He was known as a “frequent flyer,” a regular visitor to emergency departments and urgent care clinics who consistently failed to manage his diabetes. Living in Boston, he was close to some of the best medical care anywhere, but his illness remained out of control.
At first, the patient’s repeated bouts of illness mystified Monica Bharel, an HMS instructor in medicine at Massachusetts General Hospital and commissioner of the Massachusetts Department of Public Health, but as she learned more about the man’s life, the mystery was solved. One key issue was the fact that he was homeless.
Bharel, who went on to serve as chief medical officer for the Boston Health Care for the Homeless program, spoke about the challenges of caring for the most vulnerable patients at a seminar hosted by the HMS Department of Global Health and Social Medicine and the School’s Center for Primary Care. She was joined by James O’Connell ’82, an HMS assistant professor of medicine and founder and president of the Boston Health Care for the Homeless Program, and Paul Farmer ’88, the Kolokotrones University Professor of Global Health and Social Medicine and head of the HMS Department of Global Health and Social Medicine.
“People’s stories matter,” Bharel told attendees. “We know so much about the pathophysiology of diseases, but we know so much less about where a man should store his insulin when he sleeps under a bridge.”
The speakers agreed that building personal relationships with individuals and communities is the foundation for providing excellent care.
“It’s about learning who you are serving and what they want,” O’Connell said, noting that homeless programs around the country all look different because different communities have different needs.
Farmer noted that one difference between health care work in places like Boston and in nations without existing health care systems is that in the latter, spending on health and education hovers near zero.
“The first thing we need to do in nations without good systems is let costs soar,” Farmer said, not only because money is needed to deliver better health care, but because investments in health and education yield immense dividends in economic growth.
The speakers felt that the work of treating vulnerable patients was not only morally necessary but richly rewarding.
“Caring for poor people—whether they are in another country or living within the shadows of this campus—is a challenge requiring great creativity,” O’Connell said. “That’s the real work of places like HMS.”