Chi-town, part 3: The Public Hospital

September 29, 2006 at 1:09 am (Michael's Posts)

This week, my thoughts are on some time that I spent at Cook County (Stroger) Hospital shadowing a health counselor who specializes in substance abuse.

His work is part of a program called SBIRT (Screening, Brief Intervention, Referral, and Treatment) whose main goal is to educate substance users (from tobacco to alcohol to street drugs) and get them connected to appropriate treatment programs. SBIRT screens every patient that comes into the hospital. They have counselors in the ER, Cardiac wards, on every General Medicine ward, and soon (we hope) in the ambulatory clinic. My program will, ideally, funnel some of the slack in the counselors’ schedules over to the ambulatory clinic where I will be doing the S (Screening) and they will be doing the BIR (Brief Interventions, Referrals), and hopefully, a few people will get hooked up with T (Treatment). How my screening and possibly their interventions will fit into the flow of the ambulatory clinic remains to be seen, but that’s the idea. More posts to follow on my particular program as it evolves.

When I was following this particular counselor around,  there was such a flurry of activity around him all the time, but he just steadily went around on his business, screening each new patient and talking to them a little bit about their substance use patterns and trying to get higher level treatment to the ones who needed it.  It was an elegant dance, but also very relaxed and sweet.  Very compassionate guy, much slower paced than the other care providers, and spent a kind of time with the patients listening that they seemed absolutely starved for.  Those kind of fast-paced, full hospital situations are not ideal for good bedside manner, and this counselor seemed to make up for some of the lack of it in other care providers.  Lovely to watch how relaxed and open they got with him around with his ears just wide open.  A good lesson in listening and being Present.

But back to the hospital. This place is a piece of work. One of the largest public hospitals in the country, it has a wonderful policy to treat everyone who comes through their doors. As you can imagine, they’re in pretty serious debt. But they’re also wonderful. The cases they see are often pretty wild because the people who can’t afford healthcare often get SUPER sick before they check in. For instance, a young man who couldn’t walk from the pain in his leg waited weeks before he decided to check in. By then, his abcess was as big as the palms of both of my hands. I have pretty decent-sized hands. The place is huge and FULL of patients. It’s also full of wonderful people taking care of those patients. The nurses seem tough and compassionate which is a mix that I think is lovely.

I kind of wish that I was spending a little more time at the hospital because it’s so damn cool, but I suppose that in terms of what I see myself doing with my life, the clinic is closer to that vision. It’s a great place to be getting some experience, but also a very interesting look at how unweildy public hospitals can be. I may learn ways to be weildy in them though, as this SBIRT program seems pretty flexible and strong.

In other words, I am creeping closer to the time when I’ll actually be working on this project and I am starting to get a sense of the work environment (fantastic) and the patient base (extremely diverse and mostly very poor) and my colleagues (awesome). Here’s to learning how to do this stuff right!

On a more academic note, I’m reading some Foucault on Western medicine. It’s called The Birth of the Clinic and is fascinating if you can get down with the philosophe. He talks about how Western medicine is based on an intense empirical way of seeing and what that seeing is made up of. It’s pretty deep stuff, and more than a little esoteric, but it’s also very much worth the slog.

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