Students and patients help each other at Cardinal Free Clinics

Patients aren't the only ones who benefit at Cardinal Free Clinics. The nonprofit clinics for low-income and uninsured patients are operated by Stanford undergraduates and medical students, under the supervision and mentorship of Stanford physicians. The students say it's an invaluable experience.

Courtesy of Arbor Free Clinic Young man checking the blood pressure of a woman at a screening

Among the services the clinics provide are free health screenings to disadvantaged and under-insured communities in the Bay Area.

At Cardinal Free Clinics (CFC), most of the patients have no insurance and some haven't seen a doctor in years. The doctors, when their shifts are over, will head back to class at the Stanford School of Medicine, where they will one day earn their MDs.

CFC is a unique partnership between the medical school and residents of the Bay Area in which Stanford undergraduates and first- and second-year students at the Stanford School of Medicine offer free care to low-income and uninsured patients, and gain valuable clinical experience in return.

All staff work on a volunteer basis, and CFC receives the majority of its funding from private donors and organizations including the Brownstone Foundation, Gilead Foundation, Health Trust, Kaiser Permanente San Jose, Palo Alto Community Fund, Palo Alto Medical Foundation and Stanford Hospital & Clinics.

"We sort of have a dual mission, to provide high-quality medical care to the underserved patient population, and to educate medical students and undergraduates," said Kaylin Pennington, a manager of CFC's Arbor Free Clinic, who earned her undergraduate degree in human biology in 2009.

'It's one of the greatest experiences I've had'

CFC is made up of two clinics, which were united as CFC in 2005. Arbor Free Clinic was founded in 1990 and is located in the Menlo Park VA Hospital, and Pacific Free Clinic, founded in 2003, runs out of San Jose's Overfelt High School.

Pacific is open every Saturday from 9 a.m. to 3 p.m. and Arbor is open every Sunday from 10 a.m. to 2 p.m. Both clinics see patients on a first-come, first-served basis and do not require scheduled appointments.

Both clinics provide general services as well as specialty clinics and screenings. Arbor offers cardiology, dermatology, mental health, orthopedics, ophthalmology, neurology and women's health. Pacific specializes in hepatitis B and cardiovascular diseases. Neither clinic offers pediatric services.

Typically, Stanford undergraduate volunteers check in patients, conduct brief interviews to discuss patients' backgrounds and chief complaints, and serve as interpreters. Medical students examine each patient and determine a potential diagnosis.

The medical student then presents the case to an attending physician or resident (a Stanford-affiliated, licensed MD). Both come up with an assessment and plan, return to the examination room to speak with the patient and order labs or prescriptions as needed.

David Purger, a second-year medical student and manager at Pacific, said the opportunity to work with patients in a real clinical setting during medical school is an invaluable experience.

"It's one of the greatest experiences I've had," Purger said. "There's no substitute for seeing a lot of patients, talking to a lot of different people and building a database of what's normal, so you can figure out what's not normal. It's a really crucial experience and you're not able to get it just by attending classes."

Evelyn Ho, CFC managing director in the medical school's Office of Community Health, said CFC offers courses in the School of Medicine that medical students and undergraduates can take, covering topics such as health education and medical interpreting, to help prepare them for their experiences volunteering for CFC.

Stanford medical students also are required to volunteer for at least one shift at CFC as part of the Practice of Medicine curriculum, which spans their first and second years.

Because medical students have so little experience, they are closely monitored by the attending physicians. However, Pennington said working with the doctors, many of whom are top experts in their specialties, is an important part of the process.

"That's something that actually is a huge part of the clinics—this mentorship component," Pennington said. "We're providing a service, but we also want to educate, to foster this educational experience for our students."

Looking to the future

Though CFC's first clinic, Arbor, is celebrating its 21st anniversary, the staff continues to improve the system and quality of care it offers. July marked CFC's switch from paper records to an electronic medical records system, in an effort to foster smoother communication between medical staff and gather more comprehensive data about the patient population. The CFC staff says the transition so far has gone smoothly.

"The care patients receive is only going to get better from here on out," Purger said. "There's a lot less capacity for errors. It will be harder for things to fall through the cracks."

The electronic system also will help staff with one of the clinic's most important functions: referring patients to low-cost primary medical care providers or other clinics as needed. CFC has partnerships with primary care clinics throughout Santa Clara and San Mateo counties, and sends patients to county hospitals for procedures such as MRIs and CT scans. The referral staff also provides screenings and education about patients' eligibility for health insurance and other assistance.

"Our goal is really to transition them to a medical home," Pennington said. "The referral staff works hard to ensure we can connect the patient to an alternate provider, because we simply don't have the resources to serve as the primary care provider for these patients."

Ho said CFC wants to recruit more physicians to volunteer, and the clinics also plan to embark on donor campaigns and reach out to alumni who participated in CFC to increase awareness of the clinics and ensure they remain financially sustainable.

"I often talk to people in the community who are pleasantly surprised to hear that Stanford has these clinics," Ho said. "The clinics are a great asset for Stanford, and students absolutely love the experience."

Saving lives, educating the next generation

Wendy Zhang, a junior biology major who volunteers as a Spanish/Mandarin translator and publicity/fundraising chair at Arbor, said CFC's unique model helps students and patients equally. Volunteers can gain experience in nonprofits, health management and health education in addition to medicine. For patients, the opportunity to be treated by Stanford physicians and students free of charge is often lifesaving.

She recalled translating for one patient, a recent Chinese immigrant, in a process that lasted the entire day.

"We went through a very thorough physical test, and the physicians were able to see, after two hours of talking, that she had a pinched nerve, which is incredibly painful," Zhang said. "In the end the doctor was able to alleviate that pain that's been bothering her for years."

Robin Migdol is an intern with Stanford University Communications.