Turning Good Intentions into Good Outcomes: Ethical Dilemmas at a Student-Run Clinic and a Rubric for Reflective Action

Blog by Nicholas Peoples, Thomas Gebert and Dana L Clark

Student-run clinics represent a unique medical education and healthcare delivery model powered largely by good intentions. These good intentions may produce questionable results, however, when juxtaposed with intense academic pressure for students to fill their curriculum vitae with personal achievements, leadership roles, and peer-reviewed publications. It becomes a legitimate ethical question, then, whether student-run clinics consistently and materially enrich the care of underserved communities, or merely inspire a litany of rushed, short-term and low-quality projects that sidestep patient welfare or even cause brazen harm.

As co-directors of HOMES Clinic, a student-managed clinic which offers free health and social services to people experiencing housing insecurity, we routinely encounter such well-intentioned but ethically questionable proposals. In this essay, we present four short case studies that dissect some of these common yet suspect assumptions underpinning student-run clinics. We then conclude with a rubric for reflective, calibrated action.

To be sure, SRCs can be a powerful mechanism to promote health equity. At the heart of this work, we simply ask students to think critically about what constitutes ‘benefit’ and what constitutes ‘harm’, recognising that activities which are conventionally assumed to offer benefit may not, in fact, always do so. Such directed reflection is the path towards serving our patients with both the necessary initiative to effect meaningful change and the requisite humility to first do no harm.

 

Read the full article on the Medical Humanities journal website.

 

Portrait of Nicholas PeoplesNicholas Peoples is a 4th year M.D. student at Baylor College of Medicine in Houston, TX and a Schwarzman Scholar at Tsinghua University in Beijing, China. He is the former Co-Executive Director of HOMES Clinic in Houston, TX. 

 

 

 

 

 

Portrait of J Thomas GebertThomas Gebert is an MD/PhD student at the Baylor College of Medicine in Houston, TX. He is the former Co-Executive Director of HOMES Clinic in Houston, TX. 

 

 

 

 

 

Portrait of Dana L ClarkDana L Clark, MD is an Assistant Professor of Family Medicine and Community Health at Baylor College of Medicine and the Medical Director of both HOMES Clinic and Reed Family Clinic, both operated by Healthcare for the Homeless-Houston.

 

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