HL20: Jim Withers, MD—Bringing Tender Care to the Mean Streets

"They feel like they are an outsider and they adapt in a really deep way to not being part of us," he says. "It is an endlessly fascinating spectrum of the human condition, but there are people who are thwarted by survival instincts that kicked in when they were younger—someone was molesting them or hurting them when they were younger. They stood up to it and the pattern becomes one of defiance. You tend to use the tools you have in your toolbox. I do think that there is a survival mode, that a lot of people have gotten to where they just focus on what is in front of them."

In the 20 years since Withers and Sallows teamed up, Operation Safety Net has grown to include 20 employees and more than 100 volunteers, including physicians and nurses, all of whom have served thousands of homeless patients on the streets and in clinics.

The mission has expanded, too. "A lot of things have grown off of the initial house call vision of taking medical care under a bridge," Withers says. "We have housed more than 800 individuals in apartments over the past eight years. We have a severe weather center that we run and a lot of volunteers help serve food and other activities. Plus we have people who donate material goods."

There is even talk about building a curriculum around street medicine for medical students. "They are beginning to understand how popular it is and all the incredible intrinsic lessons it teaches for patient-centered care and meeting people where they are," Withers says. "An organization like ours creates a fabric within the street communities that lets people attach themselves and say, 'When I am ready, there is an option. There is someone who is not going to judge and dismiss me because I was having a bad day. They actually are accepting my reality, and who I am is okay.' "