Vignette

A fourth year medical student working in a homeless shelter clinic observes the difficulty that some of the patients have in accessing physicians at his medical school. Each of the patients has chronic and disabling medical problems, has Medicaid insurance, and has been referred by their primary doctor at the clinic to a subspecialist at the medical center. The patients have included a man with refractory seizures (referred to a neurologist), a woman with sickle cell anemia and severe avascular necrosis who needs a hip replacement (referred to an orthopedic surgeon), and a woman with poorly controlled type I diabetes and recurrent diabetic ketoacidosis (referred to an endocrinologist). In each case, thepatient had been informed that they could not be evaluated by the subspecialistbecause the practice did not accept Medicaid insurance.

Commentaries

• A Medical Student Perspective
• A Faculty Perspective