When internal medicine physician Neil Flynn teaches medical students about the importance of empathy, he tells the story of Joan Viteri.
He knew her as a bright and kind relative of a staff member. She also was someone who injected drugs. The dismissive way some physicians talked with her made her afraid to seek help in time for a treatable skin infection that, because of the delay, became fatal.
Flynn has since turned Viteri’s death into a lesson for doctors-in-training.
“Her story proves that not having empathy can be deadly,” he said.
Expanding community-based care
A group of Flynn’s students in 2002 decided to take his lesson into the community. They asked UC Davis School of Medicine leadership if they could start a new student-run clinic named for Viteri. They said it would be a place where people who use drugs could get health care ― free of charge and judgment.
“Luckily, we don't know how to say no to students like that,” Flynn said.
The doors of Joan Viteri Memorial Clinic (JVMC) in Sacramento’s Oak Park neighborhood have been open almost every Saturday since. The original patient focus has expanded to include those who work in the sex trade or who are transgender. No one is turned away, and the waiting room is nearly always full.
All care at the clinic is provided by medical students with physician oversight. UC Davis undergraduate students help with patient intake, vitals and other support needs. The community service organization Harm Reduction Services (HRS) provides needle exchange services.
HRS also gives medical students at the clinic a chance to participate on a mobile outreach team that brings care directly to people living and working on the street.
Ro Taylor is one of those students. Currently in her second year of medical school, she just completed a year as JVMC co-director.
“The student-run clinics are the reason I’m at UC Davis,” Taylor said. “Other medical schools usually have one or two, but no other school has 11 of them.”
Each clinic focuses on a specific patient population that otherwise may not have easy access to health care, with locations selected for maximimum convenience. Taylor chose the JVMC because she has known people with substance use disorders who were treated as “less than” by medical practitioners.
“Everyone makes different choices with their health,” she said. “The last thing they need is a lecture about how they screwed up. I want to be the kind of doctor who helps them where they are at that point in time and encourages them to keep seeking care. Every single time they are in a health care setting and treated like a human being is a chance for them to get help and get well.”
Like many of her JVMC colleagues, Taylor wants to be an emergency medicine physician. Others will seek careers in primary care. Several have known people with substance use disorders. Another commonality, according to current medical director Alicia Agnoli, is a social justice approach to medicine.
“The clinic can be a huge passion project for students who want to reduce stigma and make health care comfortable,” Agnoli said.
Agnoli is a UC Davis Health family and community medicine physician who researches ways to improve treatment for pain and substance abuse. At JVMC, she expands Flynn’s empathy lesson by teaching the specifics of caring for people who can be marginalized.
“We talk about what rapport and a culture of acceptance are like in terms of how you talk with and respond to patients,” Agnoli said.
It makes a big difference, according to Taylor. She recalls treating a patient with a skin abscess like the one that killed Viteri. In talking with him, she learned he had a deep fear of hospitals. He said if it weren’t for the clinic, he may not have sought treatment at all.
“That was a powerful moment,” Taylor said.
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About the UC Davis School of Medicine student-run clinics
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