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Dome - Prescribing hope

January 2012

Prescribing hope

Date: January 10, 2012


East Baltimore Medical Center
At the East Baltimore Medical Center, Leonard Feldman watches as Sara Mixter examines patient Shantell Whitfield.

On a typical day, Sara Mixter may see a child with coughs and sniffles, counsel a patient who’s trying to quit smoking or help young adults in need of health insurance to cover their monthly medications. As a second-year Urban Health resident, Mixter provides primary care to inner city patients at East Baltimore Medical Center, a health clinic serving underprivileged individuals and families.

Mixter, a Harvard Medical School graduate from Maryland, says the Johns Hopkins Urban Health Residency Program stood apart from others she considered because it combines her interests in primary care and social justice. “It was serendipity,” she says of finding a place in the residency’s first graduating class.

Designed to transform training primary care physicians into leaders who can address challenges facing the urban poor, the Urban Health Residency Program aims to improve the health of disadvantaged patients and families living in East Baltimore and beyond.

Young physicians learn about substance abuse, mental illness and urban violence among other social issues often overlooked by traditional residency programs, says Lenny Feldman, director of the Urban Health Residency Program.

“It’s not just about the medicine,” says Feldman, who is both an internist and a pediatrician. “If it were, things would be pretty easy.”

As residents care for single mothers who have to choose between filling their children’s prescriptions or their own, or elderly patients who lack transportation to appointments, they learn to consider the many social determinants that impact their patients’ health.

“Around 4O percent of our adult patients read at less than a 7th grade reading level. Health literacy is hard to attain when you can’t read well. Many patients don’t make enough money to have food on the table or to afford the home air conditioning or heating bills,” Feldman explains. “Then their doctor asks, Why didn’t you get these medicines, why didn’t you come into clinic and why aren’t you prioritizing your health?”

During the four-year program, residents rotate through a health clinic for the homeless and a substance-abuse center for adolescents, learn about policy at the health department and shadow community health workers during visits to patient homes. After receiving dual certification in adult and pediatric medicine, residents can extend their education by two years and become attending physicians at Baltimore City practices that care for the urban poor. Eligibility for loan repayment and full tuition for an advanced degree program in business, education or public health make the program extension an attractive option for residents. A new Urban Health Track allows internal medicine residents at Hopkins Hospital to gain similar training.

Feldman hopes the residency program and track can help to decrease health care disparities, minimize the local shortage of inner city primary care physicians and train future leaders to advocate for an often ignored group.

—Shannon Swiger