Health Care and Hope

Marquette physician assistants learn the intangibles of health care, including empathy and kindness, at the Repairers of the Breach clinic in Milwaukee.

By Allison Dikanovic

A man walked into the Repairers of the Breach community clinic on a Tuesday afternoon complaining that his feet were extremely sore. According to Pastor James West, executive director, it’s not uncommon for people to stop into the daytime shelter and resource center on West Vliet Street after walking for miles. Most of the people who frequent the center are experiencing homelessness.

Melissa Gorman, a student in the Physician Assistant Studies program, also walked to the clinic that day, but for a different reason. She was there to provide medical care under the supervision of her professor and a retired physician as part of a partnership between Marquette and Repairers. The community-based clinical experience has become a tenet of Marquette’s PA education, and the clinic has gained a reputation in the community as a place where anyone can receive dignified, individual care.

Gorman recalled welcoming the man in, eager to practice the skills she was learning in school in an attempt to offer reprieve and care for his bleeding feet.

However, despite her best intentions, Gorman’s plan for how the exam would go came to a screeching halt when the man refused to take his shoes off.

“He definitely had anxiety around doctors and medical providers,” she says. “He was very apprehensive.”

Josh Knox, Grad ’11, a clinical associate professor who forged this program partnership in 2011, said that a lot of people who visit the clinic haven’t had many positive experiences with medical professionals in the past and that seeing a provider can be traumatizing to some people. He said this is something he wants his students to learn to be conscious of when they provide care to people from a variety of circumstances.

When Gorman asked the man again to take off his shoes, she said she could tell he was getting agitated. She realized she would need to take a different approach.

“We took a step back,” she says of herself and the fellow student she was paired with. The students paused and then started a more casual conversation with the man, asking about what brought him in, how his day had been going and what his living situation was, all in an effort to make him feel more comfortable.

“You could see some of his anger and fear fade away,” Gorman says. “He looked at us and stopped us mid-sentence and says, ‘You know, I think I’m ready to take my shoes off. You can go ahead and look at my feet.’”

Gorman proceeded with her exam and got the man shoe inserts, which is a practical need that Knox said is just as important to providing care as doing a blood pressure check or refilling medication.

After learning more about the man’s medical history — including that his vision was impaired — she also discovered something unexpected.

“We found out he was diabetic,” she says, which would explain his sore feet and blurring vision. “It felt really good to problem solve and get down to the root cause, which had gone untreated for a long time.”

Gorman said she learned an invaluable lesson that day: If they didn’t create the space for this man to feel comfortable enough to share the things that were bothering him, and if they didn’t listen deeply to his individual experiences, they would have mistaken his diagnosis.

This ability to make people feel safe, seen and heard is a goal of Marquette’s PA program, according to Knox, because it is directly connected to the Jesuit idea of cura personalis or “care for the whole person.” Building these soft skills is the intention of the community clinic partnership.

“We want to develop an attitude, disposition and belief in our students that everybody deserves healthcare, empathy and, dare I say, kindness,” Knox says.

“Critical to the foundation of public health is the idea that one size does not fit all. Context matters.”

Pastor West says that he has observed the way the PA students value their relationships with the patients at Repairers, taking the time to answer their questions.

“When we have students who come in and show concern, it is a source of hope for the patients,” he says. “It also helps the members, because you can’t be all you can be when you have a disease and don’t even understand your health problems.”

Health education and referring patients to different resources in the community are integral parts of the visits.

Learning more about the challenges that people in the Milwaukee community experience when trying to access health care or make healthier decisions, especially those who are affected by poverty or homelessness or are lacking legal documentation or insurance, equips the students to provide better care for anyone, Knox explains.

Each PA student visits Repairers of the Breach once a quarter, starting in the spring of their first year in the program, and develops a bond over time while improving their skills. “If you want to do this work, you have to establish trust,” Knox says. “By building a history, students build a relationship with the organization and also see themselves getting better in real time.”