The team asked me to do an outreach with him in the following weeks to see if we could salvage any semblance of a bridge. He was homeless so I met him at a bus stop with his social worker and the following conversation ensued:
Me: How are you feeling?
Patient: Not too good, I’m so tired all the time and get short of breath just walking a short distance.
Me: Have you been taking your medications? We were able to refill most them so you should be feeling better.
Patient: No. Last time was like a week ago.
Me: You know taking the meds is important right? How come you haven’t taken them? (In my head: Of course you feel bad. If only you would just do what I said you would start to get better.)
Patient: (points to other street corner) Well, I hide my stuff behind the trees there and all my meds are in my bag. I only go to my stuff once a week or so or else people will see and steal it. When I go, I take my meds.
Me: oh... (looking away in shame)
This patient encounter gut punched me right in my heart, highlighting my arrogance in thinking I had all the answers when in reality, I was so ignorant of the true barriers to health this patient faced. He had daily worries and fears that would never cross my mind, and unfortunately, would never have informed my treatment plan.
I doubt any patient refuses to take medications because he or she wants to feel bad. All sorts of factors contribute to patient non-compliance, and it is my job is to understand and identify those and (sometimes creatively) address them. Sadly, the current health delivery system with our 15-minute time slots and ever-growing checking list of audit requirements makes it difficult to see, hear, and really understand where our patients are coming from and the barriers they face. Fortunately, there is headway being made with approaches like housing first, harm reduction, and trauma-informed care, but there is much still to be done.
My patient was enrolled in our program and began to receive medication management from our team nurses. They got him a pillbox small enough to keep on his person and would weekly arrange his daily medications. Eventually, with the help of our social workers, he was able to secure housing, and since then has been taking his medications on his own. With regards to his health, he still has a ways to go (still working on that alcohol intake), but he is at such a better place compared to when we first met him.
It really is true that we have to walk a mile in another person’s shoes in order to have a window into the challenges he or she faces. Of course, Pocahontas already tried to teach me that though “Colors of the Wind”:
“But if you walk the footsteps of a stranger
You'll learn things you never knew, you never knew”
I hope and pray that my daughter gets it the first time around.
Jack Tsai, MD, is a family physician at The Children’s Clinic, “Serving Children and Their Families,” a Federally Qualified Health Center in Long Beach, Calif.