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Underserved Communities Essay Outline

"What does giving back mean to you?" As physicians, this is a question that we often overlook or take for granted. But the answer rings loud and clear to me: Giving is part of who I am and my career as a physician.

But I am not a martyr. Giving is in the fabric of all physicians. The Hippocratic Oath states, "I will remember that I remain a member of society, with special obligations to all my fellow human beings." For me, personally, this mentality began long before taking this sacred oath.

I grew up on a small farm in Southern Indiana and was taught, as a child, the importance of giving and supporting those in need.

Throughout my career, giving back has meant many things to me. As a young physician running a small practice in rural Southwest Georgia, giving back meant helping those whom others would not treat and who could not help themselves. I would see patients in my office who would otherwise have had access to only emergency rooms. I developed relationships with them, learned what they needed, and collected donations for vital items. I approached local organizations, church groups, and volunteers to participate and was constantly inspired by the generosity of others.

As I gained more experience, I began visiting Third World countries. My first experience abroad, in the 1970s, was at a mission hospital in Yemen — at the time the most medically underserved country in the world. I gained a whole new perspective on life and medicine during my time there and was able to connect with people and help them through horrifying situations.

In the 1980s, I was introduced to Physicians with Heart, a partnership between the American Academy of Family Physicians Foundation and Heart to Heart International. Physicians with Heart was created to mobilize resources to improve health, provide medical education, and foster the development of family medicine worldwide. I immediately plugged into the group and took two rewarding trips to Azerbaijan and Uzbekistan.

In Azerbaijan, I worked in an orphanage. I treated young girls who had no stable medical attention and faced lives of struggle and solitude. They were in a constant battle to stay alive. In Uzbekistan, I helped teach local doctors how to treat the unique cases in their distressed country. In both places, I connected with many young doctors — some of whom I still keep in touch with today.

After more than 20 years, I departed from my background as a family physician to join the "corporate side" of medicine. I worried that shift might limit my ability to volunteer my time practicing medicine in communities in need. I was wrong.

At the corporate level of medicine, the opportunities to give are many. I joined LifePoint Hospitals in 2007 as Chief Medical Officer for the hospital system, overseeing physicians in more than 50 nonurban facilities across the country. Over the last four years, not only have I been able to continue personally giving back to underserved communities domestic and abroad, I've also been able to create opportunities for other healthcare providers to respond to the call to give.

For example, when Haiti was devastated by a massive earthquake in January 2010, I worked with colleagues to create the LifePoint Disaster Relief Fund, which raised more than $110,000 to help Haitians in need of medical attention, basic living supplies, and support to rebuild their lives. That February, I took my first trip to Haiti with Heart to Heart International to help treat patients in the aftermath of the disaster.

When I returned, I was met with overwhelming support from my LifePoint colleagues and physician peers. Healthcare providers from across the country began offering to participate in helping Haitians in need, and we organized a second trip to the tiny, ravaged nation in May. This experience helped us realize how we could expand our efforts beyond this one disaster, and the LifePoint Disaster Relief Fund will serve as a permanent vehicle to help not only the citizens of Haiti, but other communities in crisis.

The way physicians, nurses, and others across the LifePoint family have banded together to meet the needs of our communities and respond to crises around the world has been an amazing and eye-opening experience for me. It reminds me every day of that fundamental and critical obligation we have to our fellow humans.

As physicians, we are in a unique position to give back to our patients, our communities, and those in need. We are leaders and generally recognized as esteemed members of our communities. We have resources and talents many others do not. With this position comes great responsibility. We must set an example, share our good fortune and expertise, and respond to our calling to give back.

On the most fundamental level, physicians can give back by listening. It is easy to get caught up in patient throughput, schedules, and goals. But something so basic as taking a few extra minutes to really listen can mean so much to our patients and our practices. Empathy is a gift, and we must not forget that.

For new physicians, remember that giving back does not have to be through a financial contribution. Give blood. Serve on local boards. Organize a clothing drive. Donate your old medical books to Third World countries. Volunteer with local nonprofits. The opportunities are endless.

