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“I’m not going to order a chest X-Ray based on his social situation”

“I’m not going to order a chest X-Ray based on his social situation”

“I’m not going to order a chest X-Ray based on his social situation”

Wednesday, May 17, 2017

Susan Rutherford is a medical student who set up a homeless shelter in Leamington Spa. She explains why homeless healthcare is an issue close to her heart:

Earlier this year a guest at the night shelter told me he was suffering from night sweats, a fever, weight loss and a productive cough. Tom* had previously been hospitalised with TB, an infectious and potentially fatal disease that can be spread by coughing, and Tom’s symptoms were in keeping with this diagnosis. I did not want to risk the health of the other guests at the shelter, so in both Tom’s best interests and those of the others sharing a room with him I took him to A&E. Following a consultation with the A&E registrar, Tom was given inhalers for his asthma and told to see his GP. He did not undergo any investigations and was left to return to the night shelter. This seemed completely unsatisfactory to me and I asked to speak to the registrar myself. He told me that Tom’s problems were his asthma and “probably a lack of self-care”, and that there was no need for a chest x-ray or blood tests. I flagged up his significantly concerning symptoms, his previous TB history, the difficulties he faces in getting a GP appointment and the fact that his homelessness itself puts him in a high risk category for having TB. The response I received was stark - “I am not going to order a chest x-ray based on his social situation”.


In 2014, Homeless Link produced data showing that 41% of the homeless population suffered from a long-term physical health condition and 45% from a mental health problem, compared with 28% and 25%, respectively, in the general population. Perhaps this is due to the unhealthy living conditions faced by homeless people, or it may be a reflection of a deeper inequality in the standard of healthcare provision, or a combination of both. What is clear however, is that there is much work to be done.


I have just spent a 6-week elective period in London with the Pathway Homeless Team at University College London Hospital. I wanted to explore how the country’s capital treats its homeless patients, and how it differed to my experiences in the West Midlands. The biggest thing that stood out to me during my time in London was the way in which patients’ medical treatment was considered in the wider context of their social situation. Health needs can rarely be met satisfactorily without a place to call home. A patient may receive excellent medical care while in hospital, but this can all be undone overnight if a suitable discharge plan is not in place. This could happen if a patient with open leg ulcers returns to the streets where they cannot keep their wounds and dressings clean, or someone who has successfully detoxed while in hospital and wants to stay off drugs is discharged with nowhere to go but the squat they have been living in with other drug users. It is clearer to me now than ever before that health and homelessness cannot be separated if either is to be resolved.


In the future, it is my ambition to work in a primary care centre for homeless and marginalised patients, whose access to healthcare is often taken for granted. I believe that in these populations, the system needs to be as flexible as it can to work around the needs of the individual, who often lead extremely chaotic lives, and for whom a 10-minute doctor’s appointment is just not going to suffice. I want to challenge the views of those who believe that social circumstances do not bear weight on the need for medical investigations, and raise awareness of the need for the healthcare system to adapt to the patient in front of it. Homeless people deserve to live beyond the age of 47 as much as anyone else does, so something has got to change.

Join the Conversation – do you have an experience of homeless health care you’d like to share or a question you’d like answered? Join the discussion here.

Find & Treat TB Service – University College London Hospital has a unique Find & Treat service to help homeless people with TB. You can find out more here. 

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