Making Medicine Human

Author’s Note: No real patient identifying characteristics were included in this narrative.

A 68-year-old homeless woman presented to the emergency department after slipping and hitting her forehead against a bus railing. The emergency department physician could tell she was in considerable discomfort, and I, working as his medical scribe, very much agreed. Physical examination showed that she had a medium-sized purplish contusion to the mid-forehead. Luckily, her head CT images were negative for any concerning signs of an intracranial fracture or hemorrhage. Physically, she was going to be fine. After reassuring her that her imaging results were benign, the attending emergency department physician wrote up a short prescription for anti-inflammatory pain medications and made her ready for discharge home. There was just one problem — what home do you discharge a homeless person to? On a normal evening, the woman would have made her way back to the downtown homeless shelter before its doors closed for the night. However, after having spent hours in the emergency department this evening, by the time she was ready to be discharged the shelter’s doors had long been closed. She was now left with nowhere else to go. Medicine had helped her rule out severe head trauma and had effectively treated her headache, but what could it do about her homelessness?

What is the goal of medicine after all? A common answer is to heal others. In order to do this we treat symptoms and diseases. Symptoms are easily categorized. A cough, a runny nose, a fever, a headache. Diseases are more complex and can cause several symptoms. After all, the word “disease” comes from the words des and aise in old French which refer to anything that causes a “lack of ease.” When using such a broad definition, even the common cold can be a disease. In addition to physiological diseases there are psychological diseases. Depression, post-traumatic stress disorder, schizophrenia, and addiction to name a few.

How about something that is neither purely physiological nor purely psychological, like homelessness? Can this be a disease? Certainly, it causes its sufferer to experience a lack of ease. It has symptoms which include being without a stable long-term shelter, not having steady access to nourishing food options, and being isolated from the rest of society. Can we treat it? There are no vaccines, medications, or surgical procedures to use against it. Perhaps it may help us to first classify what kind of disease it is before we begin thinking of how to treat it. A society with a high degree of homelessness tends to be perceived as socially dysfunctional. Perhaps we could classify homelessness as a social disease — a disease that afflicts society as a whole rather than just the individual. Indeed, homelessness is a well-known social determinant of health and a common target for public health initiatives.

Our modern medical system in the U.S. excels at treating some diseases yet underperforms when attempting to treat others. We have a myriad of drugs that can treat almost any conceivable symptom, and we have more MRI machines per capita than almost every other developed country in the world. Yet what can our medical system do about a homeless woman with nowhere to stay for the night? Unfortunately, too often the answer is not very much. There is always room for improvement even for a medical system as advanced as ours, and this shortcoming illustrates an area in which we can do better. In a system that prides itself on embodying the humanistic ideal of helping others, how can we make medical care more human-friendly?

Let us return again to our homeless patient. She slowly trudged out through the emergency department sliding doors, bracing herself for a bitter night on the downtown streets. Suddenly, she stopped as she heard someone calling her name. She turned around to find the physician who had just treated her running through the doors calling after her. He came bearing more good news. He had just gotten off the phone with the shelter that had closed its doors for the night and was able to convince the administration to arrange a space for her given her extraordinary circumstances. Furthermore, he had arranged for a taxi to transport the woman from the hospital to the shelter at no additional expense to her. The woman’s eyes welled up with tears of gratitude. He had just given her something more valuable to her than a prescription for ibuprofen or a free taxi ride. He helped her maintain her dignity. The physician did not just treat her headache or her concussion, but also her homelessness.

Watching this physician deliver such holistic care to this patient was a profound experience I will carry with me for a long time. Before this, my primary understanding of medical treatment was simply the alleviation of symptoms. However, he taught me that the delivery of medical care must always place the human condition first and foremost. With the arsenal of medical technology currently at our disposal, it is regrettably easy to become lost in the unprecedented diagnostic power we have within our grasp while forgetting about the individual who lies beyond the diagnosis. Yet we must always remember that we are not simply treating symptoms or diseases. We are treating humans. To work in medicine is to care for the entirety of our fellow humans, including the physiological, the psychological, and the social. To embody all three of these components is to be human. We need and deserve medical care that treats us as such.