The homeless visit: enhancing residents' understanding of patients who are homeless.

BACKGROUND: With their interest in providing continuous, comprehensive care, family physicians are well-suited to treat persons who are homeless. Yet family practice residents most frequently encounter homeless patients in crowded public hospitals where time constraints and competing philosophies of patient care create suboptimal conditions and encourage the development of cynical attitudes and behavior patterns. EDUCATIONAL INTERVENTION: To address these problems, the Department of Family Medicine at Baylor College of Medicine in Houston developed a homeless visit program in which second-year residents spent one half day at a day center for the homeless. Residents interview the center's homeless clients, address their medical and psychosocial problems, and review each client's case with a faculty physician. Residents have the opportunity to explore the underlying causes of homelessness, the impact of homelessness on clients' health and well-being, and the bureaucratic barriers that homeless individuals must overcome to regain entry into the health care system. PROGRAM EVALUATION: After the first year, the program was evaluated to assess whether its original objectives had been met. Each of the second-year residents reported that the experience had been worthwhile. They recommended that the program expand the number of half days spent with homeless patients and the ancillary personnel, equipment, and supplies available. Each of these changes has been implemented and the program continues to thrive and improve.
CONCLUSION: The homeless visit serves as a successful model for resident programs willing to devote as little as a half day in a 3-year curriculum toward training residents to better understand the intricate relationship between homelessness, physical and emotional needs, and an environment that simultaneously promotes illness and hinders medical attention.