Free medical clinics: helping indigent patients and dealing with emerging health care needs

An innovative movement of free medical clinics, which began in the 1960s, has helped indigent people without access to traditional health care. In this article, the author relates his experiences at three free clinics. Aside from the delivery of good care to deserving people, these clinics also had an impact on other relevant issues in medicine: The first of these clinics became involved with a chronic illness that affected medical research, the second provided another venue for medical teaching, and the third increased volunteerism, especially among senior clinicians. These secondary features are the focus of this article. The first clinic, created in a time of troubling social change, cared for many young people with infections, probably including some who were part of an evolving epidemic that was only later recognized as HIV/AIDS. The second clinic began when the traditional hospital and outpatient clinic settings for teaching medical students-both in their preclinical years and during clerkship rotations-were not conducive to learning the skills of interviewing and physical examination of cooperative patients. The more informal, less frenetic pace of a free clinic appealed to students and some residents as a place to build clinical skills. The new Liaison Committee on Medical Education standard to provide student service learning may formalize the use of free clinics in medical schools. The third clinic, like any of the 1,200 or more free clinics in the United States, cares for indigent people who have no access to established health care. The free clinic movement, which can provide some of the needed care, relies on volunteer physicians, many of whom are older and retired clinicians, who find that their contribution to free clinic care can be both useful to the patients and most rewarding to themselves.