Using Our Clinical Standing to Diagnose the Ills of our Communities

Dr. Hillary Tompkins, CIR National President

It’s a familiar scene. You’re in the clinic or the emergency room. You knock on the door and enter the exam room to meet a patient for the first time. Not long into the visit, you realize that whatever you can do to meet her medical needs at that moment is not going to touch the growing economic and social needs she has; needs that will likely bring them back to your clinic and emergency room again and again.

CIR means many things to many residents: negotiating salary, protecting and improving our benefits, improving everyday life in the hospital to help maximize our learning and ensuring our own personal well-being. But CIR also helps us to make sense of a dysfunctional healthcare system and empowers residents to become involved in the process of reforming our system.

What is happening right now in our hospitals, our communities and beyond to address disparities in health care is exciting. We are seeing resident physicians and community groups come together to tackle childhood asthma and obesity in places like the Bronx and New Mexico. We are seeing clergy members, activists, academic leaders and CIR members in Newark join forces to defend their public hospital against mergers or privatization that threaten vital health services to a vulnerable community. Around the country, physicians are speaking out as part of a growing public debate about inequality in this country.

This is not new to CIR. In 1970, CIR leaders in the South Bronx recognized a major disconnect between the mission of teaching hospitals and the needs of the community. They strove to empower the community around Lincoln Hospital and break down barriers to care.

Those CIR members knew then what we are finding out again today: When a doctor shows up at a community forum or event wearing a white coat, people take notice. As physicians, we must recognize that we play an important role in our communities that allows us to raise issues of inequity, both inside and outside the hospital—and when we do this, elected officials, the press and our patients listen. We can make a difference.

CIR residents often train in hospitals that serve the poorest patients, and we often see firsthand the unequal systems of health care that exist for the rich and the poor. I was fortunate to have worked at Boston Medical Center, where there is a strong tradition of providing equal care to everyone who walks through the hospital doors without regard to the ability to pay. With the economic downturn and healthcare reform in Massachusetts, this mission becomes challenging. Programs to help our populations in need, such as a food bank in the hospital, or cooking and nutrition sessions for diabetic patients are in jeopardy of being cut or no longer exist. We know the value of social programs in maintaining the health of our neediest populations. Remember, we have the ability and position in the community to lobby our local governments to make sure patients have access to parks, nutritious food and affordable preventative health care, so that our efforts to improve health are not in vain.

What are you doing to attend to the needs of your community? We want to hear about how you are taking action within your program, your hospital, or your community. Write to me at

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