For physicians with more experience, I encourage you to step out of your comfort zone, visit other countries, and help communities across the world that are not as medically advanced as ours. There are dozens of organizations that coordinate volunteer trips, including Physicians with Heart, The Flying Doctors, Doctors without Borders, and Samaritan's Purse.

I've made it a point to make giving a part of my life, and the rewards I've received and relationships I've built are far more valuable than anything I can do for someone else. It does not matter where you are or what type of medicine you practice. It's an attitude. If we all weave giving into our lives, we are responding to our call as physicians in a fundamental and profound way.

I am grateful for being a physician. And I am grateful for the responsibilities that come with it.

Lanny R. Copeland, M.D. is chief medical officer for LifePoint Hospitals. A practicing family physician for 20 years before transitioning to positions at health systems, Dr. Copeland has served as Chairman/President for the American Academy of Family Physicians and President of the American Board of Family Medicine.

This article originally appeared in the November 2011 issue of Physicians Practice.

Empowering, energizing and exhausting are terms sometimes used by family nurse practitioners Tim Rausch and Ricky Norwood to describe work with underserved populations. Both agree it is also rewarding.

Rausch, RN, MSN, FNP, sees patients at the UCLA School of Nursing Health Center at the Union Rescue Mission in downtown Los Angeles. He provides primary care for patients who often are homeless. Presenting with an acute need such as an abscess, the flu or a headache, his exams often reveal patients have undiagnosed chronic diseases. “They might have hypertension with a pressure over 200 [systolic], or blood glucose above 400,” Norwood said.

Most clients, he said, also have mental health or substance abuse concerns. Poor health literacy often adds to the issues these clients face.

While some patients return for chronic disease management, he said others never come back. Averaging 15 patients a day, Rausch performs well-child exams and screenings along with adult care.

The patient base is somewhat similar at the Sacramento County Health Center where Norwood, DNP, MSN, RN, FNP-BC, sees patients. The county clinic is associated with the Betty Irene Moore School of Nursing at UC Davis in Sacramento through a first-of-its-kind cooperative agreement. As an assistant clinical professor with the SON, Norwood works in the clinic’s new Healthy Partners program. The program, according to the county’s health and human services website, provides primary and preventive healthcare to low-income, undocumented adults residing in Sacramento County.

Long, but rewarding days

“We work very long, but rewarding days,” Norwood said. “I come in energized and leave exhausted.” He said 80% of patients have never had healthcare, so he performs a thorough history and physical exam, then proceeds with care based on the findings. Most patients are Hispanic, require an interpreter, and common findings include diabetes, hypertension and thyroid disease.

Norwood said he takes true pleasure in this work, because as a child growing up in Mississippi, he had no healthcare access. “I understand these patients’ need and issues,” Norwood said. Likewise, Rausch, a former ICU and critical care nurse, chose to specialize in primary care for underserved populations because he believes it helps prevent hospitalization, and even disability and death for many of his patients.

He first sampled the work as an NP student on rotation and is convinced it’s an exceptional experience for NP students. “Students very quickly become immersed in the social determinants of health,” Rausch said. “Instead of learning about lab values and diagnoses, they’re learning what got these patients to where they are and how that impacts [the patients’] health. Students learn how to develop strategies for patients that empower them to take control of their health, It’s a unique kind of experience.”

Norwood, who will begin precepting NP students at the Sacramento clinic this summer, agrees. “You can’t get a better model of care than this,” he said. “It’s totally holistic care.”

Skills required to serve the underserved

Success in treating underserved populations demands energy and top skills, both NPs assert. Rausch said a natural affinity toward patient education is also valuable.

“So many of the issues involved with poor health in this population are due to poor health literacy,” Rausch said. “As we give them the knowledge they need about their conditions, and encourage them to return for follow-up care, we can prevent really bad outcomes that will land them in the ER or a hospital.”

Being creative and committed to find a way to connect with each patient and develop a relationship is also necessary.

Norwood added, “If you want a job that will challenge you on a daily basis, give you an opportunity to lift up others and give back, you’ll never have a dull moment. You’re rocking and rolling from the time you start until you leave.”

The investment of skills and patient connection pays off, according to Rasuch. “In the end, it’s rewarding to know that we are helping the patients who otherwise may not be receiving care,” Rausch said

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