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  • Rob Orman

3. Street Medicine


At the end of the day, have you made the world a little better? My guess is that you have, even if only in a small way. That’s certainly true of today’s guest, Dan Bissell, MD. Dan is co-founder of Portland Street Medicine, a medically focused non-profit dedicated to caring for the homeless. What’s unique about the care delivered is that it happens in the austere environment of homeless camps, underpasses, and street corners. In this episode, Dan and I cover what a day of the street medicine team looks like, how his group started, and how street care has impacted his everyday medical practice.

We discuss:

  • What it means to follow your bliss: the life you ought to be living is the one you ARE living. (The Power of Myth) [00:45]

  • How an emergency physician who provides medical care on the streets for homeless people believes that the very best medicine he has to give are tangerines and socks. Other things: wound care, basic primary care, social services, carecoordination. [04:45]

  • The goal of Portland Street Medicine is to build continuity and trust. It’s more about helping people get connected into a setting of sustained care than of providing definitive, comprehensive care. [07:15]

  • Working in an environment with constrained resources forces you to be creative and to approach problems with new eyes and to come up with different solutions. [11:55]

  • Design thinking recommends we approach people in need with empathy, and we should always circle back to that empathetic impulse of discovering what that person needs. [12:44]

  • Homeless communities are complex, heterogeneous, vibrant, and cohesive. Working with them is humanly gratifying. [23:15]

  • The secret sauce to success of Portland Street Medicine is to provide care without having their own dedicated clinic. This allows them to give aid without being a threat to other social service agencies. [28:18]

  • Portland Street Medicine serves three populations: 1) the folks on the street, 2) other social service agencies with whom they collaborate, and 3) the provider community. Encounters with patients are clinical (where vital signs are taken, notes written, and treatment rendered) and/or social (providing care coordination, housing, blankets, etc). [29:00]

  • How wearing a stethoscope around your neck shows that you care and that you’re here to help. [34:00]

  • The case of Susannah, whose peritonitis from a ruptured appendix was suspected by street providers who facilitated the care she needed to save her life. [37:00]

  • How homeless people are at a minimum ignored and at a maximum shunned. Yet they are just people like the rest of us and deserve to be treated with empathy and respect. [40:50]

  • Getting to know someone who is homeless can help providers get back to the roots of empathy and bring more hope and excitement to their clinical work. For Dan, it has also reformed his thinking about how we structure health care. [42:20]

  • The first step to building awareness about homelessness is to ask some honest questions. “What’s going to happen when you leave here today? Where are you going to go?” [46:55]

  • How slowing down, even in the chaotic environment of an emergency department, can help you find joy. [50:38]

Show Notes by Melissa Orman, MD

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