“Excuse me, sir! You cannot just walk out in the middle of your appointment with the medical student!” Our clinic superhero and patient care coordinator, Parisa, hurries after one of our older patients, hands thrown to the sky in emphasis. He slows his steps through the parking lot but does not stop.
“He wanted me to remove my shoes.” The man practically spat on the pavement in his discomfort.
A pause. “My good sir, you came to the clinic for foot pain!”
“On my other foot! Not this one.”
“Oh, sweet man, he needs to compare your painful foot to the other foot…” She gently but firmly walks him through the reasons that a student might have for asking the patient to undergo the unpleasant task of shoe removal in the medical office. She combats his discomfort and sharp words with the grace of a skilled acrobat, calming his nerves in his native tongue. By the end of the interaction, she has convinced him to both re-enter the exam room and apologize to the harried medical student he left behind.
Miracle workers. Parisa spends her day juggling phone calls from worried patients and transportation, slipping in and out of patient appointments to ask sensitive questions, googling resources for new furniture (and bed bug removal), all while finding time to cheer up the many babies and younger kiddos who find themselves at our clinic. Her role is critical to our community’s health.
You see, any person who has ever been to the doctor knows that a visit is not just the 15-minute appointment. This is especially true for anyone who is new to the country, is without transportation, is more comfortable with a different language, or someone who has complex medical problems. Our population of refugees tends to fall into all 4 categories, which makes Parisa’s job even more important. Even for the patients who were physicians in another country, the intricacies of insurance and the number of specialists to visit can make the American healthcare system daunting—nearly impossible for even the locals to navigate.
Patient Care Coordination is a very new idea. The career began in the 1990s with a surgeon named Harold P. Freeman in Harlem, New York. The goal was to reduce disparities in cancer care to help more patients receive diagnosis and treatment. This idea caught on quickly, as the patient coordinators helped to reduce hospital readmissions and improved overall continuity of care. In 2010, the Affordable Care Act introduced Accountable Care Organizations and Patient-Centered Medical Homes with similar goals, rewarding healthcare institutes for improved outcomes and efficiency, while penalizing for readmissions and hospital-acquired infections. These financial motivations are cited as the primary reason for the recent increase in patient coordinators across the United States.
Prior to this new era, communication with patients was an ill-defined responsibility. Nurses, social workers, medical assistants, front office staff, and physicians were each given specific information to share with the patient, who was seen as the responsible party to navigate their own care. The burden of understanding was largely placed on the patient, with dire consequences if there was a small gap in communication somewhere along the line. A study presented in Annals of Internal Medicine from 2007, prior to the Affordable Care Act, reported that 24% of outpatient test results were not followed up appropriately, which led to delayed diagnoses or missed treatment options. Thankfully, patient care coordinators can add clarity to an otherwise extremely confusing healthcare system (for patients and providers alike).
Let me re-introduce you to Parisa, one of my favorite colleagues at Wesley Refugee Clinic. Her day begins with an extensive to-do list, including a myriad of tasks that seem to be outside of her contract. She will go with patients to their appointments with medical specialists and therapists, attend meetings at schools for Individualized Education Programs (IEPs) and other accommodations, help figure out the documents required for food stamps and insurance, navigate between simultaneous hold lines for physicians/insurance companies/drivers, and spend countless hours explaining and simplifying medication management for patients with confusing treatment plans. Her passion for the job far exceeds the 9-5 hours that she is contracted for, and she is uniquely qualified for this position, due to extensive experience with the needs of a refugee from personal experience.
Her position did not exist a few years ago. Back in 2020, our physicians handled patient communication, spending long hours doing documentation and organization for our 250+ patients, along with their main, contracted responsibilities. Many patients missed their appointments because of confusion over transportation and schedules. A recent look into our own patient management system shows that there are fewer no-show patients than there were prior to hiring Parisa. This position (and Parisa’s passion for the population that we serve) has dramatically changed our impact on the community and the internal efficiency of our clinic.
As a medical student, it has been an honor to work with Parisa and see the dramatic difference that she makes in the lives of the physicians, patients, and students she works with. The data shows that her job is incredibly important for the health of our patients, but I would also argue that her job improves the quality of life for physicians, giving them back the most precious resource—time. She is not just helpful, she is essential. As medicine becomes increasingly specialized and complex, it is so easy to forget that the thread that holds it all together is not always a stethoscope– sometimes, it’s a cell phone and a spreadsheet, wielded by someone like Parisa. As we move up in our training, let us never forget to appreciate the ones who walk patients back into the room, translate frustration into understanding, and make the clinic run in ways we barely notice.
Hannie Lynch
Born, watered, and grown in Phoenix, Arizona, Hannie has spent her entire life trying to be anywhere else, photographing weddings all over the US & abroad to avoid the heat. Returning to this city for medical school after undergrad in Tucson at UArizona (Bear Down, Go Cats) was a difficult and beautiful decision that has culminated in a deep fondness for the populations that this city serves: the unhoused, the underprivileged, the migrant, and the refugee. As such, she spends a lot of time working with Street Medicine and other free clinics on 7th Avenue, and will probably be pursuing a career as an ED doc so that she never has to sit still again.