Bringing the doctor to the patient, Johns Hopkins works to bridge gap with community

Johns Hopkins residents practicing medicine within the community

Sitting in the library's glass pavilion, Highlandtown residents shared their stories of suddenly becoming caregivers for a sick mother, grandmother, husband or sister. One woman recently started caring for two elderly women who were not related to her but had no one else to look after them.

The stories shared common threads; the residents all spoke of feeling overwhelmed and stressed, and sad to see their loved ones ill. They grappled with the guilt of stealing precious moments for themselves.

Listening attentively were students and faculty from throughout the Johns Hopkins University and hospital system, there to try to bridge the gap between the institution and the community. The meeting at the Southeast Anchor Library in Highlandtown is part of a broader effort throughout the Johns Hopkins Health System to take more medical care out of the doctor's office and into the community.

The health system is enlisting the help of the schools of medicine, nursing and business at Johns Hopkins, along with the Peabody Institute and the undergraduate campus at Homewood, and encouraging students and faculty to bring some of their skills and energy to bear to help with health issues.

The thinking is that if doctors understand patients' lives, they can serve them better. While a doctor can diagnose, it's what happens after the 15-minute appointment, when the patient goes home, that truly determines health outcomes. Do they have transportation to pick up their medications? Is their house safe? Do they have enough food?

As a manifestation of that broader initiative, medical residents at Johns Hopkins Bayview Medical Center are required to do a community outreach project under a program called Medicine for the Greater Good. The program was featured recently in a New England Journal of Medicine article.

"Communicating to people how to change behaviors is hard and requires meeting people where they are," said David Hellman, chairman of internal medicine at Johns Hopkins Bayview. "It is hard to see people horizontally instead of vertical in a hospital bed."

At the recent Caregivers Cafe at the Highlandtown library, named because participants got coffee and pastries, a woman talked about taking care of her grandmother, who has diabetes. Even though family members live with her, she takes on the brunt of the care. Another woman talked about her elderly mother recently moving in with her.

Florence Sdanowich of Canton is caring for her husband, who had both legs amputated because of circulation problems. Her two daughters live out of state, so most of the caretaking duties fall on her. She is scared to leave him alone and came to the caregivers meeting while he was taking his afternoon nap.

"I don't get out of his sight much," she told the group. "I am always there."

It breaks her heart when her husband gets down. The 80-year-old turns to her religion for comfort and tries to stay strong.

"If I cry, I cry at night," she said.

Dr. Panagis Galiatsatos, co-director of Medicine for the Greater Good, shared his own story of losing a loved one, then asked those around the table how it made them feel to be a caregiver.

"We are here to see how you're doing," said Galiatsatos, a pulmonary and critical care fellow at the Johns Hopkins University School of Medicine. "We want to hear what you're going through."

Caregivers at the discussion also heard from nonprofit social service agencies about available support services, such as meal delivery and legal help.

Since Medicine for the Greater Good started in 2013, 82 residents and students have engaged in 282 projects that have reached more than 1,000 city residents.

Under one initiative, residents taught members of various churches how to do blood pressure screenings. Another held classes for refugees to teach them how to navigate the medical system, including how to make a doctor's appointment. A third project worked with parents to teach them how to manage their children's asthma.

Dr. Richard G. Bennett, president of Johns Hopkins Bayview, said community always has been important to the medical center and the resident outreach program is an expression of its concern.

"These programs put structure around things that are hard to do," he said. "If you are an intern or resident it is hard to figure out the health care disparity of a young woman who doesn't speak English or kids brought to this country at 8 or 9 years old without a birth certificate."

The medical students and residents also learn from the community, Galiatsatos said.

Anila Chaudry, a 24-year-old medical student, started the Asthma Free initiative to teach parents about controlling their child's asthma after talking to a school social worker who said students were missing school because of flare-ups. She meets with parents and teaches them how air moves in and out of the lungs and what causes an asthma attack. She tries to instill in them the importance of an asthma maintenance plan for their children.

But Chaudry said she would like to improve attendance at the program. As she works more with the community, she is trying to figure out what will attract residents to sessions. Maybe some prefer small groups to one-on-one sessions. Maybe the sessions are being held at an inconvenient time of the day. It's all about meeting the community where their needs are, she said.

"Patients are people and they have lives," Chaudry said. "They have a community they are a part of and that is where the impact has to come from."

Some residents in African-American communities may remember how some researchers experimented on patients without their consent, engendering mistrust or doctors and other healthcare providers

Galiatsatos and others hope Hopkins' outreach efforts help build good faith. But they realize that trust building takes time and the program won't work if doctors pop in and out of communities without consistency.

The Rev. Drew Scott, the pastor at Sowers of the Seed in East Baltimore, said he noticed his congregants paying more attention to their health after Hopkins doctors started training them as health educators. He said Hopkins helped his members take ownership of their health and gave them personal attention.

"They don't feel as if they're numbers or just in a cube," Scott said. "They feel that somebody hears them. It is a partnership."

Hellman hopes the Hopkins Bayview program could be a model for other medical schools and residency programs.

"I think this is a booster shot for humanity and all residency programs would benefit from additional programs that fortify that spirit of humanity," Hellman said. "I also believe this helps doctors learn to listen better and hopefully learn to communicate better."

amcdaniels@baltsun.com

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