I started volunteering on Saturday mornings out of a feeling of restlessness. Having been in primary care for several years, I was looking for something new, to break from routine, and to feel like I was doing real good. Which is how I ended up at our medical student-run free clinic, and have been blessed with an opportunity that has grown into a primary passion of mine. We see mostly Spanish-speaking patients, many undocumented, who come with a variety of both medical and social challenges. Many of us may take these for granted: having a refrigerator to store insulin, or to walk on the street and come to our clinic without fear of being accosted just for existing. Our system was not designed around these patients, and does not serve them well. But with this enthusiastic and devoted group of medical students, we do something life-changing: both for our patients, and, at least for me, for my clinical experience in ways I can only find here.

Most of our medical students speak Spanish fluently, one of their multitude of skills. My own Spanish is passable but imperfect. I make my best attempt (under the guidance of a fluent translator), and my patients will correct me, kindly, and teach me how better to say things. And it is here, in the walls of our free clinic, that I feel the most connected to my patients and am most reminded of how important it is to build that connection. My patients show me that the effort and the willingness to meet them in their own language, even imperfectly, makes a meaningful difference to the atmosphere of the room. They have spent so many years navigating a system that disconnects them from their physician, and from medicine, both in its underlying design and even in the language used to communicate, that it is very different when a physician speaks directly to them. Even if imperfect, the attempt shows something that the words can’t always express. “Gracias, doctor.” I hear this quite frequently at the free clinic. And even though I am sure we all hear this regularly in our regular practices, I can’t help but feel different when I hear it here. Reflecting on what might be different here compared to elsewhere, I come to the conclusion that it is not the medicine itself, as there is nothing especially brilliant in the plans I formulate with the medical students, but rather it is the personal connection. Eye contact, speaking directly to patients, and making them feel seen in a system and a country that makes them feel invisible.

These visits remind me of how important presence is in good medical care, and how conversations we have when our patients feel genuinely seen, holding space where our patients feel safe to share, create the connections that make medicine meaningful, and also help us find more ways to help our patients. We learn about the diet that might be driving a rising A1c, or the small but consequential error in insulin administration that could be doing the same. We hear about symptoms patients might otherwise keep to themselves, for fear of being dismissed or misunderstood. We discover that the visit made ostensibly for one complaint can sometimes really be about an entirely different one, so long as we stay long enough to ask. One Saturday, a medical student asked me: “Why can’t we do this kind of care all the time?” My teaching point that day became the limitations of our system. But I was glad she asked, because it meant she understood something important. I hope she carries that question with her into every patient interaction, and into every conversation she has about how care should be delivered. I understand why our formal system is invested in efficiency, and that the pressures on primary care are real. The Saturday clinic reminds me to hope for more, and to try to make meaningful change to push for more. Unhurried, relationship-centered care is increasingly treated as a relic of a time gone by, and a luxury afforded to those who can pay for it, but one that the system cannot afford. And yet, if we honestly weigh the intangible benefits that come from spending real time with patients and fostering genuine connection, we may find relationship-centered care to be the real value-based care.

The people I see on Saturdays remind me why I chose medicine. Our encounters are stripped of the extraneous: no RVU targets, no care gap metrics, no documentation obligations that pull me away from the person in front of me. What remains is clarifying: caring for the patient before us, and fostering the therapeutic relationship between us, in service of their health and well-being. I did not start at the clinic expecting to learn something new about medicine. I thought I was going there to give of myself and my time. As it turns out, I have had the privilege of both giving and receiving. My patients thank me in Spanish, even when my grammar is wrong. I thank them too, for the reminder that this work, practiced the way it deserves to be practiced, is still worth doing.

John Wei is an internal medicine physician.