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Bringing medicine to the streets

By Mollie Frost

There may be no place like home, but more than half a million people in this country don't have one. And because people experiencing homelessness don't connect with health care systems very well, some physicians and other clinicians are reaching out to them directly.

As part of a movement called street medicine, teams of physicians, students, and outreach specialists go to campsites and under bridges, providing direct patient care and following those who need to go to the ED or hospital. In addition to caring for the homeless wherever they are, street medicine programs train medical students and residents outside of the traditional four walls of clinics and hospitals. Longtime street medicine practitioner and educator James S. Withers, MD, FACP, calls it “a classroom of the streets.”

He founded the Street Medicine Institute in 2009, and its student coalition now represents about 35 medical schools in the U.S. and Puerto Rico that reach out directly to people experiencing homelessness. During his 30 years on the faculty at UPMC (University of Pittsburgh Medical Center) Mercy and its predecessor, The Mercy Hospital of Pittsburgh, Dr. Withers has taught fourth-year medical students during a one-month elective at Pittsburgh Mercy Family Health Center, where he is founder and medical director of Pittsburgh Mercy's Operation Safety Net. The latter program has provided medical and social service outreach to people experiencing homelessness in Pittsburgh and greater Allegheny County, Pa., for the last 26 years.

“I would regard [Dr. Withers] as the founder of the street medicine movement,” said A.J. Pinevich, MD, FACP, vice president of medical affairs for UPMC Mercy.

What started as Dr. Withers' personal interest in street medicine has expanded to become a broader movement to bring health care directly to people in the U.S. and beyond. His latest effort is launching the first known street medicine fellowship in July 2019. The one-year, nonaccredited fellowship is a partnership between Pittsburgh Mercy, which will serve as the fellowship's primary clinical classroom for experiential learning, and UPMC Mercy, the main sponsor and acute care-based academic host. “I think the traditional attitude has been, ‘Well, if people who are homeless want care, why don't they come to us?’ which, to me, shows a lack of empathy and, frankly, a lack of curiosity,” Dr. Withers said. “More and more academic centers and cities have begun to not wait for people to come to them.”

Read the full article in ACP Internist.

ACP Internist provides news and information for internists about the practice of medicine and repots on the policies, products, and activities of ACP.

Back to the August 2019 issue of ACP IMpact