SOCIAL EM & POPULATION HEALTH COMMITTEE
Street Medicine: Uncheck Your Biases Silvi Spirollari Pomeroy, OMS-IV
T
he term street medicine is self-defining delivering medical services directly to an unhoused patient population by physically reaching them— whether in encampments, on the streets, wherever they are in need. This represents a groundbreaking form of medicine, recognizing a patient demographic with a healthcare access gap while simultaneously addressing additional social determinants hindering them from receiving proper care. The statistics are clearcut, unhoused individuals face a significantly reduced average lifespan compared to housed counterparts, while simultaneously having exponentially higher healthcare costs. Despite these stark realities, street medicine remains a much understaffed and unfamiliar to many healthcare practitioners. As a medical student, my initial encounter with the term “street medicine” led me to erroneously connect it with other misunderstood topics from lecture, similar to the Krebs cycle or bilirubin metabolism disorders.
Arriving in the country at the age of two, I witnessed early on the disparities associated with limited healthcare access.
The reality is the field itself is vitally crucial, yet underserved and undersupplied. Focusing on one aspect, unhoused individuals have higher rates of substance use disorders and mental illness, yet many street medicine teams do not have access to full time psychiatric care. Scaling this facet by the intricated complexity of the pathology, both medical and social, prevalent in unhoused population paints a picture of a complex medical field that demands more advocacy champions. One such champion is Dr. Victor Cisneros, MD MPH CPH, who can speak for the importance of street medicine via his experience leading a mobile unit in Coachella Valley, California, while also serving as the Director of Diversity, Equity, and Inclusion & Community Health Outreach for graduate medical education at Eisenhower Health, embodying the advocacy needed to address the unique healthcare needs of those experiencing homelessness.
Silvi Pomeroy (SP): Tell us about your interest in Social Emergency Medicine and Street Medicine. Victor Cisneros (VC): My interest in these fields stems from personal experiences as an immigrant. Arriving in the country at the age of two, I witnessed early on the disparities associated with limited healthcare access, leading to the use of the emergency department as our primary care due to a lack of insurance. I encountered barriers like language difficulties and food insecurity. My perspective deepened during my MPH studies, providing valuable tools and insights often not covered in medical school, particularly in understanding the impact of social determinants of health. I believe these factors are as crucial, if not more so, than prescribing medication or treating a diagnosis.
Social Emergency Medicine (Social EM) is about integrating these social determinants into acute care settings, like the ED. The aim is not to burden practitioners with additional screening tools, but to optimize and collaborate with colleagues like social workers. Breaking down silos in the emergency department (ED) is vital; understanding that roles, like physician, social worker, and case manager, should not be assumed but rather comprehended collectively. The key lies in understanding the landscape of each other’s roles. SP: What are modifications that emergency medicine programs nationally can make to be more conscious of the unhoused population? VC: Recognizing the significance of this issue is the initial step for residency programs. Internal champions are crucial to advocate for the unhoused patient population and emphasize the importance of addressing social determinants of health. Without this awareness, progress can feel like an uphill battle.
The second step involves having individuals, like myself, or other passionate colleagues who are well-versed in understanding and trained to tackle these issues. Investing in the education of the next generation of residents requires Social EM fellowship-trained professionals or those with a keen understanding of public health and health-related social needs. To effectively educate residents, innovative approaches are essential. However, residency programs must secure institutional buy-in and emphasize the importance of these initiatives. Building a curriculum and >>
46
COMMON SENSE MARCH/APRIL 2024