Working at the Good Samaritan Health Center (Good Sam) has dramatically changed the way I (Veronica) think about healthcare. Good Sam offers a holistic Full Circle of Health model and through strategic partnerships we address social determinants of health (SDOH). It’s a special place, unrivaled in the southeast and on par with much larger clinics across the country.
But as impressive as this is, it is not the aspect of Good Sam which has most changed the way I view patient care.
Rather, it is the deep compassion with which our providers approach wounded people. Our doctors and nurses take their time in the exam room, screening for SDOH, checking for depression, but most importantly – listening. Breanna has shared with me that some of her first patient visits with homeless men and women are simply listening sessions, while she pieces together a fragmented medical history and life story. Sometimes she holds hands with a patient and prays for them. Occasionally the purpose of the visit is changed mid-way because a more pressing life need emerges than the reason for which the visit was scheduled. Clinician flexibility is key.
When Good Sam first started our homeless clinic program three years ago, the people who came to us for care were very skeptical. They had been in exam rooms before and had bad experiences – one patient recalling that at a previous clinic the exam room was sprayed profusely with Lysol before the doctor came in for a very brief evaluation. They didn’t like going to the doctor because the conclusion was often “this is what’s wrong with you”. At Good Sam (which our founder Dr. Bill Warren affectionately refers to as Cheers, where everybody knows your name) our providers are trying to answer a slightly different, but more important question, “what happened to you?”
The slight shift in the question has important implications for treatment planning. If a homeless patient presents in our waiting room and he is agitated, cursing out our staff, and threatening to throw things at other patients (true story) and our staff members think to themselves, “What’s wrong with this person?” we might then move to calling the police, having him escorted out, or prescribing a strong sedative. If instead we ask the question, “what happened to you?” and approach the person with patience and understanding, we’ll eventually realize that this young man has been homeless his entire adult life and as he ages, surviving winters on the street is weathering him. We’ll then work for two years to establish permanent housing for him, at which point his mood and health will drastically improve. And while this patient will probably always be limited in his ability to be self-sufficient, he will live much healthier and likely much longer than he would have otherwise.
But the amazing thing is that providers at Good Sam don’t stop there. Once a patient is stable and improving, they move on to the next question (often with the assistance of our Certified Peer Specialist). They transition to “what’s strong with you?” This question reminds patients that they are not confined by their history or diagnosis, and no matter how broken, have positive qualities and skills to offer to the world. It is this second question that gets people on the path to self-healing and increased resilience.
The good news is that cutting edge scholarship on positive psychology shows that human limits and unavoidable suffering do not have to permanently impact an individual or community’s prospects for thriving. In fact, with appropriate interventions, human frailty plays an important role in the journey to truly living well. In the view of psychologists Fowers, Richardson & Slife, “human limitations contribute in important ways to the quality of life” and further “human beings do not flourish despite the difficulties they face. Rather, we flourish as human beings through approaching these difficulties in the best ways.” You could also say negative social determinants can contribute in positive ways to quality of life when they are effectively dealt with and overcome.
So our patients can one day say, “What has previously been wrong is now making me strong.”