Home for a Clinic with Heart
Date: June 7, 2010
It takes the generosity of Suburban's caregiver volunteers to serve hundreds of uninsured patients.
It’s 6:30 p.m. and Karen Carlson yearns for home. As she prepares to leave, one more patient straggles into the clinic, a middle-aged man who totes his medical records in a shopping bag.
After a long day’s work as a nursing director in Suburban Hospital’s radiology department, she has spent the last three hours helping uninsured patients with cardiovascular symptoms at the MobileMed/NIH Heart Clinic in the hospital’s cardiology suite.
It’s been a busy evening. Patients included a man with atrial fibrillation who was sent to NIH for a transesophageal echocardiogram, an older woman also struggling with an abnormal heart rhythm and two young adults who both complained of chest pains.
Carlson and NIH nurse Cyndy Brennan, another volunteer, lead the last-minute patient into an examination room to check his vital signs and review a medical history that includes three heart attacks, two stent procedures, a disjoined list of medications and a smoking habit. NIH cardiologist Richard Cannon, a frequent clinic volunteer, examines the patient and writes an order for a cardiac MRI and a follow-up appointment.
“This is a totally different branch of nursing,” says Carlson, who has been at Suburban since 1994. “These patients are uninsured and some don’t really know how sick they are until they get here and are evaluated.”
For nearly three years, Carlson, 49, has donated her expertise to the Thursday evening heart clinic, as has a team of nurses, administrators, technicians and physicians who share her commitment to accessible specialty care.
A collaboration of Montgomery County’s Mobile Medical Service, the National Heart, Lung and Blood Institute and Suburban, the clinic relies almost entirely on volunteers to provide diagnostic exams and treatment for patients who are uninsured, homeless, unemployed or among the working poor. All are referred by primary care providers at MobileMed or other health care groups that comprise the county’s safety net.
During the current fiscal year, patients have made more than 500 visits to the heart clinic. In the same time period, the cost to Suburban for pro bono surgical procedures has surpassed $200,000.
Carlson has been a cardiac clinic mainstay since its inception, helping to determine criteria for referrals and to plan the complex cycle of care that gives patients one-stop access to examinations, tests, medications and follow-up care.
Working at the clinic has opened Carlson’s eyes to the health care barriers encountered by Montgomery County’s 100,000 uninsured residents. The economic downturn has also brought a growing number of patients who recently lost their jobs and insurance. “It’s as important for these people to get access to health care as it is for everyone else,” Carlson says.
Her convictions extend to the entire Suburban community. “Health care is a right,” says Monique Sanfuentes, director of community outreach for the hospital. “Perhaps a newcomer to the country ends up with open heart surgery, something that may cost the hospital $60,000. We’re sending a message that there is a way to receive care and that there is a way for those without insurance to have a medical home and to be cared for without going straight to the emergency department, which can be even more costly to all concerned.”
Frequently arriving by public transportation, the patients willingly wait as long as three or four hours for their consultation with one of 12 cardiologists in the volunteer rotation. When patients occasionally come in with dangerously elevated blood pressure or showing signs of stress, they are whisked to the emergency department, and in some cases, straight to surgery.
For cardio nurse Mandy Murphy, volunteering in the clinic has made her aware of “things I never would have thought of,” such as the isolation experienced by immigrants who don’t speak English, and the need to adjust to cultures where modesty prohibits women patients from disrobing in front of men. Each week brings her new insight into “the difficulties faced by the immigration population in this area, of not being able to communicate or being able to get into a system of health care,” she says.
As time-consuming as it has been, Carlson prizes her work at the clinic. “Your insured patients tell you every day how wonderful you are,” she says. “But volunteering has taught me how appreciative these uninsured patients are and that there is such a great need in the community for care.”