Third World Medicine in a First World Town

by Carol A. Westbrook

On Wednesday evenings, I volunteer at a free clinic. For a few hours I become a primary care doc in an urban setting, instead of a high-priced oncologist in a modern medical center.

Our clinic, The Care and Concern Clinic, in Pittston, PA, opens weekly at 5:30 pm, and closes when we have finished seeing our 30 to 40 walk-ins. We make no appointments, and we ask for no payments, insurance or Medicare. We can do this because our overhead costs are low, as our space is donated by a church, and all of our staff are unpaid volunteers, from docs to nurses to clerks and social workers. We use our funds to purchase medications, and to pay for lab tests and X-rays, and provide them without charge to our patients as needed, though we have to be sparing in their use, because we have to make sure there is enough to go around. We are a nonprofit supported by charitable donations, and we have a tight budget.

Practicing medicine at C&C is a breath of fresh air for me. I see a sick patient, figure out what's wrong, treat it, make sure the patient gets follow-up, and spend as much time as needed for questions and reassurance. I try to keep the patient's prescription costs as low as possible. I rely on my clinical judgment rather than X-rays or blood tests whenever possible. I don't have to order every possible test to make sure I don't get sued. I write my chart notes and prescriptions by hand, because we don't have electronic records. I don't have to bill, or code my level of service, or fill out innumerable forms. I don't have to turn a patient away for the wrong insurance. I don't have quotas to fill. For one evening a week, I can practice medicine the old fashioned way–by spending my time with the patient instead of with the paperwork.

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