When I think of the emergency department, I think of patients in crisis from a heart attack, traumatic injury, overdose or other medical emergencies. However, physicians are now recognizing that the underlying drivers of these health crises are social, economic, political and structural inequalities that physicians can't solve alone.
In order to help reduce health inequity, Jennifer Newberry, MD, JD, a clinical assistant professor in emergency medicine at Stanford, started Stanford Health Advocacy and Research in the Emergency Department, or SHARED. SHARED provides an opportunity for Stanford undergraduates to screen patients and connect them to local resources and programs.
SHARED consists of two programs. It started in 2012 with the Stanford Alcohol Screening and Brief Intervention program, which aims to identify and reduce high-risk alcohol use. Stanford undergraduate volunteers administer electronic screening questionnaires and provide patients with information on alcohol safety, and then high-risk patients are able to meet briefly with a social worker.
SHARED then expanded to develop a Help Desk, which screens emergency department patients for social and legal needs -- such as problems with health insurance, food insecurity, homelessness and employment. The undergraduate team identifies patients' unmet needs, eligibility of support and the appropriate community resources during the ER visit. They also follow up by calling the patients every two weeks to provide further assistance.
"So many patients and families carry the stress and anxiety of food insecurity, impending evictions, or even potential deportations, without anyone to hear their story. Our students listen and provide compassionate support amidst the chaos of an emergency department," Newberry said.
Volunteer Josh Bloomstein said he joined SHARED in 2016 to make a difference in the lives of underserved patients.
Bloomstein's Spanish skills have come in handy at the Help Desk during his two-hour shifts twice per week. For instance, he told me about his experience with an uninsured Spanish-speaking patient:
The patient was concerned that I was working with the billing department and was also hesitant to answer questions about immigration. I assured her that the purpose of the Help Desk is to assist patients with social needs and that all topics remain confidential. Together we found a primary care physician and a dentist who offered discounted services near her home. She was also grateful for the information we provided her on Covered California insurance, JobTrain skills training classes and the immigration advocacy organization Libre.
Newberry and Bloomstein emphasized that many patients are very grateful for the help and are happy to spend time speaking with the volunteers.
SHARED is an example of the larger movement of social emergency medicine, Newberry said:
Our emergency departments will continue to be overwhelmed as safety net health care and social services are cut. It is our privilege to see anyone, regardless of ability to pay, citizenship, or belief, at any time of day. We must recognize this as an opportunity to fulfill our responsibility to truly attend to the health of our patients, by addressing the social determinants of health through programs like the Help Desk.
Previously: Improvements planned for new Stanford emergency department and Dean Lloyd Minor calls attention to environmental factors shaping health
Photo by Sloane Maples of SHARED volunteers Nathan Pan-Doh, Josh Bloomstein and Kyle Lin