A Doctor's Experience: Talking with Mrs. F.
"I concentrated on using the latest technology to make the correct diagnosis." But after working with people who are homeless, Bechara Choucair talks and listens "so I can understand what they want and need."
Bechara Choucair well remembers his approach to health care when he first came out of medical school: “I concentrated on using the latest technology to make the correct diagnosis.” But after working for more than ten years with people who are homeless, his focus now is “on talking and listening to people so I can understand what they want and need. I start from where they are.”
Dr. Choucair was first exposed to the distinctive needs of underserved populations in a unique Family Medicine residency program at Baylor College of Medicine in Houston, Texas in 1997. The program included a track on providing healthcare to indigent and underserved populations in the U.S. and around the world.
As the first chief resident in the Baylor College program, Dr. Choucair recalls, “I worked at the Health Care for the Homeless project in Houston. When I graduated, I looked for a position in one of the Health Care for the Homeless (HCH) projects.” After serving for two years as Medical Director of HCH at Crusader Clinic in Rockville, Illinois, he became Medical Director for the entire clinic. Two years later, he assumed his current position as Medical Director and Managing Director of Heartland Community Health Center which also operates a HCH project.
Today, Dr. Choucair works with medical schools in the Chicago area to include health and homelessness in their curricula. A faculty member at Northwestern University, he plans to include a year-long clinical rotation at Heartland Community Health Center as part of the University’s Family Medicine residency program.
When asked what keeps him going after ten years, Dr. Choucair explains, “We do have successes. For instance, there is Mrs. F. who I first met when she was asking for money outside of a 7-11 Store. I would always say hello to her on my way home. About a year ago, I started providing services at a food pantry and she came in. She came up to me and said ‘I saw you at the 7-11 Store and you said hello to me. I want you to help me with my asthma. I am having a hard time breathing and I haven’t seen a doctor in a long time.’
“I began seeing her regularly at the food pantry, and found out she had dangerously high blood pressure as well as uncontrolled diabetes and asthma. She was adamant about only working on her asthma, so we focused on decreasing the symptoms. Then she was ready to tackle her hypertension and we made progress with that. This last fall I was riding my bike to work and she saw me. ‘Doctor,’ she called out, ‘we need to get you a better salary so you can afford a car.’ ”
He laughs and declares, “Mrs. F. exemplifies the lessons I’ve learned from working with people who are homeless. First and foremost, it is important to see the whole person and meet them where they are at. She just wanted to breathe easier, and wanted me to work on the asthma and only that. As a physician, I saw the myriad of medical problems she had. However, I had to put my concerns aside and start with hers. After four months, she is breathing easier, her blood pressure is lower, and most importantly, she comes and sees me regularly.”
Dr. Choucair finds his biggest challenge in providing care to people who are homeless is having the time to talk and listen to each patient. The demand for his services coupled with a lack of resources requires a daily balancing act. “I talk to other clinicians working in HCH projects and we are all stretched,” he says. As Chair of the Steering Committee of the HCH Clinicians’ Network (http://www.nhchc.org/network.html), Dr. Choucair is in a unique position to hear from the field and advocate for resources. “There is a Mrs. F in all of our communities and we want her to have a home.”
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