Symptoms of Poverty

A patient I'll call Linda Soto comes to my clinic every three months to discuss her diabetes, high blood pressure and depression.

Over the past two years, I've gotten to know Ms. Soto well. I know she has a bachelor's in business, she loves to dance and is active in her church. She is open and talkative, so time flies during our visits.

Today her blood pressure is higher than usual and I ask if everything is okay. She says she's anxious because she came straight from the unemployment office. Three years ago Ms. Soto was laid off from her job as an administrative assistant. Eventually high rents forced her out of her suburban house and into a studio apartment in a new neighborhood. She became socially isolated and depressed.

Finally last Christmas, she was hired as a seasonal employee at a local big box store. It was obvious she felt overqualified. "Well it's retail," she'd say. "But you gotta start somewhere, right?" She was determined to get hired full-time after the holidays.

Instead the store hired her as an "on-call" worker, meaning she works unpredictable  hours at unpredictable times. Often her shifts fall on Sundays when she'd like to go to church. Some weeks she actually earns less than she would if she was collecting unemployment.

With her erratic schedule and meager budget, she started dropping by a local soup kitchen for dinner. The food is often high in salt and carbohydrates, which she knows she should avoid, but it's better than going hungry.

As doctors, we spend years learning the biology of disease and how to treat it. But what we never learn is how to treat the environment. As a resident, I've been trained in techniques like motivational interviewing to help patients change unhealthy habits. But the problem with patients like Ms. Soto is not a lack of motivation, it's an environment that sets them up to fail.

Perhaps it's time to incorporate these environmental ailments into our medical school curricula. And perhaps it's time for all of us to treat the many symptoms of poverty not as personal failings but as consequences of public policies for which we are responsible. And perhaps we start by getting on the radio and telling the story of just one of many hard-working patients.

As Ms. Soto would say, you gotta start somewhere.

With a Perspective, I'm Sonia Singh.

Sonia Singh is a resident in internal medicine at Stanford Hospital preparing for a career in primary care.