Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Most of the homeless are invisible

Nilesh Kalyanaraman, MD
Physician
August 21, 2012
Share
Tweet
Share

Last week I went on my first outreach visit to the homeless. In preparation we stocked up on water, gloves, gauze, and medications, put on our sneakers and headed out to the streets. We exited the front of the building, turned right and walked three blocks until we reached the corner with the highway on-ramp. We started crossing the street and about halfway, just past the service road and before the on-ramp, we stopped and turned right into a narrow triangle of grass over- grown with trees. We followed a lightly-worn path through the trees and came out into a small clearing with tents and makeshift cardboard lean-tos. We called out to see if anyone was around but nobody was home. We would have to come back again some other time.

The most recent census, done in 2011, shows that approximately 636,000 people experience homelessness on any given night. It’s estimated that approximately 3.5 million people, 1% of the population, experience homelessness at some point each year.

The chronically homeless are the ones who we traditionally think of as homeless. They’re the ones who are disheveled, who occupy storefronts at night, who carry all their belongings with them. And they’re the ones with higher rates of asthma, heart disease, mental health disorders and death. Yet they comprise only about 18% of the homeless population.

Most of the homeless are invisible: they dress the same as you or I do, they shop in the same supermarkets and they are either working or looking for a job. In fact, looking out over the waiting room of the homeless clinic where I work, I am struck by how utterly unremarkable the scene is, as if it was just any old doctor’s office.

Regardless of whether someone is briefly or chronically homeless, their needs are complex. As part of their health care we work on getting them housing, nutritional assistance (food stamps), and mental health services as needed. It does no good to talk about eating right and taking your medications if you don’t also care about where they’re going to sleep tonight. I may not be able to fix their homelessness today, but working towards the solution builds trust and acknowledges that their needs go beyond just health.

Complicating this effort is the fact that about 70% of the homeless don’t have health insurance despite the fact that they live in poverty. Thankfully, in 2014 when Medicaid expands its eligibility to everyone making less than 138% of the federal poverty level access to health care will greatly increase. They will be able to get the care that most of us take for granted which will in turn make it easier for them to stay employed and break out of the cycle of homelessness.

As for the folks in the clearing who were out during the day, some of them were at work, some of them were trying to get a meal, and others were just not in. We’ll have to go there again in a few days to see if they have any needs we can help them with. In the meantime, I now look around while I’m walking, alert to the world that I always looked past, alert to the invisible.

Nilesh Kalyanaraman is a physician who blogs at Progress Notes.

Prev

The impact in primary care isn't always immediate

August 21, 2012 Kevin 3
…
Next

Doctors: Become a key opinion leader using social media

August 21, 2012 Kevin 5
…

Tagged as: Primary Care

Post navigation

< Previous Post
The impact in primary care isn't always immediate
Next Post >
Doctors: Become a key opinion leader using social media

ADVERTISEMENT

More by Nilesh Kalyanaraman, MD

  • Why the American Health Care Act takes us in the wrong direction

    Nilesh Kalyanaraman, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Isn’t caring for your child worth as much as caring for your parents?

    Nilesh Kalyanaraman, MD
  • a desk with keyboard and ipad with the kevinmd logo

    The USPSTF should stay independent from politics

    Nilesh Kalyanaraman, MD

More in Physician

  • How New Mexico became a malpractice lawsuit hotspot

    Patrick Hudson, MD
  • Why compassion—not credentials—defines great doctors

    Dr. Saad S. Alshohaib
  • Why Canada is losing its skilled immigrant doctors

    Olumuyiwa Bamgbade, MD
  • Why doctors are reclaiming control from burnout culture

    Maureen Gibbons, MD
  • Why screening for diseases you might have can backfire

    Andy Lazris, MD and Alan Roth, DO
  • Why “do no harm” might be harming modern medicine

    Sabooh S. Mubbashar, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • How fragmented records and poor tracking degrade patient outcomes

      Michael R. McGuire | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How I learned to stop worrying and love AI

      Rajeev Dutta | Education
    • Understanding depression beyond biology: the power of therapy and meaning

      Maire Daugharty, MD | Conditions
    • Why compassion—not credentials—defines great doctors

      Dr. Saad S. Alshohaib | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • How fragmented records and poor tracking degrade patient outcomes

      Michael R. McGuire | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How I learned to stop worrying and love AI

      Rajeev Dutta | Education
    • Understanding depression beyond biology: the power of therapy and meaning

      Maire Daugharty, MD | Conditions
    • Why compassion—not credentials—defines great doctors

      Dr. Saad S. Alshohaib | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Most of the homeless are invisible
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...