Figure 2. Dr. King visits a patient who has taken shelter in a tunnel. Taken by Alex Gittinger of The People Concern.
Medicine has always been a classical mix of art + science. Nowhere has this been more present than in homeless health care and Street Medicine. Here, the science is fundamental medical knowledge and skills with an added focus to address the specific needs of our homeless neighbors. Addiction and mental illness often exacerbate their complex living conditions. As always in medicine though, this science must be delivered to real human beings with emotions and sensitivities. This is the art of Street Medicine. Within this artform, the brushes and chisels are the tools of social medicine which include motivational interviewing, a harm reduction approach, assertive engagement, a practice of trauma-informed care, and linkage to housing.
Street Medicine and the home visit are not new. Physicians from the beginning have been leaving their offices to see patients where they are, and thus removing the barriers that stand in the way of sick people trying to get appropriate care. This is the fundamental prerequisite requirement to actually calling it “Street Medicine.”
The modern iteration of Street Medicine has its innovators and leaders still active in defining the field. Jim Withers in Pittsburgh, is our Johnny Appleseed and creator of Street Medicine Institute, Jim O’Connell in Boston defined long-term engagement by once spending several years with a patient without taking vital signs. At Venice Family Clinic, our late saint Terri Brehove taught us the value of always attempting to see everything through the patient’s eyes and perspective.
As the street homelessness crisis worsens, we are tasked with the need to go out beyond four walls and provide health care to unsheltered people more and more every day. Those of us who have created and learned our own definition of Street Medicine have the task of teaching it to the next generation who are now going out to provide this service. Our task is not just to teach them what we know, but to teach everything we know so they can do it better than us, and to pass it on to inspire the next generation of Street Medicine champions. Thus, this is our humbleinitial attempt to develop Venice Family Clinic Street Medicine guidelines and curriculum.
—Coley King, D.O
Director of Homeless Health Care Services