Physician Makes ‘House’ Calls to Patients on the Street

I grew up on a farm in Hanover, Pa. My father was a doctor and my mother was a nurse, and when I look back on my childhood, it was great. I can’t imagine anything better.

My father was a family practitioner, and I can remember riding with him in his Volkswagen Beetle when he made house calls. He had a solo practice and frequently delivered babies in the middle of the night.

I was very much aware of how his

JIM WITHERS Age: 48 First professional job: Faculty member, Mercy Hospital of Pittsburgh Current job: Medical director, Operation Safety Net, Pittsburgh, and faculty member, Mercy Hospital of Pittsburgh

patients viewed him. He had a very deep relationship with the people he served, and they could see his goodness. Both he and his patients had a profound commitment to each other.

When I got my driver’s license, I used to drive my mother around for her volunteer work with Meals on Wheels. Doing that taught me two things: first, how to parallel park, and second, to see people who were truly forgotten.

My parents were very smart. They introduced me to the best of life and to people who were in need, and their way of helping was not full of fanfare but just the normal way to behave.

When I told my father I wanted to go to medical school, he sat me down and told me the things about medicine that were not fulfilling, such as the fear of lawsuits and the paperwork. Nonetheless, the message was still that this was a noble career. Today many doctors have lost sight of our real contract with society, which is to serve, accept, and love people. We are very privileged individuals, and we often forget that.

After finishing my residency, I began teaching at Mercy Hospital of Pittsburgh, which attracted me because it is very mission-based in its commitment to serving the poor.

One of the things I did was to establish a domestic-violence center here in the 1980s — it was a partnership with a women’s shelter and the hospital. We had a huge litmus test as to how we were going to respond — we worked both to prevent domestic violence as well as to heal those who had been victims, as the health of these women was certainly affected by their exposure to violence. I got pretty good at understanding domestic violence and began to consult with physicians who didn’t know how to treat these women or where to refer them.

Then I became interested in people who were not “user friendly” — the unsheltered homeless — and what that said about us as people and as a society. We do have a responsibility to everyone, and if we can’t figure out a way to make things better for them, then that is an indictment of us.

I felt that we needed to find a way to get into the shoes of people who are not being served well and to look at things from their point of view. I really wanted to get into a setting that would allow me to practice reality-based health care. One of the things I noticed about the street people who came in through our emergency room was how the hospital staff just could not communicate with them.

Then I met Mike Sallows at a local homeless shelter, where he was employed to do outreach work. Mike used to be homeless, and he turned out to be my ambassador to the unsheltered homeless. Mike’s outreach meant going to those people living under the bridges, for instance, rather than the usual visits to soup kitchens and shelters that most outreach work consisted of in those days.

The reasons I didn’t approach Mercy at first was because I wanted to pilot the program with my own street experiences, due to concerns for student safety and the need to work out my own “street medicine” practices. Sometimes it is better to apologize later than ask permission first. Plus I really wasn’t sure what I was getting into.

I dressed like a street person and tried to wipe my mind clean of preconceptions of what I was going to do to help these people. I listened to them telling me their life stories, and I realized they were not losers, but were heroes. They weren’t giving up, and as a health-care professional it was a relief to have people talking to me like real people. Treating a patient as a number is not a fulfilling way to practice medicine.

By about 1992, I had a street practice and a number of med-school student volunteers. We went under the bridges and the abandoned buildings to get to know our patients as people. If someone says he is the King of Cuba, it is important for you to listen and learn about his kingdom.

I feel very strongly that we are obliged to nurture the spirit of service in our students, and I’ve tried to create a safe place for students to see the people who were thrown out of the emergency room. It doesn’t make sense to brush things under the carpet and think we are so smart in doing so. As the great physician William Osler put it, “It is better to know what person the disease has than what disease the person has.”

The students love this work, and after graduation have gone on to other parts of the country and set up similar programs.

In 1993 I began Operation Safety Net with a $50,000 grant from Mercy. Operation Safety Net pairs medical people with those who are homeless, and we send teams out two or three times a week.

While we do have some supplies in our backpacks, we encourage homeless men and women to seek care, whether in one of our clinics throughout the city or elsewhere. We see about 1,200 individuals a year, have a 24/7 hotline that they call, and do get involved with finding them housing and appropriate social services if that is what they wish. Today we get money from private donors, from grants, from the federal government for housing, and money from Allegheny County.

We often deal with injuries, such as wounds that are festering, broken fingers, problems with diabetes, and so forth. But with the homeless, you really have to deal with them on their own terms.

We are also paying witness to people with diseases that are not being treated, such as cancer and high-blood pressure. By going to the streets, we are able to begin the process of getting them the treatment they need: Too often these unsheltered homeless have given up, think no one cares, and have no insurance.

Last year I organized the first International Street Medicine Symposium, which was held in Pittsburgh. People from all over the world came together. We were all so happy to meet each other, it was like we were all from the same spaceship.

It is hard, but it is important for the health-care industry to maintain humane values and serve people who are not easy to work with. I’m so grateful for what I learned from my parents about taking care of those who are less fortunate, and to the homeless people who are our professors.

— As told to Mary E. Medland