February 2007
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Specialty medical care for all
Weiner winner David Urion devotes himself to community health
During the past few decades, there has been a growing awareness of the need to bring primary care to the communities, especially to people living in medically underserved areas. But the delivery of specialty medical care in those areas hasn't increased at the same rate. So David Urion, MD, a Children's Hospital Boston neurologist, took matters into his own hands. Fifteen years ago, he started bringing his neurologic expertise to inner city youth by seeing patients at the South End Community Health Center (SECHC) every week.
It's work that's led him to be named the winner of the David S. Weiner Award, which annually recognizes an outstanding individual at Children's who helps to improve the health of children through advocacy, developing programs, partnering with the community and/or conducting health services research.
Urion currently serves as the director of the Behavioral Neurology program, which includes the multidisciplinary Learning Disabilities program, that sees more than 1,600 outpatients a year. But it's his work at the SECHC that's closest to his heart. The center has been run by an independent community board since its inception in the 1960s, providing pediatric and adult medical care to an underserved, mostly Latino population. It's a population—and a community—that Urion is passionate about. "I know my patients there better than any other subset of patients," he says. "I've seen them in their community for 15 years now, so I know who's having marital troubles, who got kicked out of their house, who's living in their car—and who's never going to show up for their appointment. That closeness allows you to practice medicine at the level of a small town doctor, and that's invaluable in terms of the kind of care you can deliver."
Urion's involvement with the community health center came about from a paper that he has yet to write. The topic he'd hoped to address, a decade and a half ago, was, 'Why do some people who live 15 minutes from Children's have a harder time reliably making their appointments than people who live 30 miles away?' "To find out, I interviewed health center directors," he says. "I met Gerry Hass, the director of SECHC, who looked at me with his terrific little grin and said, 'If the patients don't come to the doctor, then why not have the doctor come to the patients?'" Urion agreed that neurology was a portable specialty, and joined the clinic on Washington Street to screen and treat children for neurological disorders.
His first few weeks there, Urion worked with a Spanish-speaking interpreter to communicate with his patients. But he decided to learn Spanish in order to fully connect with his patients. "It's not elegant, but I can get by," he says. (In fact, his command of the language is good enough for him to travel to South America and present lectures in Spanish.) And to further his commitment to his patients, Urion is currently tackling Haitian Creole. Having won the grant that goes with the Weiner Award, he will be able to test how a community-based specialty consultation like his can impact a child's health care. "One thing we know from the analysis we've done is that a good way to make sure people get to their appointments with sub-specialists is by bringing the sub-specialist to the community," Urion says. "The next question is, 'Does that actually improve the child's health outcome?'"
"My suspicion," he continues, "is that the keeping of appointments has the downstream effect of those patients making fewer trips to the emergency room for problems that come with not taking medicine reliably and not sticking with a complicated treatment regimen."
Urion will analyze data he's gathered at the center to test his hypothesis. If his theories are proven, there could be significant implications for Children's big-picture model of care when it comes to helping a population to which the hospital is already devoted. "We see more children on public assistance than any other facility in the Commonwealth," he says. "Everyone is interested in how to best serve them."
In addition to delving into these questions, Urion plans to continue to bring medical students to the center to see how the program works, in hopes that the experience will teach young physicians about the importance of providing specialty care in communities. He also hopes to impart how fulfilling community-level work can be. "It's the one place where I'm guaranteed to finish the day feeling like the doctor I wanted to be when I graduated from medical school," he says.
A celebration event in Urion's honor will take place on Thursday, Feb. 22, from 2:30 to 3:30 p.m. in the Patient Entertainment Center. All are welcome to attend.
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