“I think there’s a sort of natural, easy path to say, here are some folks who just don’t have any other options, and no one’s taking care of them, so the students should sort of fill this void and do their best to help these people,” Buchanan says. “But I don’t think that’s the approach we should take as a society. I don’t think it’s a good bargain for the patients.”
Proponents of the student-run free clinic argue that patient care and student education can coexist, perhaps even augment one another. They dismiss the argument that student-run clinics provide care that is sub-par. Studies have been published comparing patient outcomes at student-run free clinics with those at staffed, insurance-accepting facilities, many of which have revealed no significant gap in quality. Advocates see the student-run clinic as a win-win situation: individuals without regular healthcare receive much-needed attention, and medical students get the opportunity to flex their clinical muscles and gain firsthand exposure to health disparities.
But to Dr. Renee Witlen, an adult psychiatry resident at the Cambridge Health Alliance near Boston, there is no guarantee that student volunteers will leave the clinic with such lessons intact. Medical students come to the clinic motivated by a number of things, including the opportunity to see interesting pathologies, to practice their physical examination skills, or to network with older students and physicians. To Witlen, students cannot be expected to emerge from the experience fully formed and empathic to a homeless individual’s social situation just because they spent a few hours volunteering at the clinic. In fact, she worries the experience might even reinforce negative beliefs, namely that it is permissible for students to learn by practicing on the impoverished.
“I think there were plenty of people in medical school, where, while they weren't grossly dehumanizing toward the poor, they had different priorities,” Witlen says.
Williams, the Michigan clinic advisory board member, admits that he initially had reservations about student-run clinics but has now been converted into a “total cheerleader, bleachers-sitting advocate.”
“If your comparator is an ideal situation, no, I don’t think from a clinical point of view that a student-run free clinic is as good as a … ” Williams says, trailing off. “As an ideal,” he clarifies.
But Williams believes that not doing something because of the theoretical risks of a project is both ineffective and paralyzing. As long as volunteers have enough oversight to learn from their mistakes and adjust, he sees no reason why the student-run free clinic shouldn't continue to flourish. “Compared to the realistic alternative, which is nothing, the community is a ton better off,” he says. “This is a great example of not making the perfect the enemy of the good.”