Humans of EHHOP

 "While EHHOP has long treated patients struggling with substance use disorders, we started an initiative in 2018 to better understand this patient population because substance use makes it harder for our patients to manage chronic medical conditions like diabetes. We sought to learn how many patients at EHHOP have substance use disorders and how we can best provide care. To answer these questions, students from EHHOP’s primary care clinic and Mental Health Clinic began working together and screening all patients for substance use disorders. Patients who screen positive are contacted by one of our team members, and if they have problematic alcohol or drug use, are immediately referred to the Mental Health Clinic for further evaluation. To support mental health student clinicians treating patients with substance use disorders, EHHOP is offering a free day-long training in motivational interviewing in December. This therapeutic technique is widely used in addiction specialties and helps patients make long-lasting behavioral changes. Finally, we worked with the pharmacy that supplies medications free-of-charge to EHHOP patients so that they would begin carrying naltrexone, a medication shown to support patients who are recovering from alcohol use disorder. We hope that this project will help us provide high quality care to all EHHOP patients who are struggling with a substance use disorder. Our efforts have been supported by the American Psychiatric Association’s Helping Hands Grant."

"I don't think it is an exaggeration to say that EHHOP changed my life trajectory. As someone who came to medicine interested in public health and social justice I knew the importance of primary care. But working as a chronic care senior at EHHOP as a third year medical was the only experience I had as a medical student to practice true primary care and through this experience I fell in love with the practice. I had the opportunity to actually follow my patients over time, get to know them as individuals, and see incremental changes over time.

One of my chronic care patients was Mr. D. He was a 40-something year old gentleman and when he first came to EHHOP his hemoglobin A1c was 18. Once he established care at EHHOP, he came to every appointment on time (actually early) and with the addition of insulin and monthly appointments, his A1c came down to 9. He was so close to his goal! What was keeping him from a 7? I did a detailed diet history and his one vice remained "pan dulce". I am a white girl from Massachusetts so I had no idea what this was, but his description sounded like the opposite of what someone with diabetes should be eating. I suggested he cut it out from his diet, but he was reluctant. He said I would understand if I tried some pan dulce and the next week he brought me a grocery bag filled to the top with puffy pasties still warm from the oven, with crystallized sugar crusted over the top. We split one in the exam room, and I totally understood."

“I first met John when I started volunteering at EHHOP as a nutritional counselor three and a half years ago. He wanted to talk about how he could change his nutritional habits to help improve his diabetes. John told me about how he walks five to seven miles a day from his job in one of the outer boroughs since it is cheaper than taking public transit daily. Working six days a week from 6:00 a.m. to 7:00 p.m. did not leave much time for relaxation. He shared that he got home and was so tired from a long day's work and his commute that he wouldn't think about what he ate carefully, often opting to have five to six tortillas without considering the effect they would have on his health. As I worked with him consistently throughout the past three years, he has chosen to open up to me and reflects on his thoughts and feelings about how he takes care of himself. I could see that with more reflection and conversation, he began to realize that sometimes medications can't be taken at the exact same time every day, and that was okay. Sometimes he wanted to eat a bunch of tortillas, and that too was okay, as long as he strove to get back on track. John has illuminated the challenges of living with complex diseases, like diabetes, and how the trajectory to health is not always linear. John has been kind enough to entrust his care to me and has always been open, honest, and thoughtful in speaking with me. I have been incredibly honored to partner with him to improve his health. I believe that our connection is one that is unique and will endure. It is my hope that he continues advocating for himself and taking control of his health, as he has done since we first met.”

"I followed one patient over the course of three years at EHHOP, as a chronic care senior, as a teaching senior while I did a research year, and then as chief teaching senior my last year of medical school. He was a young man with very severe diabetes that continued to worsen during the three years.. He cared about his medical care, came to his appointments, and tried hard to improve his outcomes despite his worsening disease. He faced many challenging social factors. He worked long hours, had very little money, had very little support, and had poor health literacy. While I was frustrated by my inability to curb the continued advancement of his disease, I was humbled to see his effort despite such trying circumstances and frustrating results. I work in the emergency department now and often see patients who are suffering from chronic disease that our system is not set up to help. EHHOP is a place that provides excellent medical care to patients who would otherwise be completely failed by our medical system. Additionally, it provides budding physicians the opportunity to gain independence in caring for a population with complex medical needs, to learn to advocate for patients with little to fall back on, and to learn how to teach compassion and medicine to their junior colleagues."

"My time at EHHOP had an important influence on my career and where I currently practice. I take care of people living with HIV or at risk of HIV who are publicly insured or uninsured at San Francisco General Hospital. An experience that stuck with me was the Chronic Care Program, where I cared for a small panel of patients, predominantly middle-aged men who immigrated from Mexico or Central America to work in the food service industry. I remember distinctly when a patient who we had worked hard to control his diabetes was arrested by immigration enforcement. Dr. Meah and I tracked him down and found him in a detention center in New Jersey.

I remember the physician at the detention center being particularly touched that his patient's former caregivers had worked so hard to get him his medication list and history. I think of my time at EHHOP often as I care for patients struggling with the U.S. immigration system in California and I am indebted to EHHOP for how it taught me to appreciate chronic care and compassionate care.”