A Detroit DO’s advice for treating homeless patients

The homeless population makes up a third of trips to the emergency room and an estimated 80 percent of those visits could be avoided with preventive care. Richard Bryce, DO, trains volunteer medical students to bring care directly to homeless patients in his role as medical director for Street Medicine Detroit (SMD) and a faculty advisor for Detroit Street Care (DSC).

The groups, led by medical students at Wayne State University School of Medicine and Michigan State University College of Osteopathic Medicine-Detroit Medical Center, are non-profit organizations dedicated to ensuring access to quality medical care for the city’s service-resistant homeless population.

Treating homeless patients for the first time can be uncomfortable, says Dr. Bryce, who offers medical students five tips to guide their approach.

1. Accept your preconceived notions–then let them go

The first step is accepting that we’re all human beings and as such, we all have moments where we prejudge someone, according to Dr. Bryce.

“If we allow ourselves to understand we all create stereotypes of people, we’re not so hardened, and we’re willing to admit that even though this is an emotional challenge, we can learn a lot,” says Dr. Bryce. “Our medical students and residents want to help people that are vulnerable improve their health and their lives, and they’re willing to learn how to do it.”

2. Go out with a team

For your own safety and that of your patients, Dr. Bryce says don’t go it alone.

“There’s always this [notion] you’re going to get sued or get in trouble if you make a mistake,” says Dr. Bryce. “But there haven’t really been cases where students have gotten themselves in trouble if they are careful. This means being in as safe an environment as possible and being with someone else.”

Treating a vulnerable patient can be tough, and it’s helpful to have someone with you to assess the situation and judge if it’s time to back up, Dr. Bryce says.

3. Take no for an answer

Student physicians sometimes have difficulty understanding why a homeless patient may refuse care, Dr. Bryce notes. Homelessness itself often springs from a set of complex factors and these patients, like any other, have the right to say no to medical assistance.

“You can’t assume you’re coming in to change the world or change somebody’s world,” says Dr. Bryce. “You have to build trust to make that difference.”

Giving a patient respect when they say no is important in building relationships with homeless populations, he adds.

4. Respect their space

Sometimes when Dr. Bryce is on a run with SMD or DSC, he comes to a door leading to a vast open space under a bridge near the Detroit River where some of Detroit’s homeless sleep. Even though the door is unlocked and there is no doorbell, Dr. Bryce makes sure to announce himself loudly so potential patients don’t feel like he’s encroaching.

Whether home is a cardboard box, a sleeping bag or a doorway, one of the best ways to show your patients that you care is to respect their space.

“Make sure you’re not standing above your patient,” says Dr. Bryce. “Get down on their level, shake their hand and look them in the eye. That’s half the battle right there and it’s a key component of the osteopathic philosophy.”

5. Consider the societal barriers homeless individuals face in obtaining health care

Dr. Bryce recalls a librarian reaching out to SMD about a homeless man who slept behind a Detroit library during a harsh winter and needed to get his frostbitten toes removed. But the patient was more concerned about obtaining proof of citizenship to get a state ID.

“Two students and I drove him back to his old high school and the county building to get the necessary paperwork to get his ID, and every step of the way, people judged him,” Dr. Bryce says. “Because we got him an ID, that created the trust needed to get him into the hospital to get the care he deserved.”

Dr. Bryce also encourages SMD and DSC volunteers to go beyond the basic questions and to ask how patients ended up homeless.

“You get to learn not only about the person, but also about yourself,” says Dr. Bryce. “How would you react to those situations if you put yourself in the shoes of your patient?”