef with the CHC model (and she makes it well known, so I'm not "outing" her here), is its arrogance and self-righteousness. "We're doing good things for poor people," we say, but what we mean is: "We're doing better than nothing for people no one else cares about." We who reject a "cush" job in the 'burbs with a well-educated, well-insured patient population are sure we're saints. And to be sure, many people who work in CHC's have indeed made great personal sacrifices to work with and advocate for their patients.

The danger in this arrogance, however, is the "better-than-nothing" mindset. It makes us work hard and feel justified, even if our patients wait for hours to see us only to be turned away or told they need to go to the emergency room. Even if our clinic looks dingy and has folding chairs and no toys or magazines during those waits. Even if we skimp on using phone translation because it's so darn slow and seeing more patients must mean we're doing "better".

We get so caught up in doing better care for the indigent, we excuse the fact that we don't question why medical indigence even exists. We doctors don't want to admit that a few trained community health workers could do at least half of the services we're doing more efficiently. No one wants to ask the patients what they really want because we already know the answer. They want what we want, and we wouldn't want to travel by bus and by foot for 30 minutes just to sit in a dingy waiting room all day only to be told that our baby's horrible, scary cough doesn't need any treatment and then be scolded for not using the thermometer correctly.

We would want a trusted person or persons we could call on when we were afraid of a symptom or unsure whether to go to the doctor. Someone who would gather community members together to help everyone figure out how to make the whole environment healthier. When we did need a doctor, we would want to go to a warm, welcoming place where the staff greeted us as a friend and enjoyed serving us and we were happy to pay for their care in one way or another. We want a relationship with at least one person in this office who we can trust to be our advocate. We want these people to communicate well with any higher-level or specialty care we might need.

And if some of us deserve this, all of us deserve it. Shouldn't we all work for it? We would have to give up a system of "better than..." The trouble with trying to make things good for everyone is that a lot of better than disappears. Martyrdom and crusades have to be let go of, given up. We crusaders don't think we are holding up change, but as long as we work for CHCs existing in their present form, we are part of the inertia.

- Keisa Bennett