The Making of A Doctor: An Interview with Dr. Lise Alexander

TC:  It sounds like you have to be part physician and part social worker.

LA:  In our community, yes. At the Seattle Indian Health Board, some of our patients have at least two or three medical problems, at least one psychiatric diagnosis of depression or anxiety or bipolar or substance abuse, and at least one social issue, being homeless, a victim of domestic violence, a history of incarceration. So when you're dealing with your patients there you are addressing the three facets of their life: their health, their emotional or mental health, and their social health. And you need to make sure that if you're going to offer them something that they realistically can do it. It doesn't do any good to recommend to a man who has sleep apnea to get a CPAP (an electric machine and mask put over the mouth to assist breathing during sleep) if he is homeless. You can never ever assume your patient has access to normally-assumed resources. They may not have a home, they may not have transportation, they may not have money for medicine and they won't tell you about this lack of resources. You have to be really clear on anything you do.

TC:  What do you do when you run into a patient like that? It would seem as if you have to get him other services to support whatever it is you're trying to do for him in you office.

LA:  Yes. And that's one of the great things about our clinic. We have an amazing system in that we have social workers that work with our patients, we also have patient advocates that will sit down with our patients one-on-one and make sure that they're accessing all the resources that are available. You know, you might have a patient that's eligible for DSHS, let's find out. And our patient advocates sit down with them, help them fill out the paperwork and apply for it. If somebody's homeless, we help them fill out the paperwork to get on the housing list. Is there shelter someplace that they could move into? If a patient's trying to seek substance abuse treatment, can we get him into a program so that they can be safe and start their treatment program? For us to be successful for a clinic we have to offer that.

It's absolutely insane to be just a medical clinic, because ninety percent of our medical problems are directly affected by their psycho-social issues. So we have to. And that's the beauty of working at our clinic, is that oftentimes, you know, just helping that elder get into stable, safe housing is enough, because now they're safe. Now they have a place to live. Now they can really start addressing their healthcare issues. And I can help them with that. I have one patient that's homeless and he only comes in and gets his meds once a week. I can't give him a thirty-day supply because he loses it or it gets stolen from him. So that's one of the things that we've done. Until he can find stable housing, he comes in every Monday morning and picks up his meds. One week's worth. And then that way if they get lost or stolen, he's only lost a week's worth of meds, instead of a month's worth of medications.