October 10, 2019

‘Nothing tells a story like the patient’

Care of the Homeless Patient unit teaches medical students perspective and compassion


The Wayne State University School of Medicine’s new curriculum continues to build upon the school’s promise for urban clinical excellence by bringing its matriculates inside the heart of its mission. Most recently, medical students met with several formerly homeless community members last month for a one-day series of panel discussions on “The Care of the Homeless Patient.”

Panel and Students
Medical students and faculty meet with panelists after the Care of the Homeless Patient unit presentation on Sept. 26, 2019.

The presentations on Sept. 26 followed a two-week unit of the school’s Population, Patient, Physician and Professionalism course, or P4.

“The P4 Care of the Homeless Patient represents a critical part of the unique education we receive as medical students at Wayne State University. We had an opportunity to learn from the first-hand experiences of homeless patients and physicians who work with the homeless population of Detroit and under-insured patients,” said Class of 2022 student Arif Musa. “I am greatly appreciative of the courage and willingness of the panelists to share their stories and answer our questions. Obtaining the views of providers and homeless patients allowed for students to gain a broad perspective.”

The participants were individuals who the School of Medicine previously worked with through student organizations like Street Medicine Detroit, Community Homeless Interprofessional Clinic and Breakfast Service.

“This exposure in the first and second year of medical school is so important, and sets Wayne apart. It’s a foundational professional skill,” said Kelly Panoff, the P4 course coordinator.

The P4 course a Year 1 to Year 2 segment that emphasizes the evolving professional identity of a physician connected to patients and populations. The course exposes students to their roles as clinician, leader, interprofessional collaborator, scholar and systems analyst through large-group sessions, small-group sessions, online modules, self-directed reflective assignments and clinical opportunities in the community.

“It’s where a lot of discussion in medicine is going. It is critical to understand the social context of the patient before you can provide any hope of clinical care,” said Assistant Professor of Internal Medicine Jarrett Weinberger, M.D., FACP.

Dr. Weinberger volunteered as one of four panel moderators at the presentation. He is director of the School of Medicine’s Internal Medicine residency program.

The panelists shared their personal stories of how they became homeless, from a heroin addiction to mental illness and suicide attempts, as well as their education and job history, what their childhood was like, their current living situation, their thoughts on the health care system, how they have been treated by health care providers, how they wish to be treated, and more.

“Nothing tells a story like the patient. Nobody expresses the human psyche like the patient,” he said. “The students were really insightful about questions. They wanted to know about the underlying issues of homelessness.”

Rafael Ramos was one of the nearly 300 students who attended.

“Having the opportunity to hear the stories of the men and women who took it upon themselves to share their experiences with homelessness was a necessary and thought-provoking exercise to remind us that there are layers of social difficulty that a lot of us in medicine have not gone through,” Ramos said. “Living in an urban area like Detroit, this is a population we interact with colloquially in our everyday lives, and it was important to understand where our own prejudices and assumptions lie about people who fall under this umbrella. It is important to know this part of ourselves and carry these lessons as we continue our training as physicians.”

The faculty physicians who participated shared the difficulties students may face within medicine to provide adequate care for those with unstable living conditions.

“It is important to solidify that any free clinic work or volunteering that we may do in the wider community is part of a wider network of care. It was empowering to hear that some of the work we can do as students has a tangible effect in the lives of the people we work with and it's an enormous incentive to take our involvement in these activities seriously,” Ramos said.

Like Ramos, Musa has seen what a student can do when given the opportunity.

“Homeless patients often experience discrimination, prejudice, and sub-optimal care. The panelists were instrumental in teaching me about the unique circumstances faced by homeless patients that make it difficult or nearly impossible to adhere to the directions of providers. Not only is there a stigma surrounding homelessness, but health care providers may feel that homeless patients are only seeking shelter and a hot meal rather than having a genuine medical concern. Knowing this, I hope to treat homeless patients in the same way I would treat any other patients – with respect, compassion and a genuine desire to improve their circumstances regardless of their background,” Musa said.

Improving care for the homeless patient has been a mission of Musa’s since attending graduate school in the University of Southern California Keck School of Medicine’s Global Medicine Program, where he developed a business operations improvement project to streamline care to the homeless population at the John Welsey Community Health Center in Los Angeles.

“After I came to Wayne State University, I learned how to communicate with patients to assess their living situation and access to basic needs with confidence, tact and evidence-based communication strategies,” Musa said. “My experiences at Keck School of Medicine and Wayne State University School of Medicine have allowed me to continue to develop the skills necessary to care for the homeless and under-insured patients that I will surely see in my training to become a physician,” he said.

The P4 course for the Class of 2022 began in the summer of 2018 with a poverty simulation exercise. Since then, the students have attended presentations related to food insecurities, veteran’s health care, patients with development disabilities and more.