Humanizing Patients and Physicians Through Storytelling

By Eniola Gros, MS4 and Al’ai Alvarez, MD, APD on behalf of the Academy for Diversity and Inclusion in Emergency Medicine The Story…

In one of the most racially segregated cities in America, I sat in the clinic conference room going over flashcards for my next shelf exam. It was hot and I couldn't hear myself think over the loud blower fan in the corner. Had I arrived at five o’clock that morning, I would have seen a line of patients waiting anxiously outside, hoping that their spot in line would allow them to be seen by a doctor. There were babies crying in the stuffy waiting room, mothers and fathers taking advantage of their only opportunity that week to charge their phones, and patients randomly checking boxes on their triage forms because they don’t know how to read the questionnaires.

Saint Louis is one of the many cities in this country that still experiences the wrath of de jure segregation. In 1916, the City of Saint Louis established a racial segregation ordinance mandating 75 percent of residents within any given

“We are people responding to a calling. All of us can be part of the effort. We are brothers and sisters in medicine.”

neighborhood be of the same race. Given the already segregated parks, hospitals, and universities, the city needed to find a suitable dividing line to establish this law. That dividing line is Delmar Boulevard. Despite deeming this ordinance unconstitutional in the late 1940s, its effects remain today. Just by crossing the “Delmar Divide” traveling north-bound, your life expectancy decreases by six years and your overall health rating (rated from low to highrisk), as determined by demographics, socioeconomic status and access to quality health care, increases four-fold.

The free student-run clinic at my school serves more than 2,000 patients that fall into this bracket. We serve single mothers and patients who are either without a home or with prior convictions — all working-class citizens without health insurance.

As I listened to the preclinical student’s patient presentation, I wasn’t surprised that it was different from my history and physical exam findings. Before I saw the patient, my junior student informed me that “the patient is a poor historian.” Hearing a commotion on the other side of the door, I opened

it to find three kids running around the room while our patient rested on the examination table. An immediate sense of relief came across her face when she saw me. Ms. Smith was her name. During the brief history, I asked her how long she’d had diabetes. She replied, “What’s that? I don’t have diabetes, I have high sugar.” She shared how she splits her metformin (“the thick white pill”) in half in order to save money on the prescription. She'd taken two different buses with her children to get here. She shops for groceries at a local gas station, because it’s within walking distance and more importantly, “why would anyone spend $4 on fresh produce when you can buy a 20-pack of Twinkies ® that won’t expire in five days?”

As future physicians who volunteer in the community, we get to put our short white coats on, “play doctor” for a couple of hours, and drive home to our air-conditioned downtown lofts, feeling good about the service we provided for the day. We rarely take the time to think about how our patients get home (if they even have a home) or where their next meal will come from. Some of us get annoyed with our patients’ poor medication compliance, tardiness, or appointment no-shows.

It took me about an hour to explain to Ms. Smith her treatment plan, establish follow-up, organize her bus routes, and find the cheapest location for her medications. I offered her GoodRx coupons to help defray the cost of treatments. As she left, my patient turned around and said “whatever you gotta do to finish school…do it. We need you.” She needed me not only to manage her health but also to keep her human. In our talk, I wasn’t worried about my student loans, upcoming shelf exam, or clerkship grades — I was focused on being a physician for my patient. Ms. Smith helped me remember why I joined this profession in the first place and because of this, I realized I needed her, too.

COVID19 restrictions continue to affect the recruitment of students for residency and the job market, especially underrepresented in medicine (UiM) applicants. We have an opportunity to reflect on how we can humanize our future colleagues in medicine. We can look beyond the metrics and also honor their distance traveled and the many other intangible qualities not easily reflected in traditional applications without doing a holistic review. This is how we advance diversity. This is how we break structural racism and design for better equity. This is how we pave the way for increased representation — for us and for our patients.

As Dr. Vivek Murthy, the 19th Surgeon General of the United States, said, "We are people responding to a calling. All of us can be part of the effort. We are brothers and sisters in medicine."

ABOUT THE AUTHORS Eniola Gros is a medical student (MS4) at Saint Louis University School of Medicine. @Eniola_Gros

Dr. Alvarez is assistant residency program director at Stanford Emergency Medicine. He is the 2020 recipient of ADIEM’s Outstanding Academician Award in recognition of his scholarly contributions addressing health disparities. @alvarezzy